Evaluating evidence-based practice in light of the boundedness and proximity of outcomes: Capturing the scope of change.
Micheal Sandbank, Jason Chow, Kristen Bottema-Beutel and 1 others
PMID 33943022WHAT IT FOUND
Interventions that teach specific skills in structured settings often look highly effective because they are measured close to the training context.
Clinicians should check if an 'evidence-based' label reflects generalized development or just narrow, context-bound learning.
Key findings
01Many evidence-based practice reviews fail to distinguish between outcomes that reflect generalized, distal development and those that are highly proximal or context-bound.
02Interventions that produce only narrow, specific changes are often given the same 'evidence-based' designation as those producing broader developmental gains.
03Effects measured in contexts similar to the intervention (e.g., same therapist, same toys) are likely to be inflated estimates of true functional change.
STILL TO COME
How it was doneWhat they foundWhat it means for SLPs
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What it does not show
This is a conceptual review and does not present new empirical data or a systematic search of literature. The definitions of 'boundedness' and 'proximity' are proposed by the authors and may not yet be standardized across all clinical or research communities. The paper focuses on early childhood interventions and communication outcomes, though the concepts may apply elsewhere; its direct relevance to physical or occupational therapy is not explicitly argued in the text.
Declared interests
The authors declare no conflicts of interest. They note that they are the authors of a recent review (Sandbank et al., 2020) that they cite as an exception to the problem they describe, which introduces a potential bias in their comparison of review methodologies.
The easy way to misread this
Do not assume that an intervention labeled 'evidence-based' for communication will improve functional language in natural settings. The paper argues that many such labels are based on highly proximal, context-bound measures that overstate generalized learning.