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The strongest and most relevant evidence is used by evidence-based practitioners. Because it generates the most trustworthy and thorough analysis possible, a systematic review is the finest source of information about treatment effectiveness (Slocum, Detrich, & Spencer, 2012). Because (1) research is identified in a thorough, analytic, and standardized manner, (2) clear procedures for selecting/weighing evidence are developed, (3) the process is transparent and can be replicated, and (4) the objectivity of the process minimizes arbitrary and idiosyncratic decisions because personal decisions are removed from the process, systematic reviews are the least biased source of evidence (Slocum et al., 2012).
Systematic reviews necessitate a thorough examination of the study findings' quality, quantity, and consistency (Moher, Liberati, Tetzlaff, Altman, & The PRISMA Group, 2009; Slocum et al., 2012). The process of starting a systematic review usually starts with a group of specialists who are interested in answering one of two sorts of questions.
Method #1. “Is a given treatment effective?” the specialists might inquire ", The specialists in this case look at all of the evidence from all populations in relation to a single treatment. Method #2. “Does a particular population have any effective treatments?” ", In this case, the specialists look at all of the evidence for all of the treatments that have been researched for the general public.
Both approaches to systematic reviews are valid; nevertheless, the answers to the two queries are different. Evidence-based practitioners must be able to distinguish between these techniques in order to use evidence effectively in EBP decision-making. If a practitioner's purpose is to find the entirety of evidence supporting a certain treatment, Method #1 will be most effective. Every study that has been undertaken with various populations is included in systematic reviews utilizing Method #1. (e.g., young and old people, individuals with disabilities and those who have no diagnoses, studies completed in schools, homes, hospitals, and communities, etc.). The benefit of a Method #1 systematic review is that it allows practitioners to learn about all of the evidence that is available for a particular treatment.
Evidence-based practitioners must understand how experts assess the strength of the evidence supporting a treatment in order to be critical consumers of systematic reviews (Slocum et al., 2012). Systematic reviews are always concerned with the amount, quality, and consistency of study findings.
QualityExperts assess a study's quality since they are aware that not all published research give solid data. The research design, dependent variable, and treatment fidelity (i.e., how well a treatment was applied) are all factors that influence study quality. Many studies additionally assess participant ascertainment (i.e., the accuracy of the procedures used to determine the participant's diagnosis/diagnoses) and generalization (i.e., the amount to which treatment effects extend to other relevant contexts or persist over time). Social validity is also examined in several systematic reviews (i.e., the extent to which the end users describe a treatment as fair, appropriate and reasonable in a given case; Wolf, 1978).
Varied groups of experts set different inclusion criteria for systematic reviews, therefore the evidence-based practitioner who critically assesses systematic reviews should be aware of this. Some experts exclusively consider randomized controlled trials (RCTs) because they believe they are the highest-quality studies. The majority of published research are excluded from systematic reviews when professionals only review studies that meet a very high threshold.
Studies using single-subject research design (SSRD) are increasingly being included in systematic reviews, however they are frequently assigned less weight (Moeller, Dattilo, & Rusch, 2015). That is, SSRD are frequently regarded as less reliable sources of information, however this is not always the case. Because SSRD is the scientific underpinning for ABA, evidence-based practitioners should rely on systematic reviews that include SSRD. It's also vital to recognize that not all studies that use SSRD generate good evidence. Finally, it's critical to recognize that all research designs, including RCTs and SSRDs, are flawed. That is, due to the limits of any research methodology, it is feasible to derive the incorrect conclusion.
Even if a study is of exceptional quality, it is insufficient to tell if a treatment is successful. There's a potential that a study yielded false results (i.e., outcomes that appear valid but are not). A cornerstone of the scientific process is the replication or extension (i.e., doing a study identical to one that has already been published) of existing literature. The results are only considered trustworthy once a treatment effect has been replicated.
Prior to undertaking a systematic review, experts develop a threshold for the number of studies required to assess whether or not a treatment is beneficial. The number of studies required may be influenced by the study design (group versus SSRD). To assess if a treatment is beneficial, systematic reviews that include SSRD require a larger number of trials.
Consistency of outcomes, in addition to quality and quantity, aids in determining whether or not a treatment is deemed beneficial. The criteria for identifying consistency have been discovered in some systematic reviews. If a treatment works in certain well-controlled studies but not in others, the evidence-based practitioner must proceed with care before recommending it. In addition, systematic reviews should contain information about harm (e.g., side effects) so that treatment selection decisions can be made with confidence (Khan, Kunz, Kleijnan, & Antes, 2003).
After all studies have been examined for quality and quantity, the results must be integrated to determine consistency of outcomes. Studies that use the same treatment are grouped together (e.g., Treatment X). This process is more difficult than it appears at first glance because (1) different studies use the same name to describe procedurally very different treatments; (2) different studies use different names to describe procedurally very similar treatments; and (3) the question of “How ‘pure' does a treatment have to be (e.g., what if it is combined with another treatment)?” must be answered.
The results are assessed against a criterion representing the level of effectiveness (e.g., two or more well-controlled RCTs or five single-subject research design studies) once treatment categories have been defined and data on quality and quantity have been calculated. A treatment is regarded effective when the requirement is met.
When a requirement isn't met, it's said to as experimental or lacking evidence. A meta-analysis is sometimes used to develop effectiveness criteria. When utilizing meta-analysis, one problem is that treatments must be very comparable in order to provide relevant results (Leucht, Kissling, & Davis, 2009). This may or may not be possible depending on the size treatment category. Meta-analyses, on the other hand, can be immensely useful when conflicting results are published. Unfortunately, many studies lack the necessary information to conduct a meta-analysis, therefore the results may be based on fewer studies than were actually conducted.
All of the choices made in this section have the potential to influence whether or not a treatment is deemed "effective." When more than one systematic review is undertaken with the same population, the outcomes can be quite different. Many comprehensive systematic reviews (e.g., NSP 2.0, Wong et al., 2015) have shown remarkably similar results. Evidence-based practitioners, on the other hand, can examine the approach for doing the systematic review and evaluate which results are most relevant to their clients.
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