Clinical Research in Communication DisordersPRinCiPles anD stRategies

Fourth Edition

Clinical Research in Communication DisordersPRinCiPles anD stRategies

Fourth Edition

M. N. Hegde, PhDAnthony P. Salvatore, PhD

5521 Ruffin RoadSan Diego, CA 92123

e-mail: information@pluralpublishing.com Website: http://www.pluralpublishing.com

Copyright © 2021 by Plural Publishing, Inc.

This book was previously published by: PRO-ED, Inc.

Typeset in 10.5/13 Garamond by Flanagan’s Publishing Services, Inc.Printed in the United States of America by McNaughton & Gunn, Inc.

All rights, including that of translation, reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, recording, or otherwise, including photocopying, recording, taping, Web distribution, or information storage and retrieval systems without the prior written consent of the publisher.

For permission to use material from this text, contact us byTelephone: (866) 758-7251Fax: (888) 758-7255e-mail: permissions@pluralpublishing.com

Every attempt has been made to contact the copyright holders for material originally printed in another source. If any have been inadvertently overlooked, the publishers will gladly make the necessary arrangements at the first opportunity.

Library of Congress Cataloging-in-Publication Data: Names: Hegde, M. N. (Mahabalagiri N.), 1941- author. | Salvatore, Anthony P., author. Title: Clinical research in communication disorders: principles and strategies / M.N. Hegde, Anthony P. Salvatore. Other titles: Clinical research in communicative disorders Description: Fourth edition. | San Diego, CA : Plural Publishing, [2021] | Preceded by Clinical research in communicative disorders : principles and strategies / M.N. Hegde. 3rd ed. c2003. | Includes bibliographical references and index. Identifiers: LCCN 2019000565| ISBN 9781635501872 (alk. paper) | ISBN 1635501873 (alk. paper) Subjects: | MESH: Communication Disorders | Research Design | Medical Writing Classification: LCC RC428 | NLM WM 475 | DDC 616.85/50072--dc23 LC record available at https://lccn.loc.gov/2019000565

v

Contents

Preface to the First Edition xiPreface to the Fourth Edition xiii

PaRt i. science and the scientific Methods 1

1 Why study science and Research Methods? 3Evaluation of Research 4The Need to Study Scientific Methods 5The Need to Produce In-House Knowledge 8Why Research by Clinicians Is Limited 9Problems Associated With Certain Research Practices 10Problems Associated With the Education and Training Models 13Summary 16References 16Study Guide 16

2 an introduction to Research: the Formal and 19 Formative approachesWhat Is Research? 21Why Do Scientists Do Research? 21How Is Research Done? 28Serendipity in Research 34Planning Is Still Important 37Summary 37References 38Study Guide 38

3 science and its Basic Concepts 39What Is Science? 40Outcome of Scientific Activity 44Variables and Their Types 45Causality and Functional Analysis 50Experiment and Experimental Control 53Hypotheses in Scientific Research 54Theories and Hypotheses 57Inductive and Deductive Reasoning 58Theories and Scientific Laws 61Data and Evidence 62

vi CliniCal ReseaRCh in CommuniCation DisoRDeRs

Summary 63References 64Study Guide 65

4 treatment Research 67Evidence-Based Practice 68What Is Treatment Research? 68Consequences of Treatment 69Treatment Research: Logical and Empirical Constraints 74Group Treatment Research: Randomized Clinical Trials 77Single-Subject Treatment Research: Multiple Control Conditions 87Randomized Clinical Trials Versus Single-Subject Treatment Research 106Classification of Treatment Research 113Summary 119References 120Study Guide 122

5 Other types of Research 123Ex Post Facto Research 124Normative Research 127Standard-Group Comparisons 131Experimental Research 133Clinical and Applied Research 138Translational Research 142Sample Surveys 144Qualitative Research 146Mixed-Methods Research 150The Relation Between Research Types and Questions 151Summary 152References 153Study Guide 154

