OVERCOMING BARRIERS TO EVIDENCE-BASED CLINICAL PRACTICE
M. Elkins1, T.P. Yamato2, L.K. Kwah3,4, V.S. Paramanandam5,6, J.F. Meneses-Echávez7
All authors, affiliations and abstracts have been published as submitted.
1University of Sydney, Faculty of Medicine & Health, Sydney, Australia, 2Universidade Cidade de São Paulo (UNICID), Physical Therapy Masters/Doctoral Program, São Paulo, Brazil, 3Singapore Institute of Technology, Division of Physiotherapy, Singapore, Singapore, 4Singapore Physiotherapy Association, Singapore, Singapore, 5Tata Memorial Hospital, Mumbai, India, 6University of Melbourne, Melbourne, Australia, 7Norwegian Institute of Public Health, Division of Health Services, Oslo, Norway
Learning objective 1: Recognise that much of physiotherapy clinical practice is not informed by evidence
Learning objective 2: Understand the common barriers to evidence-based physiotherapy
Learning objective 3: Learn practical ways to overcome the most-common barriers to evidence-based physiotherapy
Description: Evidence-based practice involves integrating the best research evidence with clinical expertise and patient values [1], while considering the local context (eg, national healthcare system) and organisational factors (eg, resources) [2]. Although physiotherapists typically have a positive attitude towards evidence-based practice [3], their clinical practice is often not informed by evidence [4,5]. This situation is not improving with time [6].
In 2021, a systematic review identified the barriers to the implementation of evidence-based practice in physiotherapy [7]. The most-common barriers were: time to find and appraise the evidence; skills to find, recognise and apply the best available evidence; access to the evidence and other resources; and language of the publications, the search interface and other resources.
The four speakers in this symposium will each address one of those four barriers to evidence-based practice by briefly describing the ways in which it hampers physiotherapists' ability to achieve evidence-based practice and then by reviewing in detail a wide range of practical (and usually free) strategies and resources to tackle that barrier.
Time: Associate Professor Yamato will discuss: improving the efficiency of searching using physiotherapy-specific databases such as DiTA; reading condensed and high-quality evidence first; signing up to auto-alerts; reading high-quality summary appraisals of published research; automated quality rating tools such as RobotReviewer; sharing the load by joining a journal club; negotiating dedicated time to search for evidence; and focusing on the most common conditions in your caseload.
Skills: Associate Professor Kwah will describe resources to help physiotherapists improve their skills at: finding evidence that is relevant to their clinical practice, identifying the best quality evidence from amongst what is available, interpreting the clinical relevance of the study’s findings, and applying that evidence to their patients through shared-decision making. Resources discussed include: online videos such as PEDro’s YouTube channel; research blogs such as S4BE, ‘explainer’ papers such as theBMJStatistics Notes; online training in quality scales; the World Wide Journal Club; initiatives by education/research committees of national physiotherapy associations; and pre/post-congress workshops.
Access: Dr. Paramanandam will present strategies by which clinical physiotherapists in international contexts can increase their access to evidence and to other resources. These include: awareness of increasing open-access published evidence in physiotherapy [8]; increased range of links to full text on PEDro; other strategies for locating free full-text; and specific initiatives to assist physiotherapists in low- and middle-income countries to access evidence.
Language: Mr. Meneses-Echávez will discuss examples where the published evidence is being made available in more than one language (eg, Cochrane) and where search interfaces are being made available in more than one language (eg, PEDro). The availability of numerous other resources in a range of languages (eg, PEDro’s YouTube channel, Critically Appraised Papers, online training in quality rating scales, S4BE blog posts) will also be reviewed. Free translation options will also be discussed.
In conclusion, it is important that physiotherapists strive to increase the extent to which their management of patients is informed by evidence. The implication of this focused symposium is that clinical physiotherapists should use the strategies and resources described in this session to improve their capacity to achieve evidence-based practice.
In 2021, a systematic review identified the barriers to the implementation of evidence-based practice in physiotherapy [7]. The most-common barriers were: time to find and appraise the evidence; skills to find, recognise and apply the best available evidence; access to the evidence and other resources; and language of the publications, the search interface and other resources.
The four speakers in this symposium will each address one of those four barriers to evidence-based practice by briefly describing the ways in which it hampers physiotherapists' ability to achieve evidence-based practice and then by reviewing in detail a wide range of practical (and usually free) strategies and resources to tackle that barrier.
