Belief Is Not Enough

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Belief Is Not Enough

• Professor Pam Enderby
• University of Sheffield

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Reason for Title

• aphasia therapy works..

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What is belief?

• knowledge is a justified true belief.
• Knowledge includes
• learning
• experience
• observation
• etc
• ..not always evidence based or truthful!

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Non-evidence based practice
"
"
Dr Benjamin Spock
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The Systematic Review
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Gilbert et al, Int J Epidemiol, 2005

• Advice to put infants to sleep on the front for
  nearly half a century was contrary to evidence
  available from 1970 that this was likely to be
  harmful. Systematic review of preventable risk
  factors for SIDS from 1970 would have led to
  earlier recognition of the risks of sleeping on
  the front and might have prevented over 10 000
  infant deaths in the UK and at least 50 000 in
  Europe, the UK and Australasia.

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Corticosteroids for muscular dystrophy

• 37 relevant studies
• Five trials met inclusion criteria
• main result primary outcome measure-data from
  one small study used prolongation of walking as
  an outcome measure and did not show significant
  benefit

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Strength training and aerobic exercise for muscle
disease

• 36 identified
• 6 RCTs
• 2 conformed
• different diseases, different interventions,
  different time points, different outcome measures
• van der kooi, Lindeman,Riphagen 2005

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Expertise

• Strengthsawareness of complexity/heterogenity
• Weaknesses
• Importance of
• - keeping up-to-date
• - keeping questioning

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International Classification of Function

• Physiology-impairment
• Activity restriction (disability)
• Participation

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Contribution of Speech and Language Therapy
Research Unit

• Impairment---nature of aphasia, dysarthria,
  phonological disorders, language development,
  disorders of fluency, etc

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Contribution of Speech and Language Therapy
Research Unit

• Disability/activity restriction-impact of the
  condition, autonomy in therapy, role of
  technology, assessments etc

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Contribution of Speech and Language Therapy
Research Unit

• Participation restrictionimpact of the
  condition, public awareness, technology, etc

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Contribution of Speech and Language Therapy
Research Unit

• 12 books
• 10 computer programs
• 36 of the chapters
• 125 refereed journal articles
• 21 reports

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Belief alone is not enoughbut belief may play a
part

• Prayer and health care
• Being in a research trial
• Placebos

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Rehabilitation

• is a way of thinking, a philosophy---that
  states that there are always ways to help our
  patients even when traditional medical and
  surgical approaches are exhausted
• 
  Richard Langton Hewer

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Evidence base to rehabilitation

• Observation and experience
• Single case studies
• Group studies
• Longitudinal observation
• Benchmarking
• Audit

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Research synthesis

• Narrative reviews
• Vote counting
• Meta analysis
• Best evidence synthesis
• Meta-ethnography-synthesis

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Realist synthesis

• The search is for improved knowledge, using all
  sources available
• Accepting that there is no one truth and the
  importance of context.
• Change is not linear nor haphazard but
  transformational
• Triangulationwhich seeks explanation
• 
  Pawson 2006

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