6 Observation and Measurement 157Observation and Measurement 158Philosophies of Measurement 158Scales of Measurement 160Measures of Communicative Behaviors 162Client-Assisted Measurement 169Indirect Measures: Self-Reports 170The Observer in the Measurement Process 171Mechanically Assisted Observation and Measurement 174Reliability of Measurement 175Summary 178References 179Study Guide 180

Contents vii

PaRt ii. Clinical Research Designs 183

7 Research Designs: an introduction 185What Are Research Designs? 186The Structure and Logic of Experimental Designs 187Variability: Philosophical Considerations 188Experimental Designs: Means of Controlling Variability 192Validity of Experimental Operations 193Generality (External Validity) 201Factors That Affect Generality 210Concluding Remarks 212Summary 213References 214Study Guide 215

8 the group Design strategy 217Common Characteristics of Group Designs 218Preexperimental Designs 219True Experimental Designs 223Designs to Evaluate Multiple Treatments 228Factorial Designs 231Quasi-Experimental Designs 236Time-Series Designs 240Counterbalanced Within-Subjects Designs 246Correlational Analysis 253Group Designs in Clinical Research 255Summary 259References 261Study Guide 262

9 single-subject Designs 265Historical Background to Single-Subject Designs 266Characteristics of Single-Subject Designs 270Experimental Control in Single-Subject Designs 274Preexperimental Single-Subject Design 275Designs for Single Treatment Evaluation 276Designs for Multiple Treatment Comparison 290Designs for Interactional Studies 299N-of-1 Randomized Clinical Trials 302Single-Subject Designs in Clinical Research 303Summary 304References 306Study Guide 308

viii CliniCal ReseaRCh in CommuniCation DisoRDeRs

10 statistical analysis of Research Data 311Historical Introduction to Statistical Analysis of Research Data 312Statistical Significance 316Hypothesis Testing 317Statistical Analysis of Group Design Data 318Systematic Reviews and Meta-Analyses 323Visual Analysis of Single-Subject Data 326Statistical Analysis of Single-Subject Data 328Statistical Significance Versus Clinical Significance 333Summary 338References 339Study Guide 342

11 generality through Replications 343Direct Replication 344Systematic Replication 347Sample Size and Generality 351Failed Replications: Sources of Treatment Modifications 353Homogeneity and Heterogeneity of Participants 355Summary 357References 358Study Guide 359

12 Comparative evaluation of Design strategies 361Research Questions and Investigative Strategies 362Advantages and Disadvantages of Design Strategies 369Problems Common to Design Strategies 371Philosophical Considerations in Evaluation 372The Investigator in Design Selection 373The Final Criterion: Soundness of Data 373Summary 374References 377Study Guide 377

13 Designs Versus Paradigms in Research 379Limitations of Exclusively Methodological Approaches 380Research Methods and Subject Matters 380Philosophy as Methodology 382Philosophy of Subject Matters 382Philosophy of the Science of Speech and Language 384Philosophical Ways of Handling Methodological Problems 393The Interplay Between Philosophy and Methodology 396Summary 397References 397Study Guide 398

Contents ix

PaRt iii. Doing, Reporting, and evaluating Research 399

14 How to Formulate Research Questions 401How to Formulate Research Questions 402Preparation of Theses and Dissertations 413Summary 414References 415Study Guide 415

15 How to Write Research Reports 417General Format of Scientific Reports 418Structure and Content of Research Papers 419Writing Without Bias 427Good Writing: Some Principles 428Writing Style 446Writing and Revising 447Summary 448References 448Study Guide 449

16 How to evaluate Research Reports 451Professionals as Consumers of Research 452Understanding and Evaluating Research 452Evaluation of Research 453Evaluation of Research Reports: An Outline 458A Hierarchy of Treatment Research Evidence 463Evaluation and Appreciation of Research 467Summary 468References 468Study Guide 469

17 ethics of Research 471Fraud in Scientific Research 472Ethical Justification for Treatment Evaluation 476The Protection of Human Participants in Research 479Ethical Issues With Treatment Research 485Consequences of Ethical Constraints 492Protection of Animal Subjects 495Dissemination of Research Findings 496Summary 497References 497Study Guide 500

Index 503

xi

Preface to the First edition

I am a student and an instructor of phi-losophy and methodology of science and research. In my teaching of science and research, I have found it necessary to supplement information from a variety of sources. I knew that several of my col-leagues who taught courses on research and science were doing the same to make their courses more relevant and useful to graduate students. To me, this meant that we did not have a comprehensive text-book on science and research. This book is an effort to fulfill that need.

