Reference: Paci M, Raedda G, Ugolini A, Pellicciari L. Barriers to evidence-based practice implementation in physiotherapy: a systematic review and meta-analysis. International Journal for Quality in Health Care. 2021;33(2).
Abstracted by: David Ryland, PT, DPT, OCS, COMT, Anchorage, Alaska – Fellowship Candidate, IAOM-US Fellowship Program & Jean-Michel Brismée, PT, ScD, Fellowship Director, IAOM-US Fellowship program.
Context: It has been proposed that evidence-based practice is the gold standard in which physiotherapists should practice. There are several barriers that limit the clinicians from being able to practice with the most up-to-date research.
Objective: The purpose of the study was to quantitatively, using pooled data, identify the prevalence of barriers towards evidence-based practice (EBP) in physiotherapy, specifically between developed versus developing countries.
Type of Review: Systematic review and meta-analysis
Methods: Two independent investigators performed an online search in EMBASE, PubMed, Scopus, Web of Science and CINAHL databases from their inception to July 2020. Included articles were surveys that explored barriers to EBP among physiotherapists that were published in English or Italian. Any disagreements between the two investigators were resolved by a third investigator for both inclusion criteria and methodological quality assessment. The meta-analysis assessed the frequency in which each barrier was reported. Further sub-analyses investigated whether the surveys were performed in developed versus developing countries. Twenty-nine articles were deemed appropriate for this paper.
Details of Paper: Surveys have been distributed worldwide to physiotherapists regarding barriers to EBP. Twenty-nine articles were selected, which included 9337 participants. Fifteen of these studies were considered from developed countries and the remaining fourteen were from developing countries. Specific challenges to EBP include lack of time, resources, support, generalizability, language, interest, and education. The meta-analysis utilized a pooled prevalence with a 95% confidence interval of each barrier. Time, skills, interest, and statistical skills were the only barriers that were significant (P = < 0.05).
Main Outcomes: Over 50% of the responders in the surveys noted that lack of time was reported despite whether they were from a developed or developing country. This same number in developing countries only reported that there was language barrier and that the articles were not translated into their native language. One-third of the respondents in the surveys stated that lack of access, lack of research skills, and inability to understand statistical data. The inability to access literature was another barrier to EBP. Frequently, the lack of generalizability of the research was also a barrier.
Application: The main barriers were rooted in organizational and educational settings. Thus, managers in the clinical setting, university faculty, and continuing education companies can all help encourage a deeper understanding and implementation of EBP. Researchers can also focus on pragmatic clinical studies to allow for higher generalizability to clinicians.
Conclusions: Time, availability of resources and skills in being able to read and interpret research are the primary barriers to performing EBP in physiotherapy clinics. Organizations should enhance the opportunities for their employees to partake in to improve their ability to apply quality evidence into their practice. In developing countries, an emphasis on enhancing the opportunities to learn the skills needed to read, interpret, and apply research is necessary. The authors do warn of high heterogeneity of all analyses and that the readers should take caution.
Clinical Relevance: The information gleaned from this study is that it does not matter whether the clinician is in a developed country or a developing country, there are barriers that limit clinicians from utilizing EBP in their daily lives. The limitation of time is one of the primary barriers to EBP. In a culture where productivity is one of the major criteria for how clinicians are performing their job and the depth in which documentation must be written to get paid by insurance companies, it adds significant pressure to the clinicians. This may be one of the reasons the burnout rate of physiotherapists in the United States is approximately 50%.1 As new clinicians are graduating from rigorous physical therapy programs and starting their careers, a healthy work-life balance is highly important to them to reduce the risk of burnout in the future. Due to the high amount of pressure from management for seeing more patients, it likely limits the amount of time that clinicians sit down and scrutinize the literature. One method in which this can be reduced is with weekly journal clubs with colleagues. With the immense amount of research that is being published it can be overwhelming to clinicians struggling where to start looking for information, especially those who do not possess the skills required for reading, interpreting, and applying research. Unless the clinician works in an academic setting, gaining access to specific articles can be major challenge.
Content Consistency: The content in the article offered a different perspective on why individuals may not practice with EBP. My Western education has always had an emphasis on the importance of EBP and I had classes and opportunities to acquire these skills.
References:
- Pugliese M, Brismée JM, Allen B, Riley S, Tammany J, Mintken P. Mentorship and self-efficacy are associated with lower burnout in physical therapists in the United States: a cross-sectional survey study. J Educ Eval Health Prof. 2023;20.27. doi:10.3352/jeehp.2023.20.27