Time: Associate Professor Yamato will discuss: improving the efficiency of searching using physiotherapy-specific databases such as DiTA; reading condensed and high-quality evidence first; signing up to auto-alerts; reading high-quality summary appraisals of published research; automated quality rating tools such as RobotReviewer; sharing the load by joining a journal club; negotiating dedicated time to search for evidence; and focusing on the most common conditions in your caseload.
Skills: Associate Professor Kwah will describe resources to help physiotherapists improve their skills at: finding evidence that is relevant to their clinical practice, identifying the best quality evidence from amongst what is available, interpreting the clinical relevance of the study’s findings, and applying that evidence to their patients through shared-decision making. Resources discussed include: online videos such as PEDro’s YouTube channel; research blogs such as S4BE, ‘explainer’ papers such as theBMJStatistics Notes; online training in quality scales; the World Wide Journal Club; initiatives by education/research committees of national physiotherapy associations; and pre/post-congress workshops.
Access: Dr. Paramanandam will present strategies by which clinical physiotherapists in international contexts can increase their access to evidence and to other resources. These include: awareness of increasing open-access published evidence in physiotherapy [8]; increased range of links to full text on PEDro; other strategies for locating free full-text; and specific initiatives to assist physiotherapists in low- and middle-income countries to access evidence.
Language: Mr. Meneses-Echávez will discuss examples where the published evidence is being made available in more than one language (eg, Cochrane) and where search interfaces are being made available in more than one language (eg, PEDro). The availability of numerous other resources in a range of languages (eg, PEDro’s YouTube channel, Critically Appraised Papers, online training in quality rating scales, S4BE blog posts) will also be reviewed. Free translation options will also be discussed.
In conclusion, it is important that physiotherapists strive to increase the extent to which their management of patients is informed by evidence. The implication of this focused symposium is that clinical physiotherapists should use the strategies and resources described in this session to improve their capacity to achieve evidence-based practice.
References: [1] Herbert R, Jamtvedt G, Hagen KB, Elkins MR.Practical Evidence-Based Physiotherapy (3rd edition). 2022: Elsevier; London.
[2] Dawes M, et al. Sicily statement on evidence-based practice.BMC Med Educ 2005; 5: 1.
[3] Jette DU, et al. Evidence-based practice: beliefs, attitudes, knowledge, and behaviors of physical therapists.Phys Ther. 2003; 83: 786–805.
[4] Zadro JR, et al. What interventions do physical therapists provide for patients with cardiorespiratory conditions, neurological conditions, and conditions requiring acute hospital care? A Systematic Review.Phys Ther. 2020; 100(7): 1180–1205.
[5] Zadro J, et al. Do physical therapists follow evidence-based guidelines when managing musculoskeletal conditions? Systematic review.BMJ open. 2019; 9: e032329.
[6] Zadro JR, et al. Has physical therapists’ management of musculoskeletal conditions improved over time?Braz J Phys Ther. 2020; 24: 458–462.
[7] Paci M, et al. Barriers to evidence-based practice implementation in physiotherapy: a systematic review and meta-analysis.Int J Qual Health Care. 2021; 33: 1–13.
[8] Moseley AM, et al. The Physiotherapy Evidence Database (PEDro) has better free full-text access than PubMed: An observational study. Braz J Phys Ther. 2020; 26: 100392.
[2] Dawes M, et al. Sicily statement on evidence-based practice.BMC Med Educ 2005; 5: 1.
[3] Jette DU, et al. Evidence-based practice: beliefs, attitudes, knowledge, and behaviors of physical therapists.Phys Ther. 2003; 83: 786–805.
[4] Zadro JR, et al. What interventions do physical therapists provide for patients with cardiorespiratory conditions, neurological conditions, and conditions requiring acute hospital care? A Systematic Review.Phys Ther. 2020; 100(7): 1180–1205.
[5] Zadro J, et al. Do physical therapists follow evidence-based guidelines when managing musculoskeletal conditions? Systematic review.BMJ open. 2019; 9: e032329.
[6] Zadro JR, et al. Has physical therapists’ management of musculoskeletal conditions improved over time?Braz J Phys Ther. 2020; 24: 458–462.
[7] Paci M, et al. Barriers to evidence-based practice implementation in physiotherapy: a systematic review and meta-analysis.Int J Qual Health Care. 2021; 33: 1–13.
[8] Moseley AM, et al. The Physiotherapy Evidence Database (PEDro) has better free full-text access than PubMed: An observational study. Braz J Phys Ther. 2020; 26: 100392.
Funding acknowledgements: Nil
All authors, affiliations and abstracts have been published as submitted.