My own teaching experience and discussions with many of my colleagues suggested that a book on science and research should address the following concerns. The first deals with the basic concepts of science and scientific meth-ods. That is, the book should point out the need to study science and research meth-ods and summarize the basic concepts of science and research. It should describe the true and lively process of research, not an idealized and frighteningly formal-ized process that typically discourages the beginning student from a further study of science and research. The book should give an adequate description of the differ-ent kinds of research that are conducted in communication disorders. A discussion of observation and measurement, which are the basic tools of science, must be provided.

The second concern is clinical re- search designs. Most books on research designs tend to be statistically oriented. The enormously prestigious analysis of vari-ance is constantly confused with experi-

mental designs. A book on designs should present experimental designs, not meth-ods of data analysis under the guise of research designs. Furthermore, the book should address both group and single-subject designs. Generally speaking, most books that offer information on research designs focus almost exclusively on group designs. Clinically more relevant single-subject designs are not well represented in those books. On the other hand, there are some books that focus exclusively on single-subject designs. There are not many books that present adequate infor-mation on both design strategies. Regard-less of one’s own methodologic prefer-ence and practice, a critical user and producer of research must have a knowl-edge of group as well as single-subject design approaches. It was thought that a single source that offered descriptions and comparative evaluations of both strat-egies would be useful to students and researchers alike.

The third concern is the discussion of some important philosophic issues that are an inexorable part of science and research. Research is based on method-ology as well as philosophy. There is a tremendous lack of appreciation of the philosophic bases of research. Therefore, it was thought that this book should at least raise the issue of philosophy of research to stimulate further discussion in the discipline.

The fourth concern is the practical aspect of performing, writing, reporting, and evaluating research. Students need suggestions on where to find research

xii CliniCal ReseaRCh in CommuniCation DisoRDeRs

questions, how to find current research trends, how to search the literature, how to refine research questions, and how to select designs that help answer those questions. They also need information on how to get started on theses and disser-tations. A major problem instructors and students alike face is writing style and writing skills. It was thought that this book should offer basic information on principles of good writing.

The fifth concern is the ethics of research. Science and research are an ethical activity. From the beginning, sci-ence and research must be taught with due regard for the ethical principles that restrain research. A textbook on research should summarize ethical principles that govern research activities.

I have written this book with those five concerns as the guiding principles. An overall concern was to make a book on science and research especially rel-evant to clinical research in communica-

tion disorders and write it in a less formal, and I would hope, more readable style. It is thought that such a style would also reflect the process of research more accu-rately than the typical style that formalizes research to an unnatural extent.

My wife Prema and my son Manu have been a part of all of my writings. This book, which I began to write soon after completing Treatment Procedures in Communicative Disorders, would not have been finished without their full support.

I thank all of my former students at both the undergraduate and graduate levels who have been generous in their support and encouragement. My students have always tolerated and often appreci-ated my unlimited passion to teach sci-ence and research anytime and anywhere. Many students in my graduate seminar on research methods have offered excellent comments on earlier versions of several chapters in this book.

xiii

Preface to the Fourth edition

Since its first publication in 1987, many instructors have adopted this book as the main text in various courses on research methods and designs in communication disorders. Most of these instructors have offered their gracious and positive com-ments on the book. The instructors have suggested that the comprehensive treat-ment of issues and methods of research is a strength of this book. The new fourth edition retains that strength.

