Rm Ch. 8: Evaluating Treatment Efficacy Research

Front 1

treatment efficacy

Back 1

when the intervention is shown to have a clinically significant improvement in client skills (clinical outcomes are tracked with client questionnaires, clinician acquired data).
Does the intervention make a measurable change?

Front 2

treatment efficacy: cost-benefit analysis

Back 2

is improvement:
derived rom the treatment rather than extraneous variables?
real and reproducible?
clinically important?
based on tangible, reproducible test scores?
more highly controlled than effectiveness.

Front 3

evidence based practice

Back 3

integrating the best current research into clinical practice. more than statistical significance and practical significance. dependent on external validity. mix of science and art. consider: randomization of sample, sample size, systematic replication (repeated under different conditions).

Front 4

EBP: Systematic Reviews

Back 4

comprehensive review of research literature that specifies a specific clinical question. Meta-analysis of treatment efficacy research also exist.

Front 5

levels of evidence: 1A (from Agency of Healthcare Research Quality)

Back 5

meta-analysis of multiple well-designed, controlled studies (published)

Front 6

levels of evidence: 1

Back 6

well-designed, randomized controlled trials

Front 7

levels of evidence: 2

Back 7

well-designed non-randomized controlled trials (quasi experiments)

Front 8

levels of evidence: 3

Back 8

observational studies with controls

Front 9

levels of evidence: 4

Back 9

observational studies without controls

Front 10

Levels of Evidence: Class 1 (US Dept. of Health and Human Services)

Back 10

randomized treatment and control-group; time series single-subject designs

Front 11

Levels of Evidence: Class 2

Back 11

nonrandom group assignment, program evaluations, quality control studies

Front 12

Levels of Evidence: Class 3

Back 12

projects, case studies and historical reports

Front 13

clinical trials: phase 1

Back 13

research concerned with hypothesis development, safety issues, risk factors

Front 14

clinical trials: phase 2

Back 14

development of treatment methods and outcome measures, pilot studies of potential treatment effects

Front 15

clinical trials: phase 3

Back 15

randomized clinical trials for evaluating treatment efficacy (efficacy: is change measurable?)

Front 16

clinical trials: phase 4

Back 16

post marketing studies of long-term effectiveness and safety of treatment (effectiveness: is the change useful?)

Front 17

clinical trials: phase 5

Back 17

follow up studies of cost-effectiveness and consumer satisfaction

Front 18

ethics of using control groups

Back 18

is it ethical to withhold treatment? how do you prove that improvement wouldn't have happened on its own? treatment after research is over: what if they move? what if insurance runs out?

Front 19

protection of human subjects

Back 19

local IRBs, National IRBs, ASHA code of ethics, informed consent

Front 20

clinician vs. researcher

Back 20

clinician: i need to help my clients now
scientist: why waste your time with a treatment that hasnt been scientifically proven? both have the same goals: discover solutions to problems and act on these solutions. understand the roles that both sides play in intervention, agree on definitions and theory of language learning.

Front 21

reasons for efficacy studies

Back 21

assure reimbursement for services
support adequate numbers of SLPs to serve clients
compete with other service providers who offer similar services at a lower cost
assure highest quality of service

Front 22

choosing to adopt a controversial (unproven) treatment method

Back 22

accept the challenge to collect outcome data
assume responsibility to conduct solid research
present the results of this research (good or bad) to the professional community

Front 23

clinical research partnerships

Back 23

form research groups with:
other clinicians with similar interests
fulltime researchers looking for study sites in the field
physicians looking for research opportunities

Front 24

controversial practices

Back 24

presented before studies done or pilot data analyzed
treatment goes beyond support given by data
single treatment pulled out from multi-tx approach
claims that practice provides a cure
requirement of practitioner specialization (cults)
questionable research (fallacy of authority)
high intensity requirement (more time doesnt =better)
legal action against practice

Front 25

alternative medicine

Back 25

diet supplements
herbal meds
vitamins
acupuncture
reflexology
aroma therapy

Front 26

surgery

Back 26

spinal root stimulation
cutting heel cords
plastic surgery for DS
vocal cord reinnervation
stem cells/fetal tissue

Front 27

drugs

Back 27

ritalin
prozac
respiradol
NSAIDS

Front 28

educational treatments

Back 28

Lovaas treatment for autism
ABA
Relationship Development Intervention
Conductive Education
Facilitated Communication

Front 29

therapeutic

Back 29

sensory integration
craniosacral therapy
auditory integration therapy
fast for word
thermal-tactile stimulation
e-stim
deep pharyngeal neuromuscular stim

Front 30

excuses

Back 30

can't wait for controlled research
specialization=job security
too busy to read the literature
bias toward findings
fallacy of authority
desire to provide hope to families