A model for conducting clinical-outcome research: an adaptation of the standard protocol for use in aphasiology

Communication disorders scientists and practitioners face critical fiscal pressures to establish the efficacy and effectiveness of treatments. The pressures come about from (a) increasing demands from reimbursers that a variety of professions test the effectiveness of their treatments, thereby generating demands for the resources to do so; (b) increasing demands for reimbursement of those same clinical services provided by the same variety of professions; and (c) a general recision in available funds for each. While there is strong evidence that the treatments of speech-language pathologists and audiologists have generally proved patent as they have been tested, the accepted standards for clinical-outcome testing used throughout the research community (e.g. by other clinical disciplines, regulatory agencies of the federal government, and third-party payers) have been mostly ignored. In a marketplace of competition for scarce resources, and a recognized set of procedures for demonstrating the efficacy of intervention, it seems obvious that this profession cannot continue to depend on idiosyncratic approaches to clinical-outcome research. Ensuring successful claims for reimbursement requires that assertions of efficacy be justified on the basis of broadly accepted criteria of the general outcome-research community. Critical aspects of accepted standards are described, including prospective adaptations to the clinical-outcome research of our own discipline. A plausible means for conforming to the standard model is proposed in the context of treatment for aphasia.