I am glad to have Dr. Anthony Sal-vatore of the University of Louisiana at Lafayette as my coauthor of this fourth edition, published after 30 years of its first edition. Together we have exten-sively revised and updated each chapter. In the chapter on research ethics, we have included web-based sources that monitor research fraud and recalled studies.

The chapter on writing and report-ing research papers includes the report-ing standards for experimental studies, qualitative research, and meta-analyses published by various organizations.

The chapter on types of research includes new sections on translational research, qualitative research, and mixed-methods research. A critical and compara-tive analysis of these types of research has been included.

The new edition contains a new chap-ter on statistical analysis of research data. This chapter covers quantitative analysis

of both group- and single-subject study results. We have outlined both paramet-ric and nonparametric tests for analyzing research data. In addition, the chapter covers such contemporary topics as nar-rative reviews, systematic reviews, and meta-analyses of both group- and single-subject design data.

The sections on single-subject research analysis includes guidelines on visual anal-ysis and assessment of quality indicators. We have reviewed the effect size statistics for single-subject data and have included nonoverlap techniques and d-statics.

Finally, the new chapter contains a dis-cussion of statistical versus clinical signifi-cance of treatment research evidence. We have given an overview of quantitative and qualitative measures of clinical significance.

The widespread use of this book as a text in classrooms over 30 years across the country and beyond has strengthened our belief that instructors of research designs in communication disorders would wel-come a text that represents both the single-subject and group design strate-gies along with issues of measurement; philosophy of science; ethics of research; and planning, conducting, and reporting research. We wish to express our appre-ciation to all those instructors who have found this book an effective teaching device and have taken time to offer their thoughtful comments.

— M. N. H.

PaRt iscience and the scientific Methods

1Why study science and Research Methods?

Chapter Outline

◆ evaluation of Research

◆ the need to study scientific methods

◆ the need to Produce in-house Knowledge

◆ Why Research by Clinicians is limited

◆ Problems associated With Certain Research Practices

◆ Problems associated With the education and training models

◆ summary

◆ References

◆ study Guide

4 CliniCal ReseaRCh in CommuniCation DisoRDeRs

Communication disorders is both an aca-demic discipline and a clinical profession. As an academic discipline, communication disorders seeks to study and understand normal and disordered communication. As a clinical profession, it is concerned with the methods of assessing and treat-ing various disorders of hearing, speech, language, voice, and fluency. An academic discipline can research practical problems without applying the information it gen-erates. For example, a biochemist who develops a new drug that can be used in treating a particular disease may not treat patients with that disease. In communica-tion disorders, researchers who develop new information or technology also may apply that information in the treatment of disordered communication. In this sense, communication disorders is simultane-ously concerned with both scientific and professional matters.

As the discipline of communication disorders emerged and developed, the professional aspects, rather than the sci-entific bases, received greater attention. This is understandable because the start-ing point of the discipline was a profes-sional concern to understand and treat speech problems, especially stuttering and speech sound disorders. The profes-sion had to begin providing clinical ser-vices without the benefit of a history of controlled experimental research to sup-port clinical practice. Borrowing from several basic and applied disciplines, the speech-language pathologist of ear-lier days began to treat communication disorders. Historically, the emphasis has been on expanding clinical services rather than conducting experimental research to produce a scientific basis for those clini-cal services.

An unfortunate historical lesson of many human service professions, includ-

ing that of communication disorders, is that clinical services can continue to be offered without a strong experimental database. Such services may be supported by subjectively solidified clinical experi-ence, uncontrolled observations, anec-dotes widely circulated by “authorities” in the field, descriptive research, and specu-lative theories. Systematic experimental evaluation of treatment techniques may be lacking. As a result, clinical services the profession offers may not be based on controlled research evidence. However, this may not deter a profession from offer-ing services, partly because of practical exigencies and partly because something better is not available.

