Opiniões de fonoaudiólogos e estudantes sobre a prática baseada em evidências: uma revisão sistemática
Opinions of speech-language-hearing pathologists and students on evidence-based practice: a systematic review
Samara Fernandes da Silva Souza; Allya Francisca Marques Borges; Ramon Cipriano Pacheco de Araújo; Denise da Silva Medeiros; Suzanne Bettega Almeida; Cristiano Miranda de Araujo; Hipólito Virgílio Magalhães Junior; Karinna Veríssimo Meira Taveira
http://dx.doi.org/10.1590/2317-1782/e20250300pt
CoDAS, vol.38, n4, e20250300, 2026
Resumo
Objetivo: Sintetizar evidências sobre os conhecimentos, habilidades, atitudes, comportamentos e barreiras relatadas por fonoaudiólogos e estudantes de Fonoaudiologia em relação à prática baseada em evidências (PBE). Estratégia de pesquisa: Realizou-se uma revisão sistemática com buscas nas bases PubMed/MEDLINE, Scopus, Web of Science, Embase, LILACS, SciELO, LIVIVO e literatura cinzenta. Critérios de seleção: Foram incluídos estudos observacionais que investigaram aspectos relacionados à PBE entre profissionais e graduandos da Fonoaudiologia, com dados coletados por meio de questionários. Análise dos dados: A extração dos dados foi realizada por dois revisores, de forma independente, e a síntese das informações foi apoiada pela ferramenta de inteligência artificial NotebookLM, com posterior verificação manual. O risco de viés foi avaliado considerando representatividade da amostra, taxa de resposta, precisão dos dados, evidência de cálculo amostral e qualidade do instrumento utilizado. Resultados: Foram incluídos 31 estudos publicados entre 2004 e 2024, com amostras variando de 9 a 2.762 participantes. O risco de viés variou de 1 a 4 em uma escala de 0 a 6. Os estudos evidenciam atitudes geralmente favoráveis à PBE, mas indicam limitações importantes nas habilidades de busca em bases de dados, leitura crítica e aplicação das evidências. A prática clínica ainda se baseia fortemente na experiência pessoal, com uso restrito da literatura científica. As principais barreiras relatadas foram falta de tempo, acesso limitado às evidências, escassez de evidências aplicáveis e lacunas na formação. Conclusão: Apesar das atitudes positivas, a adoção da PBE na Fonoaudiologia ainda é limitada, exigindo estratégias educacionais e institucionais para fortalecer sua implementação.
Palavras-chave
Prática Baseada em Evidências; Fonoaudiologia; Atitude; Conhecimento; Revisão Sistemática
Abstract
Purpose: To synthesize evidence on the knowledge, skills, attitudes, behaviors, and barriers reported by speech-language-hearing pathologists and students regarding evidence-based practice (EBP). Research strategy: This systematic review searches the PubMed/MEDLINE, Scopus, Web of Science, Embase, LILACS, SciELO, and LIVIVO databases and grey literature. Selection criteria: The review included observational studies that investigated aspects related to EBP among speech-language-hearing professionals and undergraduates, with data collected through questionnaires. Data analysis: Two reviewers extracted data independently, and information synthesis was supported by NotebookLM artificial intelligence, with subsequent manual verification. The risk of bias was assessed considering sample representativeness, response rate, data precision, evidence of sample size calculation, and quality of the instrument used. Results: 31 studies published between 2004 and 2024 were included, with samples ranging from 9 to 2,762 participants. The risk of bias ranged from 1 to 4 on a scale of 0 to 6. Studies show generally favorable attitudes towards EBP, but indicate important limitations in database search skills, critical reading, and application of evidence. Clinical practice is still heavily based on personal experience, with limited use of scientific literature. The main barriers reported were lack of time, limited access to evidence, scarcity of applicable evidence, and gaps in training. Conclusion: Despite positive attitudes, the adoption of EBP in speech-language-hearing pathology is still limited, requiring educational and institutional strategies to strengthen its implementation.
Keywords
Evidence-Based Practice; Speech-Language Pathology; Attitude; Knowledge; Systematic Review
Referências
- 1Souza MSL, Cáceres-Assenço AM. Evidence-based practice and clinical practice in child language: an online survey with Brazilian speech-language pathologists. CoDAS. 2023;36(1):e20220272. PMid:37970891.
