Western Michigan University, 1903 West Michigan, Kalamazoo, MI 49008-5355, USA.
Lang Speech Hear Serv Sch. 2011 Jan;42(1):81-7; discussion 88-93. doi: 10.1044/0161-1461(2010/09-0046). Epub 2010 Jul 2.
This article offers a critical response to Kamhi's (2011) essay regarding the need to balance certainty and uncertainty in evidence-based practice (EBP).
Points of concordance and discordance (counterpoints) between Kamhi's essay and the author's frames of reference were considered.
In agreement with Kamhi, a major role is outlined for clinicians to use questions strategically (i.e., acting on uncertainty) to prioritize intervention targets and select approaches that best fit the context and stakeholders' values for purposes of planning, accomplishing, and evaluating change. The first counterpoint emphasizes a need for larger roles for theoretical frameworks involving systems theory and collaborative, contextualized approaches to assessment and intervention. The second notes opportunities for self-correction by using outcome data from relevant contexts outside of treatment sessions.
Clinicians should capitalize on Kamhi's ideas by working with other key stakeholders to make points of certainty and uncertainty explicit. By generating insightful questions that can guide the process of EBP and gathering evidence from broader outcomes, clinicians can gain external validation for the approach taken or for the need to consider alternatives.
本文对 Kamhi（2011）关于在循证实践（EBP）中平衡确定性和不确定性的必要性的文章进行了批判性回应。
考虑了 Kamhi 的文章与作者参考框架之间的一致性和分歧点（反论）。
与 Kamhi 一致，本文概述了临床医生战略性地使用问题（即对不确定性采取行动）的主要作用，以确定干预目标的优先级，并选择最适合背景和利益相关者价值观的方法，以规划、实现和评估变化。第一个反论强调需要更大的作用，涉及系统理论和协作、上下文化的评估和干预方法的理论框架。第二个反论指出了通过使用治疗会话之外的相关背景下的结果数据进行自我纠正的机会。
临床医生应该通过与其他关键利益相关者合作，明确确定性和不确定性的要点，充分利用 Kamhi 的思想。通过提出可以指导 EBP 过程的有见地的问题，并从更广泛的结果中收集证据，临床医生可以获得所采取方法的外部验证，或者需要考虑替代方法的外部验证。
