title: Exploring the relationship between client perspectives, clinical expertise and research evidence.
abstract: OBJECTIVE
  This paper examines the relationship between components of evidence-based practice (clinical expertise, patient perspective and research evidence).
  
  
  METHODS
  Findings are examined from two research programs: the Better Communication Research Program and Child Talk, including exploratory studies of the views of parents and children regarding speech-language pathology and studies of current practice by SLPs in England. Systematic reviews of the research literature were also undertaken. The paper analyses relationships between outcomes valued by children and parents and those reported in the literature and in practice, parents' perspectives regarding intervention in comparison with clinicians' reports of practice and the extent to which research evidence underpins current practice is examined.
  
  
  RESULTS
  Parents and children value functional outcomes and positive experiences; these are not routinely measured in research or practice. Therapy is perceived positively by most parents; however, some are ambivalent and less clear about the rationale. Commonly used interventions are supported by evidence, but there are gaps regarding some critical therapy components.
  
  
  CONCLUSIONS
  The paper discusses four challenges to evidence-based practice: the consistency and clarity of descriptions of interventions; consensus based models of practice; understanding of the mechanisms of change; and, finally, the operationalization of client preferences within an evidence-based practice framework.
authors: University of the West of England, Bristol, UK, and the Bristol Speech & Language Therapy Research Unit , North Bristol NHS Trust , UK.
authors: Sue
authors: S
authors: Roulstone
mesh_terms: D000367:Age Factors; D001291:Attitude of Health Personnel; D002648:Child; D002652:Child Behavior; D002675:Child, Preschool; D002983:Clinical Competence; D003142:Communication; D019317:Evidence-Based Medicine; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007805:Language Development Disorders / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D010287:Parent-Child Relations; D010290:Parents / Q000523:psychology; D057240:Patient Preference; D010465:Perception; D011368:Professional-Family Relations; D011369:Professional-Patient Relations; D013064:Speech Disorders / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D013066:Speech-Language Pathology; D016896:Treatment Outcome
keywords: Evidence-based practice; clinical expertise; patient perspectives