- 2Alhaidary A. Evidence-based practice patterns among speech-language pathologists and audiologists in Saudi Arabia. Commun Disord Q. 2020;41(4):242-9. https://doi.org/10.1177/1525740119843681
» https://doi.org/10.1177/1525740119843681 - 3Scurlock-Evans L, Upton P, Upton D. Evidence-based practice in physiotherapy: a systematic review of barriers, enablers and interventions. Physiotherapy. 2014;100(3):208-19. https://doi.org/10.1016/j.physio.2014.03.001 PMid:24780633.
» https://doi.org/10.1016/j.physio.2014.03.001 - 4Ubbink DT, Guyatt GH, Vermeulen H. Framework of policy recommendations for implementation of evidence-based practice: a systematic scoping review. BMJ Open. 2013;3(1):e001881. https://doi.org/10.1136/bmjopen-2012-001881 PMid:23355664.
» https://doi.org/10.1136/bmjopen-2012-001881 - 5Mansuri B, Tohidast SA, Zareei M. Knowledge, attitude, and practice of Iranian speech and language pathologists toward evidence-based practice. Middle East J Rehabil Health Stud. 2020;7(1):e100879. https://doi.org/10.5812/mejrh.101976
» https://doi.org/10.5812/mejrh.101976 - 6ASHA: American Speech-Language-Hearing Association. Evidence-Based Practice (EBP) [Internet]. 2025 [citado em 2025 Maio 29]. Disponível em: https://www.asha.org/research/ebp/
» https://www.asha.org/research/ebp/ - 7Wambaugh JL. The evidence-based practice and practice-based evidence nexus. Perspect Neurophysiol Neurogenic Speech Lang Disord. 2007;17(1):14-8. https://doi.org/10.1044/nnsld17.1.14
» https://doi.org/10.1044/nnsld17.1.14 - 8Haynes B, Haines A. Barriers and bridges to evidence based clinical practice. BMJ. 1998;317(7153):273-6. https://doi.org/10.1136/bmj.317.7153.273 PMid:9677226.
» https://doi.org/10.1136/bmj.317.7153.273 - 9McColl A, Smith H, White P, Field J. General practitioners’ perceptions of the route to evidence based medicine: a questionnaire survey. BMJ. 1998;316(7128):361-5. https://doi.org/10.1136/bmj.316.7128.361 PMid:9487174.
» https://doi.org/10.1136/bmj.316.7128.361 - 10Bannigan K, Lewin R, Metcalfe C, Wisher S. Barriers to implementing the evidence base in four NHS therapies. Physiotherapy. 2001;87(8):433-41. https://doi.org/10.1016/S0031-9406(05)65462-4
» https://doi.org/10.1016/S0031-9406(05)65462-4 - 11Jette DU, Bacon K, Batty C, Carlson M, Ferland A, Hemingway RD, et al. Evidence-based practice: beliefs, attitudes, knowledge, and behaviors of physical therapists. Phys Ther. 2003;83(9):786-805. https://doi.org/10.1093/ptj/83.9.786 PMid:12940766.
» https://doi.org/10.1093/ptj/83.9.786 - 12Majid S, Foo S, Luyt B, Zhang X, Theng YL, Chang YK, et al. Adopting evidence-based practice in clinical decision making: nurses’ perceptions, knowledge, and barriers. J Med Libr Assoc. 2011;99(3):229-36. https://doi.org/10.3163/1536-5050.99.3.010 PMid:21753915.
» https://doi.org/10.3163/1536-5050.99.3.010 - 13Maher CG, Sherrington C, Elkins M, Herbert RD, Moseley AM. Challenges for evidence-based physical therapy: accessing and interpreting high-quality evidence on therapy. Phys Ther. 2004;84(7):644-54. https://doi.org/10.1093/ptj/84.7.644 PMid:15225083.
» https://doi.org/10.1093/ptj/84.7.644 - 14Bennett S, McKenna K, Hoffmann T, Tooth L, McCluskey A, Strong J. The value of an evidence database for occupational therapists: an international online survey. Int J Med Inform. 2007;76(7):507-13. https://doi.org/10.1016/j.ijmedinf.2006.02.005 PMid:16597509.
» https://doi.org/10.1016/j.ijmedinf.2006.02.005 - 15Caldwell K, Coleman K, Copp G, Bell L, Ghazi F. Preparing for professional practice: how well does professional training equip health and social care practitioners to engage in evidence-based practice? Nurse Educ Today. 2007;27(6):518-28. https://doi.org/10.1016/j.nedt.2006.08.014 PMid:17064821.
