It has been one wild ride since this whole thing started at SLP R&R! A year ago, I was able to have a great Guest Post from Rebecca Brown from ASHA’s National Center for Evidence-Based Practice in Communication Disorders who shared some incredible Resources to help clinicians get organized and more familiar with the process of evidence-based practice for our patients. Since then, I’ve gone back to these resources now and then at different times and for different purposes. I’ve been able to figure out which resources have been most helpful for me, and which ones I may not need as much as I get more efficient and comfortable with all aspects of internal/external evidence. There’s been a LOT learned over these last couple of years, so figured now would be a great time to share my experience with this process by walking you through it from start to finish along with insights I’ve had along the way. Since there won’t be any statistic-jargon or in-depth analysis to discuss, feel free to sit back, relax, and enjoy this clinician’s review on reviewing the research!🙂
My rabbit hole started like many others by feeling haunted by questions like “Wait, what am I actually doing?” “Why am I doing what I’m doing?” or “Where did this method even come from?” For those that don’t know me that well, I am one curious person🧐. So it would be no surprise that these types of questions have been toiling over in my mind ever since hearing the ‘controversy’ over yet another swallowing maneuver, this time the hot seat being filled by “the Masako.” I finally set out to learn more about this exercise that simply instructs to “stick your tongue out between your teeth to hold, then swallow with your tongue out.” 😛
Does it work?🤔
How did this idea even start?🤓
Has there been any more recent evidence for/against its use?🤷♀️
Since all my questions were easily starting to fill up my brain faster than I could write down, I knew I had to try to narrow it down or I’d be a lost SLP Alice in Dysphagia Wonderland forever!
Truth be told, I wasn’t really going for breaking a record in how fast I could get all this done (what with having to let the pup out and then playing to stop more cute distractions while also having brief breaks every 15 minutes because of #hydrationgoals🤗). If you’ve never experienced it, when you’re already down a rabbit hole you can often find yourself getting distracted with other black holes at every turn. Before you know it somehow ending up already reading or skimming over almost an entire article without realizing it or even remember where you started in the first place…😅 (or is this just me?🥴). But the good news is–if you are simply a curious questioner, need to learn more about a certain topic, or have a specific client in mind and don’t know where to start, these resources can definitely help you out along the way at whatever pace you need!
I started by using the DECIDE Framework, which is really a great step-by-step guide. It’s helpful in keeping you organized along your journey and preventing missing an important piece of the EBP puzzle, and even has additional suggestions and reminders where to go for more in depth information like ASHA’s Evidence Maps, Code of Ethics, Checklists, or your own data! It also helped me reflect and remember everything that I already knew and could bring to the table (internal/clinical evidence) before looking elsewhere. Finally, I really appreciated having this organized guide to mull over after the whole process and feel proud of all the steps.🏆
The first step in the framework leads right into another resource by clarifying a PICO question. For full transparency, this is a step I might sometimes skip over because I may have the specific idea in my head already, and sometimes because well, life🤷♀️. However, this time it actually was helpful to try to be more specific so I wouldn’t get too side-tracked by other shiny new questions and also gave me something concrete to reference my original question, “Is the Masako/tongue-hold an effective treatment for improving swallow physiology?” It could also be helpful if you’re not really sure which route to go with an intervention for example (NMES or traditional swallow tx for LMS stroke?). And if you’re less familiar with the PICO process, this tool can definitely help you narrow your thoughts by having something actually written down to reference as you go, which can help you get better at asking future questions!
Now that I had my specific question, I had to figure out how I was gonna translate that into how I
was gonna search for it! Next, I used the Create a Search String to have something to write all my other related questions or random ideas down too! Because have you ever searched something (be it Google or wherever!) and ended up having to change what you type in that search bar a handful of times, only to forget which one of those searches was actually the most helpful? That’s where this resource came in and surprisingly helped me think a bit more outside-the-box or if I was really only interested in a change in swallow physiology🤔. The more I thought about it and started writing different terms, the more I realized I was also curious in any changes for things like swallow safety/efficiency, if any specific impairments were improved like pharyngeal pressure constriction, or if overall functional outcomes mattered (like, did the exercise facilitate quicker recommendations for an oral diet?🤨).