The problem with such a history is that the clinical practice does not change quickly when experimental research information begins to flow. The clinical practice of established clinicians may con-tinue to be based on old and unverified assumptions. Typically, it takes several years to affect clinical practice on a wide scale because the research information must be incorporated into the training of new clinicians.

evaluation of Research

Evaluation of old and new research is about as important as the creation of new in-house knowledge. Profession-als who cannot evaluate research data and theories also cannot make effective use of information. Critical evaluation of research should be a part of the clini-cian’s repertoire, and such an evaluation requires the same knowledge needed to do meaningful research.

The process of evaluating research data follows the same logical steps as

1. Why stuDy sCienCe anD ReseaRCh methoDs? 5

the process of designing experiments. Therefore, evaluation of research is pos-sible only when clinicians understand how research is done. Clinicians who are not knowledgeable in science and meth-ods of investigation in their field of study are likely to have difficulty in judging the relevance of the questions their col-leagues research, the validity and reliabil-ity of observations, the relation between results and conclusions, the transition from evidence to theory, and the distinc-tion between theory and speculation.

Furthermore, clinicians who are not sophisticated in the philosophy of sci-ence may not see logical and empirical mistakes in study designs. In such cases, clinicians who read research uncritically accept the author’s interpretations. How-ever, bad interpretations are about as prevalent as bad designs, and clinicians who cannot detect inconsistent relations between interpretations and results can-not separate data from conclusions. Data that are based on sound methods are always more valuable and durable than the author’s interpretations imposed on them. Future clinicians and researchers may keep the sound data while rejecting faulty interpretations.

Even when many practitioners do treatment-related research, a majority of clinicians will read research papers mostly to improve their practice. The popu-lar phrase “clinicians are consumers of research” has a ring of validity in that most clinicians will be users, not producers, of research. It is well known that naive con-sumers are victims of bad products. Simi-larly, clinicians who are naive in the meth-ods and philosophy of science are likely victims of bad research; unfortunately, in a clinical science such as communicative disorders, individuals who receive ser-vices also become victims.

It is thus clear that clinicians who do not do research still need to understand science and research methods. Even if there is much research that cannot be applied, clinicians will have to keep read-ing and evaluating research because that is the only way they can find out what is useful and what is not. Those who avoid reading the research literature because some of it is irrelevant to clinical prac-tice are sure also to miss what is rele-vant to them. Meanwhile, when research practices improve, and clinically relevant studies begin to be routinely published, clinicians will be unaware of them and unprepared to apply them in their prac-tice. For detailed information on evaluat-ing research, see Chapter 15.

the need to study scientific Methods

It is now widely recognized that commu-nication disorders needs to strengthen the scientific bases of its clinical practice. The need to place our clinical practice on an experimental foundation is grow-ing because of many legal, social, profes-sional, and scientific reasons.

legal and social Considerations

An increasing number of federal and state laws influence professional practices in communication disorders. A major source of influence is a set of federal laws related to the education of children with disabili-ties. The original Education for all Handi-capped Children Act of 1977 (P.L. 94-142) had a significant effect on public school special education services, including those

6 CliniCal ReseaRCh in CommuniCation DisoRDeRs

of communication disorders. The law was amended in 1986, retitled Individuals With Disabilities Education Act (P.L. 101-476) in 1990 and reauthorized periodi-cally. The latest reauthorization was in 2004 and ammended in 2015. (Many fed-eral laws are periodically reauthorized and amended to address new concerns; therefore, the reader should consult the latest versions of the laws of interest.)

Some of the most significant require-ments under these laws are that special education services must be oriented to the individual child and his or her fam-ily and the service programs must have specific procedures, objectives, and eval-uative criteria. The laws place consider-able emphasis on clinician accountability in that the effects of treatment programs must be documented objectively so that they can be verified by independent observers. Such documentation requires that changes in student (client) behaviors be measured systematically and continu-ously. As we shall see shortly, these and other mandates of the laws are in har-mony with the principles of scientific clinical practice.

