Accessing evidence in low resource countries (FS-09)


Introduction video

A Moseley1, J Damascene Gasherebuka2, V Singh Paramanandam3, G Gómez4, S Sharma5
1The University of Sydney, Institute for Musculoskeletal Health, Sydney, Australia, 2Rwanda Allied Health Professions Council, Kigali, Rwanda, 3Tata Memorial Hospital, Mumbai, India, 4Kreativa Rehabilitación, Buenos Aires, Argentina, 5Kathmandu University School of Medical Sciences, Dhulikhel, Nepal
Learning objectives:
  1. Discuss barriers to accessing high-quality clinical research, particularly in low-resource countries.
  2. Identify strategies to overcome barriers to accessing high-quality clinical research, including open-access resources, continuing professional development, and access to full-text research articles.

Description: Evidence-based practice in physical therapy is physical therapy informed by relevant and high-quality clinical research [1], which involves asking clinical questions, acquiring evidence, appraising the evidence, applying the evidence to clinical practice, and assessing effectiveness [2]. While evidence-based practice is encouraged, physical therapists (particularly those working in low-resource countries) often experience barriers that can impede the use of evidence to guide practice. A recent large-scale systematic review revealed that institutional barriers (scant resources, limited access to information, inadequate staffing, and lack of institutional support) were particularly problematic for clinicians (nurses) working in low- and middle-income countries [3]. This symposium will explore the barriers to using evidence to guide practice encountered by physical therapists, particularly those working in low-resource countries. A range of solutions to address these barriers will be considered, with a focus on accessing high-quality clinical research.
Strategies to tackle the institutional barriers include using open-access evidence resources, particularly those that efficiently direct you to high-quality evidence and that pre-appraise research quality. The Physiotherapy Evidence Database (PEDro) [4] and Diagnostic Test Accuracy (DiTA) [5] are two physical therapy-specific resources.
Engaging in open-access and evidence-based continuing professional development will also facilitate access to high-quality evidence. The massive open online courses delivered by the International Spinal Cord Society [6] and Physiopedia [7] have reached thousands of physical therapists globally.
Accessing full-text research articles is a substantial barrier globally, and particularly in low-resource countries [8,9]. The Hinari initiative from the World Health Organisation provides free access to journals from several publishers for people in low- and middle-income countries [10]. Other strategies to be discussed include open-access publishing and pdf-retrieval web-sites.

Implications/conclusions: Developing skills in recognising challenges inherent in evidence-based practice and learning how to apply solutions will improve physical therapists' ability to access high-quality clinical research to guide their management of individual patients.
[1] Herbert R et al. Practical evidence-based physiotherapy (2nd Ed). Edinburgh: Churchill Livingstone; 2011.
[2] Guyatt G et al. Users' guides to the medical literature: a manual for evidence-based clinical practice. New York: McGraw-Hill Education; 2015.
[3] Shayan SJ et al. Barriers associated with evidence-based practice among nurses in low- and middle-income countries: a systematic review. Worldviews Evid Based Nurs 2019;16(1):12-20.
[4] Moseley AM et al. Using research to guide practice: the Physiotherapy Evidence Database (PEDro). Braz J Phys Ther 2019 Nov 30:Epub ahead of print
[5] Kaizik MA et al. DiTA: a database of diagnostic test accuracy studies for physiotherapists. J Physiother 2019;65(3):119-20
[6] International Spinal Cord Society. Spinal cord injuries massive open online course., accessed 16 Jan 2020.
[7] Physiopedia. Open online courses., accessed 16 Jan 2020.
[8] Sadeghi-Bazargani H et al. Barriers to evidence-based medicine: a systematic review. J Eval Clin Pract 2014;20(6):793-802
[9] LaGrone LN et al. A global assessment of access to and use of medical information: the state of evidence-based surgery. World J Surg 2018;42(2):521-31
[10] World Health Organisation. Hinari Research for Health., accessed 16 Jan 2020.
Key-words: 1. Evidence-based physical therapy 2. Low-resource countries 3. Continuing professional development

Funding acknowledgements: Nil

All authors, affiliations and abstracts have been published as submitted.

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