Evidence Based Practice (EBP)

Evidence Based Practice (EBP) is an umbrella term for many different aspects of evidence based practice. EBP includes evidence-based medicine,evidence-based nursing, evidence-based physical therapy, evidence-based dentistry, etc.

Evidence-based practice (EBP) is the combination of

Clinical expertise

The knowledge acquired through training and professional experiences
Evidence

The best available information gathered from the scientific literature (external evidence) and from data and observations collected on your individual client (internal evidence)
Client/patient/caregiver perspectives

The unique set of personal and cultural circumstances, values, priorities, and expectations identified by your client and their caregivers

When all three components of EBP are considered together, clinicians can make informed, evidence-based decisions and provide high-quality services reflecting the interests, values, needs, and choices of individuals with communication disorders.

AHSA. (n.d.). Evidence Based Practice (EBP). Retrieved from https://www.asha.org/members/ebp/.

Levels of Evidence

The level of evidence can be defined by the type of question. Levels of evidence for a "Therapy" question are different from the levels of evidence for an "Etiology" question.

Level of evidence (LOE)	Description
Level I	Evidence from a systematic review or meta-analysis of all relevant RCTs (randomized controlled trial) or evidence-based clinical practice guidelines based on systematic reviews of RCTs or three or more RCTs of good quality that have similar results.
Level II	Evidence obtained from at least one well-designed RCT (e.g. large multi-site RCT).
Level III	Evidence obtained from well-designed controlled trials without randomization (i.e. quasi-experimental).
Level IV	Evidence from well-designed case-control or cohort studies.
Level V	Evidence from systematic reviews of descriptive and qualitative studies (meta-synthesis).
Level VI	Evidence from a single descriptive or qualitative study.
Level VII	Evidence from the opinion of authorities and/or reports of expert committees.

The table above is based on the following: Ackley, B. J., Swan, B. A., Ladwig, G., & Tucker, S. (2008). Evidence-based nursing care guidelines: Medical-surgical interventions. (p. 7). St. Louis, MO: Mosby Elsevier
.

Research Study Designs

The level of evidence can be defined by the type of question. Levels of evidence for a "Therapy" question are different from the levels of evidence for an "Etiology" question.

Clinical Question	Suggested Research Design(s)
All Clinical Questions	Systematic review, meta-analysis
Therapy	Randomized controlled trial (RCT), meta-analysis Also: cohort study, case-control study, case series
Etiology	Randomized controlled trial (RCT), meta-analysis, cohort study Also: case-control study, case series
Diagnosis	Randomized controlled trial (RCT) Also: cohort study
Prevention	Randomized controlled trial (RCT), meta-analysis Also: prospective study, cohort study, case-control study, case series
Prognosis	Cohort study Also: case-control study, case series
Meaning	Qualitative study
Quality Improvement	Randomized controlled trial (RCT) Also: qualitative study
Cost	Economic evaluation

Levels of Evidence Pyramid

The levels of evidence pyramid is a way to visualize both the quality of evidence and the amount of evidence available. For example, systematic reviews are at the top of the pyramid, meaning they are both the highest level of evidence and the least common. As you go down the pyramid, the amount of evidence will increase as the quality of the evidence decreases.

Text alternative for Levels of Evidence Pyramid diagram

Finding Evidence Based Resources

TRIP (Turning Research Into Practice) Database Plus (Free)
Searches evidence-based sources of systematic reviews, practice guidelines, and critically-appraised topics and articles -- including most of those listed above and many more. Also searches MEDLINE’s Clinical Queries, medical image databases, e-textbooks, and patient information leaflets. It does not automatically link to JCKL resources, use PRIMO or Google Scholar to find full text.