Other kinds of legal concerns necessi-tate a more objective and scientific clinical practice. Third-party payment for clinical speech, language, and hearing services is common now. Various government agencies and private insurance firms that pay for the services demand more and more systematic documentation of the need, the procedures, and the outcome of such services. Uniform and objective means of evaluating treatment effects are being encouraged by agencies that pay for services.

Many social concerns are also lead-ing us in the direction of clinical practice based on scientific methods. The profes-sion continues to take steps to increase

public awareness of speech and language problems and the services that are avail-able to individuals with those problems. Consequently, an increasing number of individuals and families are seeking and paying for services in private clinics and hospitals. At the same time, many people who are seeking services are also inclined to question the effectiveness of those ser-vices. Inevitably, widespread social aware-ness of speech, language, and hearing problems combined with higher demands for services and increasing cost of service delivery will result in a thorough scrutiny of professional practices.

Professional and scientific Considerations

Regardless of the legal and social require-ments, there are professional reasons for developing a scientifically sound clinical discipline. Much concern surrounds the professional standing of communication disorders in the community of clinical pro-fessions and scientific disciplines. There is a growing concern that the profession of communication disorders does not have high social visibility. The profession may not be well recognized by other estab-lished or recently developed professions, such as medicine or clinical psychology.

A profession can try to draw atten-tion to itself by various means. It may seek better legal recognition and protec-tion by more effective lobbying efforts. Extensive public relations and public awareness campaigns may be launched. Services may be more aggressively pub-licized through advertisements in local and national media. Since all professions have a business side, most of these efforts are fiscally necessary. Indeed, all profes-sions find it necessary to market their

1. Why stuDy sCienCe anD ReseaRCh methoDs? 7

services ethically. Such efforts may yield somewhat quick results; however, to build a lasting and more solid reputation, the profession, in addition to taking all those steps, must put its practice on a scientific footing. In the long run, no amount of public relations campaign can compen-sate for questionable and subjectively evaluated clinical practice. In fact, public awareness — which is generally benefi-cial — can expose the inherent and wide-spread weaknesses of a profession.

Scientifically based and technologi-cally competent professions enjoy good reputations and higher visibility. A profes-sion can make significant progress when its concepts are scientific and its meth-ods are evaluated objectively. The ideal to strive for is a solid scientific discipline and a clinical profession with a single iden-tity. This ideal, when achieved, will help ensure the quality of speech and hearing services offered to persons with commu-nication disorders.

The typical argument supporting a more scientific orientation is made on the basis of the legal, social, and pro-fessional requirements described so far. Such requirements are compelling, and anything that forces a more scientific ori-entation is welcome. However, a profes-sion need not be driven entirely by such requirements. Professionals need not face legal, social, and professional image-ori-ented reasons and requirements to strive to be more scientific. Although the state-ment may sound tautological, science itself is a good reason to be scientific. The logical beauty, methodological elegance, and practical benefits of science antecede legal, social, and professional pressures.

Had the profession heeded the call of science from its inception, it is pos-sible that most of the legal and social pressures would have become superflu-

ous. Clinicians who by training and prac-tice follow the methods of science do not need a push from public laws to write treatment targets in measurable terms. For such clinicians, the requirement that changes in client behaviors must be docu-mented objectively will not come as news or as a legal nuisance. Their personal his-tory of training and education will suf-fice for such purposes. Surely, social and legal demands can force clinicians to be systematic and objective in their clinical work, but those with a strong scientific background are inclined to be so regard-less of such demands. Concerns regarding bad professional image may not necessar-ily drive clinicians to conduct or evalu-ate controlled treatment research. Well-trained clinicians have better reasons, including science itself. Scientifically com-petent clinicians are unlikely to be overly concerned with image; nevertheless, they are probably better for the profession’s image than those who are concerned with public reactions but continue to offer questionable services.