» https://doi.org/10.1016/j.nedt.2006.08.014 - 16Ahmadi N, McKenzie ME, MacLean A, Brown CJ, Mastracci T, McLeod RS. Teaching evidence-based medicine to surgery residents: is journal club the best format? A systematic review. J Surg Educ. 2012;69(1):91-100. https://doi.org/10.1016/j.jsurg.2011.07.004 PMid:22208839.
» https://doi.org/10.1016/j.jsurg.2011.07.004 - 17Petrisor BA, Bhandari M. Principles of teaching evidence-based medicine. Injury. 2006;37(4):335-9. https://doi.org/10.1016/j.injury.2006.01.027 PMid:16531183.
» https://doi.org/10.1016/j.injury.2006.01.027 - 18Spallek H, Song M, Polk DE, Bekhuis T, Frantsve-Hawley J, Aravamudhan K. Barriers to implementing evidence-based clinical guidelines: a survey of early adopters. J Evid Based Dent Pract. 2010;10(4):195-206. https://doi.org/10.1016/j.jebdp.2010.05.013 PMid:21093800.
» https://doi.org/10.1016/j.jebdp.2010.05.013 - 19Flores G, Lee M, Bauchner H, Kastner B. Pediatricians’ attitudes, beliefs, and practices regarding clinical practice guidelines: a national survey. Pediatrics. 2000;105(3 Pt 1):496-501. https://doi.org/10.1542/peds.105.3.496 PMid:10699099.
» https://doi.org/10.1542/peds.105.3.496 - 20Cranney M, Warren E, Barton S, Gardner K, Walley T. Why do GPs not implement evidence-based guidelines? A descriptive study. Fam Pract. 2001;18(4):359-63. https://doi.org/10.1093/fampra/18.4.359 PMid:11477041.
» https://doi.org/10.1093/fampra/18.4.359 - 21Shiwa SR, Moseley AM, Maher CG, Costa LOP. Language of publication has a small influence on the quality of reports of controlled trials of physiotherapy interventions. J Clin Epidemiol. 2013;66(1):78-84. https://doi.org/10.1016/j.jclinepi.2012.08.004 PMid:23177897.
» https://doi.org/10.1016/j.jclinepi.2012.08.004 - 22Greenwell T, Walsh B. Evidence-based practice in speech-language pathology: where are we now? Am J Speech Lang Pathol. 2021;30(1):186-98. https://doi.org/10.1044/2020_AJSLP-20-00194 PMid:33476190.
» https://doi.org/10.1044/2020_AJSLP-20-00194 - 23Chu SY, Hara Y, Wong CH, Higashikawa M, McConnell GE, Lim A. Exploring attitudes about evidence-based practice among speech-language pathologists: a survey of Japan and Malaysia. Int J Speech Lang Pathol. 2021;23(6):662-71. https://doi.org/10.1080/17549507.2021.1877816 PMid:33823717.
» https://doi.org/10.1080/17549507.2021.1877816 - 24O’Connor S, Pettigrew CM. The barriers perceived to prevent the successful implementation of evidence‐based practice by speech and language therapists. Int J Lang Commun Disord. 2009;44(6):1018-35. PMid:19294555.
- 25Zipoli RP Jr, Kennedy M. Evidence-based practice among speech-language pathologists. Am J Speech Lang Pathol. 2005;14(3):208-20. https://doi.org/10.1044/1058-0360(2005/021) PMid:16229672.
» https://doi.org/10.1044/1058-0360(2005/021) - 26Queiroz PS, Santos MJ. Facilidades e habilidades do fisioterapeuta na procura, interpretação e aplicação do conhecimento científico na prática clínica: um estudo piloto. Fisioter Mov. 2013;26(1):13-23. https://doi.org/10.1590/S0103-51502013000100002
» https://doi.org/10.1590/S0103-51502013000100002 - 27Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372(71):n71. https://doi.org/10.1136/bmj.n71 PMid:33782057.
» https://doi.org/10.1136/bmj.n71 - 28Google. NotebookLM. Note Taking & Research Assistant Powered by AI [Internet]. 2025 [citado em 2025 Maio 29]. Disponível em: https://notebooklm.google
» https://notebooklm.google - 29Ferreira ML, Machado G, Latimer J, Maher C, Ferreira PH, Smeets RJ. Factors defining care-seeking in low back pain–a meta-analysis of population-based surveys. Eur J Pain. 2010;14(7):747.e1-7. https://doi.org/10.1016/j.ejpain.2009.11.005 PMid:20036168.
