The purpose of the study was to explore the barriers and enablers Australian exercise physiologists and physiotherapists face in implementing EBP for CLBP. Identifying these factors may inform strategies to improve patient care quality.
Forty clinicians (20 physiotherapists and 20 accredited exercise physiologists) participated in the study. Clinicians completed an online pre-interview questionnaire through Qualtrics (Version XM), which gathered data about clinician demographics, continuing professional development, biomedical/biopsychosocial beliefs, and two vignettes. Data were analysed using descriptive statistics. The study’s research question was addressed through a critical realist ontological perspective and a constructivist epistemology. Semi-structured interviews were conducted online via Zoom (Version 5.15.7 (21404)). The interviews explored clinicians' definition of EBP, understanding of EBP in the context of CLBP management, barriers, enablers, and their impact on EBP implementation. Data analysis was conducted using the 6-stage reflexive thematic analysis approach on Nvivo (Version 12). Analysis followed an iterative process, including re-visiting transcripts, generating and reanalysing codes, and creating and reviewing themes.
A complex interplay among clinician factors, systemic factors, and patient interactions was identified. Clinicians encountered challenges stemming from their misconceptions about EBP, which influenced their perspective(s) on its implementation. Clinicians expressed the challenges of implementing EBP when navigating patient expectations and beliefs, experiencing external pressures from funders and business models, and the subsequent impacts on their well-being. Continuing professional development, support from community, and workplaces that prioritised EBP enhanced clinicians’ ability to make decisions that accommodate for the complexities of CLBP and better align with EBP.
A variety of factors and their interconnected dynamics impact exercise physiologists and physiotherapists implementation of EBP. Similarities in these factors between the two professions suggest systemic influences outweigh profession-specific influences. To adequately improve the implementation of EBP, both clinician factors and deeper systemic factors must be addressed. Future research may look at combining relevant theories and frameworks, such as the Consolidated Framework for Implementation Research, to help inform intervention strategies aimed at improving Australian exercise physiologists and physiotherapists’ EBP implementation for people with CLBP.
The interplay between clinician, patient, and systemic factors highlights the need for a combined approach to implementing EBP in CLBP management. To improve EBP implementation, reforms at the structural level—such as longer consultation times, flexible funding models, and reducing administrative burdens—are essential. Clinicians are well-positioned to identify practical issues in EBP implementation, and by fostering environments that encourage education, feedback, and reflection, healthcare institutions, researchers, and policymakers can involve clinicians in discussions to enhance EBP at multiple levels. Policymakers and healthcare funders play a crucial role in facilitating EBP adoption such as by adjusting reimbursement models to prioritise evidence-based treatments.
exercise-based clinician
chronic low back pain