These comments should not be con-strued as a negative evaluation of legal, social, and professional reasons to be more scientific. In fact, governments, social groups, and professional bodies have an obligation to protect the rights of people who seek and then financially support professional services. Societal and regulatory forces are necessary for smooth and socially beneficial operations of professions as well as sciences. Such regulatory forces have helped all pro-fessions and sciences move in the right direction, as we shall see in Chapter 17. The comments are meant to underscore an additional and often neglected rea-son to be more systematic, responsible, and objective in clinical work: the phi-losophy and methodology of science that

8 CliniCal ReseaRCh in CommuniCation DisoRDeRs

are capable of providing unsurpassed safeguards for both the profession and the public. Besides, science provides an unlimited and exciting opportunity to make significant advances in all areas of professional endeavor.

the need to Produce in-House Knowledge

During the time when service delivery, not scientific research, is the urgent busi-ness, the profession is dependent on other disciplines for a knowledge base. Communication disorders historically has depended on some nonclinical dis-ciplines such as linguistics, experimental psychology, and child psychology. It also has depended on clinical professions such as medicine and basic sciences such as physiology and physics.

Communication disorders has been a borrower for a long time, perhaps too much of a borrower and too little of an innovator. It borrowed not only basic or applied information but also conceptual frameworks, theories, paradigms, models, and methods of investigation and data analysis. Therefore, the slowly develop-ing traditions of research in communi-cation disorders have been extensively influenced by other disciplines that have offered methods and theories of varying degrees of validity, reliability, relevancy, and applicability.

It is true that certain scientific ap- proaches, concepts, and methods are com-mon to many scientific disciplines and professions. Nonetheless, unless a disci-pline quickly begins to produce its own experimental database, it will continue to borrow theories and methods that may or may not be appropriate for studying its subject matter. The only way some pro-

fessions can begin to generate their own databases is to train their practitioners to do research. Professions such as medi-cine have the luxury of receiving a large and varied amount of custom-produced research information from outside their professions. Medicine has chemists, bio-chemists, physiologists, anatomists, biolo-gists, geneticists, bioengineers, and a vari-ety of technologists and technical product manufacturers (including global pharma-ceutical companies) who do research dedicated to medicine and supply theo-retical information and practical technol-ogy. There are not comparable bands of researchers and technicians supplying information and technology to communi-cation disorders. Much of the information and technology the discipline borrows is not produced for it; its relevance may be incidental and, in some unfortunate cases, mistaken.

Specialists in communication disor-ders should produce their own knowl-edge base and technology, but this does not mean that they should not selectively borrow from other disciplines. Like other professions, communication disorders will continue to borrow what is relevant and useful. Many fields of knowledge are interrelated. Therefore, the fields benefit from each other’s research. Nonetheless, what is urgently needed is a systematic effort to increase the in-house knowledge base and technology. A discipline cannot always expect other specialists to produce the basic scientific information necessary to understand its subject matter. A profes-sion cannot always expect others to pro-duce a relevant and effective technology.

The most significant problem with increasing the amount of in-house knowl-edge is the scarcity of research institu-tions and sustained research programs in communication disorders. Many univer-

1. Why stuDy sCienCe anD ReseaRCh methoDs? 9

sity programs in communication disorders are not research oriented, and large insti-tutions that specialize in research are few or nonexistent. Producing a systematic body of reliable and valid scientific infor-mation is a slow process even under the best possible conditions. Therefore, under the existing conditions, the accumulation of valid knowledge in communication dis-orders will be a prolonged process. There seems to be no easy or quick solution to this problem. Several steps are neces-sary to increase the amount of research; for example, the discipline can seek more government and private research funds, increase the number of theses produced by master’s degree candidates, accelerate research efforts at existing research and teaching institutions, and establish new programmatic research.

Another tactic is to recruit practition-ers into the kind of research that does not detract from clinical activities. That is, the field can make an effort to increase research by practicing clinicians. Since the majority of persons in the field are clini-cians, even a slight increase in the num-ber of clinicians doing research may have an appreciable effect. This is the kind of in-house knowledge base that can have immediate and simultaneous clinical and theoretical significance.