So I wrote all the additional synonymous terms to help me not only keep track of what terms were most helpful, but also so I didn’t limit myself too much in the information I would be able to find and to get the most bang-for-my-buck in my search. And a quick spoiler–by the end I also realized that by being a bit more organized before I even searched, I was able to get more relevant information instead of general things that I’d still have to pick out and sort.🤯
After figuring out my main question with a handful of different ways to look for it, my search began. Like an empty basket and an excited kid on Easter, my screen was quickly getting filled with tabs from each search’s results.
The next step might be a fork in the road for some with different ways of moving forward, so you can choose what works best for you! I chose to write down all my results first using the Track Your Results resource, which I felt was SUPER helpful in staying organized with everything I’d found to put in my ‘research basket’🤓 (I would imagine this could definitely be helpful for a lit review also). Another option could be to also first use the Which Research Design Should You Find? resource to figure out what specific type of research you’re really after, then toss aside other studies that may not be relevant and keep the ones you need most at the top of the Track Your Results resource list!
Either way, both resources are gold mines to keep handy when specifically searching for research. They not only keep track of everything you’re finding but also help clinicians (me included!) narrow down what kinds of research to actually look for depending on your beginning PICO question! For example, even after adding all my results to the Track Your Results, after glancing at the Which Research Design Should You Find? resource I was able to realize that because I was mainly curious if a specific treatment was effective or not, this meant I was going to want to keep an eye out for more controlled trials and experimental types of study designs. This was definitely helpful later when I started to read Abstracts and skim the articles for design and methods!🧐
Another best buddy to the above resources is the Study Design Features resource. While I had more of a quick glance this time around, this chart can either be a good refresher or a new way to understand just what different designs do and show, making you think twice if a study actually makes sense how it was set up.🤔
Even though it’s a bit harder for me to put all the info on the Track Your Results resource because
writing neat and small has never been my forte, this resource has been extremely helpful by having a central place to keep all my results and then be able to go back and reference. It’s also nice because while it provides some suggestions to start, the tool is kind of like a blank canvas for a little more creative for you to write what info YOU think is important or change/modify anything however YOU want! Finally, you can have multiple separate pages for each different search and/or for each different database because yes, I 100% started with Google😅 before branching out to PubMed and Google Scholar, etc. (I’m gonna have to keep experimenting with doing it all digitally instead of the “old-school” way)
After everything found thus far, I was able to narrow down all my results into 3-4 articles that I could invest more time to really dive into. For that next phase, the last resource, Identify Biases, would start playing a bigger role. While I was actually reading each of my top articles, this tool was helpful after all the said-and-done to re-evaluate and really think more critically on these tops results (like, if there were any bias in selecting the sample populations or how many participants ended up leaving the study?). I 100% recommend keeping this resource handy to reference when reading any research, as it can help all of us (me included!) to keep improving our ability to think critically as consumers of external evidence.🤓
Looking back, I was really pleased with how much I was able to narrow down not only all the thoughts that were running rampantly through my head before I even started🙃, but also how I was able to organize all the actual evidence I was able to find. After going through the whole process, I didn’t feel as overwhelmed as sometimes I might and felt more confident moving forward in learning more about the mantra of the Masako. One thing is absolutely sure–having these resources would’ve been AMAZING to have when starting out in the #realworld clinically!🤩
For #newbieclinicians or #seasonedSLPs, with some extra time and practice on the front-end, these resources can be invaluable to help us clinicians become more comfortable when turning to external evidence, empowered to advocate for our patients in more ways than one (3 in fact🔺😉), and save time by staying organized and facilitating deeper thinking for any study or patient.
Last but not least: Another huge takeaway from using all these resources so easily laid out for us? Luckily through an unavoidable blackhole, I found even MORE resources!!😅🥳😍 Resources to learn more about how to search and use search tools, resources for statistics, and more resources to appraise and evaluate different types of external evidence with videos, checklists, and worksheets!! Stay tuned as I brush up and learn more about these resources in hopes of adding to SLP R&R’s growing Resources List!
And as for what I found for the Masako and what all the evidence says and shows?
And be on the lookout for the next article review to find out!!😉😉
Until then, make sure to explore and check out all the Resources here to help you get better at searching for, finding, organizing, understanding, evaluating, and interpreting all the research you need for next time!
Have you used any of these Resources?!?
Share your experience!😃
Do you have any other resources that have been helpful in your world?!?
PLEASE share so I can add them to my growing list and we can all help each other!!🤓