» https://doi.org/10.1016/j.ejpain.2009.11.005 - 30Leboeuf-Yde C, Lauritsen JM. The prevalence of low back pain in the literature. Spine. 1995;20(19):2112-8. https://doi.org/10.1097/00007632-199510000-00009 PMid:8588168.
» https://doi.org/10.1097/00007632-199510000-00009 - 31Bennett M, Young J, Cartwright J. Evidence-based care for older people: where are we now and where to in the future? Speech Lang Hear. 2019;22(1):16-24. https://doi.org/10.1080/2050571X.2018.1538198
» https://doi.org/10.1080/2050571X.2018.1538198 - 32Chan AK, McCabe P, Madill CJ. The implementation of evidence-based practice in the management of adults with functional voice disorders: a national survey of speech-language pathologists. Int J Speech Lang Pathol. 2013;15(3):334-44. https://doi.org/10.3109/17549507.2013.783110 PMid:23642210.
» https://doi.org/10.3109/17549507.2013.783110 - 33Cheung G, Trembath D, Arciuli J, Togher L. The impact of workplace factors on evidence-based speech-language pathology practice for children with autism spectrum disorders. Int J Speech Lang Pathol. 2013;15(4):396-406. https://doi.org/10.3109/17549507.2012.714797 PMid:22967045.
» https://doi.org/10.3109/17549507.2012.714797 - 34Choi S, Hwang S. Attitudes, utilization, and barriers regarding evidence-based practice among speech-language pathologists in Korea. Commun Sci Disord. 2015;20(3):421-34. https://doi.org/10.12963/csd.15226
» https://doi.org/10.12963/csd.15226 - 35Chu SY, Ng LS, McConnell G. Using the Internet to Instruct on Evidence-Based Practice (EBP) in Classrooms across Borders. TESL-EJ. 2022;25(4):1-15. https://doi.org/10.55593/ej.25100int
» https://doi.org/10.55593/ej.25100int - 36Cormack A. A survey of variables influencing speech-language pathologists' use of evidence-based practice in clinical settings [dissertation]. El Paso (TX): The University of Texas at El Paso; 2010.
- 37Cunningham BJ, Daub OM, Cardy JO. Barriers to implementing evidence-based assessment procedures: perspectives from the front lines in pediatric speech-language pathology. J Commun Disord. 2019;80:66-80. https://doi.org/10.1016/j.jcomdis.2019.05.001 PMid:31085404.
» https://doi.org/10.1016/j.jcomdis.2019.05.001 - 38Durieux N, Pasleau F, Piazza A, Donneau AF, Vandenput S, Maillart C. Information behaviour of French-speaking speech–language therapists in Belgium: results of a questionnaire survey. Health Info Libr J. 2016;33(1):61-76. https://doi.org/10.1111/hir.12118 PMid:26272501.
» https://doi.org/10.1111/hir.12118 - 39Foster A, Worrall L, Rose M, O’Halloran R. ‘That doesn’t translate’: the role of evidence-based practice in disempowering speech pathologists in acute aphasia management. Int J Lang Commun Disord. 2015;50(4):547-63. https://doi.org/10.1111/1460-6984.12155 PMid:25652316.
» https://doi.org/10.1111/1460-6984.12155 - 40Fulcher-Rood K, Castilla-Earls A, Higginbotham J. What does evidence-based practice mean to you? A follow-up study examining school-based speech-language pathologists’ perspectives on Evidence-Based Practice. Am J Speech Lang Pathol. 2020;29(2):688-704. https://doi.org/10.1044/2019_AJSLP-19-00171 PMid:32176526.
» https://doi.org/10.1044/2019_AJSLP-19-00171 - 41Gomez M, McCabe P, Purcell A. Clinical management of childhood apraxia of speech: a survey of speech-language pathologists in Australia and New Zealand. Int J Speech Lang Pathol. 2019;21(3):295-304. https://doi.org/10.1080/17549507.2019.1608301 PMid:31122069.
» https://doi.org/10.1080/17549507.2019.1608301 - 42Hegarty N, Titterington J, Taggart L. A qualitative exploration of speech-language pathologists’ intervention and intensity provision for children with phonological impairment. Int J Speech Lang Pathol. 2021;23(2):213-24. https://doi.org/10.1080/17549507.2020.1769728 PMid:32635749.