Why Research by Clinicians is limited

It is well known that a majority of clini-cians do not do research. After all, they are busy serving their clients. There are many reasons why clinicians typically do not engage in research. For example, most clinicians do not have the needed extra time for research. Besides, when research

is thought of as something unrelated to clinical service, the clinicians obviously cannot do research. Also, the client sched-uling may be good for clinical work but bad for research; when clients are seen twice weekly for a few minutes each time, collecting in-depth data may be difficult.

Most clinical settings do not support or encourage research. Many public schools and hospitals do not require research from clinicians and may not encourage it. Much research, both good and bad, is done when research is required or valued in a given setting. It also may be noted that bad research can be done even when someone “wanted” to do research while it was not required to achieve promotions or pay raises. In many settings, research often is done over and above one’s regular duties. When it is not required for profes-sional advancement, the administration is unlikely to support research to any great extent.

It also is possible that clinicians them-selves assume that: (a) they are not well prepared to do research and (b) research does not necessarily help them, their col-leagues, or their clients. Both of these assumptions may be valid to a degree. The first assumption may be due to many practitioners’ limited training and experi-ence in research methods. To do research, one should also maintain currency in the slowly-but-surely changing field of knowledge in the discipline. The pres-sures of day-to-day professional practice may not be conducive to spending the needed amount of time and energy on reading the literature. Though significant advances in communication disorders have been few and far between, there has been an information explosion in recent years. It takes time just to keep up with published research. Because they do not have this time, many clinicians may think

10 CliniCal ReseaRCh in CommuniCation DisoRDeRs

that they lack the technical knowledge of scientific procedures and current informa-tion needed to do research.

The second assumption — that research does not necessarily help clinical practice — may be based on experience. There is some question regarding the extent to which research affects day- to-day clinical practice. Douglas, Campbell, and Hinck-ley (2015) stated that a treatment proce-dure that has support based on 20 years of research may still remain unused by the clinicians. With all the emphasis on evi-dence-based practice, there is no evidence to support that a majority of clinicians use treatment procedures that are known to be effective. In treating clients, clinicians are likely to depend upon their past train-ing and clinical experience. Practition-ers across professional settings do not automatically apply experimentally but unsupported theories, and recent trends without substance have a greater influ-ence on clinical practice than do technical research reports.

Workshops, presentations, discus-sions with colleagues, and lectures on the “latest” techniques and “hot topics” may affect clinical practice more than experi-mental evidence does. However, even those who give frequent workshops often think that clinicians rarely apply exactly what the workshops offered. For example, some individuals who frequently attend workshops agree equally well with totally contradictory approaches, and clinicians assimilate what they hear (or read) with their past experience and apply new tech-niques in modified ways. Such modifica-tions are not necessarily bad. The only problem is that unspecified and varied modifications of published techniques make it difficult to identify successful techniques. In any case, the disturbing situation remains: Controlled and techni-

cal research does not affect clinical prac-tice to the extent it should.

The belief that research does not nec-essarily help clinical practice is partially true. We are not just referring to basic research, which is not expected to give immediate solutions to practical prob-lems; we are referring to the kinds of research that are expected to solve clinical problems. Purported clinical research on assessment or treatment of communica-tion disorders also may frustrate clinicians. Clinicians who read and evaluate such research to sharpen their clinical skills may be disillusioned about the usefulness of all kinds of clinical research. In essence, certain research practices may generate a justifiable skepticism regarding the rele-vance of research to clinical practice.

Problems associated With Certain Research Practices

There are multiple modes of clinical research, and not all of them are equally helpful to the clinician in solving current practical problems. In Chapters 4 and 5, we will describe different types of research in some detail. Here it may be noted that clinical-experimental research is likely to produce results that help solve immediate practical problems clinicians face. Many other types of research, although essen-tial, may lead to solutions to practical problems but only in the future.

Clinical usefulness is not the only criterion by which the value of research is determined. Basic research often does not have immediate practical significance. However, it is valuable because it might help explain a phenomenon, put unre-lated observations in a single perspective, suggest new lines of experimental analy-