» https://doi.org/10.1080/17549507.2020.1769728 - 43Hoffman LM, Ireland M, Hall-Mills S, Flynn P. Evidence-based speech-language pathology practices in schools: findings from a national survey. Lang Speech Hear Serv Sch. 2013;44(3):266-80. https://doi.org/10.1044/0161-1461(2013/12-0041) PMid:23843652.
» https://doi.org/10.1044/0161-1461(2013/12-0041) - 44McCurtin A, Clifford AM. What are the primary influences on treatment decisions? How does this reflect on evidence-based practice? Indications from the discipline of speech and language therapy. J Eval Clin Pract. 2015;21(6):1178-89. https://doi.org/10.1111/jep.12385 PMid:26032767.
» https://doi.org/10.1111/jep.12385 - 45Muttiah N, Georges K, Brackenbury T. Clinical and research perspectives on nonspeech oral motor treatments and evidence-based practice. Am J Speech Lang Pathol. 2011;20(1):47-59. https://doi.org/10.1044/1058-0360(2010/09-0106) PMid:21173395.
» https://doi.org/10.1044/1058-0360(2010/09-0106) - 46Nail-Chiwetalu B, Ratner NB. An assessment of the information-seeking abilities and needs of practicing speech-language pathologists. J Med Libr Assoc. 2007;95(2):182-8, e56-7. https://doi.org/10.3163/1536-5050.95.2.182 PMid:17443251.
» https://doi.org/10.3163/1536-5050.95.2.182 - 47Rojas CB, Godoy AL, Viarengo NO, Díaz PAO. Creencias y actitud hacia la práctica basada en la evidencia de fonoaudiólogos latinoamericanos dedicados exclusivamente a la práctica clínica y educativa. Rev Investig Logop. 2023;13(1):5.
- 48Sandham V, Hill AE, Hinchliffe F. The current practices of Australian speech-language pathologists in providing communication services to children with autism spectrum disorder. Int J Speech Lang Pathol. 2021;23(6):641-51. https://doi.org/10.1080/17549507.2021.1923800 PMid:34229560.
» https://doi.org/10.1080/17549507.2021.1923800 - 49Sandham V, Hill AE, Hinchliffe F. The perspectives of Australian speech pathologists in providing evidence-based practices to children with autism. Int J Lang Commun Disord. 2022;57(6):1229-43. https://doi.org/10.1111/1460-6984.12736 PMid:35674484.
» https://doi.org/10.1111/1460-6984.12736 - 50Spek B, Wieringa‐de Waard M, Lucas C, Van Dijk N. Teaching evidence‐based practice (EBP) to speech–language therapy students: are students competent and confident EBP users? Int J Lang Commun Disord. 2013;48(4):444-52. https://doi.org/10.1111/1460-6984.12020 PMid:23889839.
» https://doi.org/10.1111/1460-6984.12020 - 51Thome EK. A survey of speech-language pathologists’ use and understanding of evidence-based practice [dissertation]. Oxford: University of Mississippi; 2018.
- 52Tohidast SA, Kamali M, Ghelichi L, Shavaki YA, Ebadi A, Shafaroodi N, et al. Evidence-based practice: Knowledge, attitudes, and behavior of iranian speech and language pathologists. Pharmacophore. [Internet]. 2017 [citado em 2025 Ago 12];8(6S):e-1173452. Disponível em: https://scholar.google.com/scholar?hl=pt-BR&as_sdt=0%2C5&q=Evidence-based+practice%3A+Knowledge%2C+attitudes%2C+and+behavior+of+iranian+speech+and+language+pathologists.++&btnG=
» https://scholar.google.com/scholar?hl=pt-BR&as_sdt=0%2C5&q=Evidence-based+practice%3A+Knowledge%2C+attitudes%2C+and+behavior+of+iranian+speech+and+language+pathologists.++&btnG= - 53Tohidast SA, Ghelichi L, Kamali M, Ebadi A, Shafaroodi N, Shavaki YA, et al. Barriers of implementing evidence-based practice perceived by Iranian speech and language pathologists: a qualitative study. Middle East J Rehabil Health Stud. 2021;8(2):e108223. https://doi.org/10.5812/mejrh.117262
» https://doi.org/10.5812/mejrh.117262 - 54Vallino-Napoli LD, Reilly S. Evidence-based health care: a survey of speech pathology practice. Adv Speech Lang Pathol. 2004;6(2):105-15. https://doi.org/10.1080/14417040410001708530
» https://doi.org/10.1080/14417040410001708530
Submetido em:
12/08/2025
Aceito em:
03/11/2025
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