Evidence-Based Practice: Einstellungen, Kompetenzen und Barrieren bei Ergo- und Physiotherapeuten

[Adherence to and influencing factors of evidence-based practice in physiotherapeutic care in Germany: a cross-sectional study]

BACKGROUND

The implementation of evidence-based practice (EBP) is a central goal in health care. As in other areas, the transfer of scientific knowledge into clinical practice is very delayed or incomplete in physiotherapy. The primary aim of the present study is to describe the adherence to EBP among physiotherapists working in Germany. The secondary goal is the exploratory analysis of selected factors influencing the implementation of EBP.

METHODS

The present exploratory analysis is based on the data of physiotherapists who participated in a cross-sectional study on the use of EBP by health care professionals (study registration no.: DRKS00013792). The participants in the online survey completed the "Evidence-based Practice Inventory", a questionnaire with five dimensions used to quantify the adherence to EBP. Univariable and multivariable regression analysis was used to examine the associations between various sociodemographic characteristics and EBP.

RESULTS

318 physiotherapists participated in the survey (age: 37±12 years; 60 % female; professional experience: 14±11 years). Approximately 70-80 % of the participants, in principle, had a positive attitude towards EBP and perceived EBP as helpful and useful in clinical practice. About 60 % of the respondents felt able to apply the principles of the EBP (e. g., acquisition, appraisal and application of external evidence). However, the data also showed that the implementation of EBP in clinical physiotherapeutic care is insufficient. For example, only 20 % of the respondents reported that their facility paid great attention to applying the principles of the EBP in decision-making, and only about a third of the respondents said that they frequently searched for or used external evidence. The strongest facilitators of EBP include the participation in scientific publications and more than one hour per week to read scientific literature at work.

CONCLUSION

In principle, physiotherapists in Germany have a positive attitude towards EBP, but currently do not adequately take into account the principles of EBP. These factors should be further analyzed and targeted through effective interventions.

Barrieren und Förderfaktoren in der evidenzbasierten Praxis (EBP) der Physiotherapie – Eine Bestandsaufnahme und Eruierung von Barrieren und Förderfaktoren zur Anwendung von EBP mit Physiotherapeut*innen der deutschsprachigen Schweiz

Hintergrund Die Akademisierung der Gesundheitsberufe führte in der Physiotherapie zu einem Wechsel von primär erfahrungsbasiertem zu evidenzbasiertem Arbeiten. Obwohl das Konzept der evidenzbasierten Praxis (EBP) in der Physiotherapie weitgehend akzeptiert ist, zeigen sich Probleme bei der Umsetzung in die Praxis.

Ziel Identifikation potentieller Barrieren und unterstützender Faktoren für die Umsetzung der evidenzbasierten Praxis in der Physiotherapie.

Methode Anhand eines Onlinefragebogens mit 49 Fragen wurden Physiotherapeut*innen (n = 138) zur evidenzbasierten Praxis befragt. Die Resultate des Fragebogens wurden deskriptiv wiedergegeben.

Ergebnisse Physiotherapeut*innen mit Masterabschluss arbeiten im Arbeitsalltag evidenzbasierter als Physiotherapeut*innen mit anderen Abschlüssen und zeigen eine höhere Bereitschaft, evidenzbasierte Praxis anwenden zu wollen. Unsicherheiten wurden vorwiegend beim Formulieren von Fragestellungen sowie bei der Suche und kritischen Bewertung von wissenschaftlichen Artikeln festgestellt. Eine Aus- oder Weiterbildung zur evidenzbasierten Praxis führt zu mehr Sicherheit bei deren Anwendung. Klinische Entscheidungswege basieren vorwiegend auf der eigenen Praxiserfahrung, dem Befinden von Patient*innen und auf Informationen aus Fachzeitschriften. Zeitmangel, sich während der Arbeit weiterzubilden, stellt die Hauptbarriere dar. Zusammengefasste Forschungsergebnisse publiziert auf einem evidenzbasierten Internetportal, per E-Mail-Versand oder in einer Fachzeitschrift sind die meistgenannten Förderfaktoren für die Anwendung evidenzbasierter Praxis.

Schlussfolgerung Fach- und Hochschulen sowie Arbeitgeber*innen spielen eine wichtige Rolle bei der Vermittlung von Kenntnissen und der Umsetzung von evidenzbasierter Praxis in der Physiotherapie.

[Translation of the evidence-based practice confidence (EPIC) scale into German and its cross-cultural adaption for Switzerland, Austria and Germany]

BACKGROUND

The Evidence-based Practice Confidence (EPIC) scale is a self-report questionnaire for health professionals. The EPIC scale was developed in Canada and is based on Bandura's self-efficacy theory. It comprises 11 statements on the organization and implementation of evidence-based practice (EBP) steps. The aim of the study was to translate the EPIC scale into German, to test its comprehensibility in German-speaking countries and to interculturally adapt the scale.

METHODS

The translation process followed international guidelines. After two independent translations into German and two independent back translations had been conducted, an expert committee discussed discrepancies in view of intercultural comprehensibility and agreed on a preliminary German version. The comprehensibility of this version was evaluated with physical therapists from Switzerland, Austria and Germany. They were recruited using purposeful sampling and interviewed via telephone using a semi-structured questionnaire (cognitive interviewing). The interviews were recorded and analyzed independently by two authors using a structured evaluation scheme. Based on these results, the final version was created. All changes were discussed with the author of the EPIC scale.

RESULTS

Sixteen physical therapists of the three German-speaking countries were interviewed. Demographic data showed a balanced distribution of country of origin, age group, qualification and years of work experience. In general, participants reported a good overall comprehensibility. However, they reported that (too) many scientific terms caused comprehension problems and that some of these terms were unknown to participants. During the intercultural adaptation attention was paid to simplify and shorten sentences and to paraphrase terms that were difficult to understand. Moreover, the instructions were expanded to address partial lack of knowledge of scientific terms.

CONCLUSION

The EPIC scale was successfully translated and interculturally adapted to the German language. The scale evaluates self-efficacy in EBP activities and could potentially be used to assess courses or be integrated into surveys. In the next step, the validity and reliability of the German scale should be established involving other health care professionals in this process.

Supporting evidence-based practice: Changes in service provision and practitioners’ attitudes following EBP Service Centre consultation – a qualitative study / Evidenzbasierte Praxis unterstützen: Veränderungen der Arbeitsweise und der Einstellungen von Ergotherapeuten/-innen durch die Nutzung eines EBP Service Centers - eine qualitative Studie

Evidence-based practice (EBP) aims at optimal fulfilment of clients´ needs, but also plays an essential role in establishing an effective and efficient health care system. It is no longer a question whether EBP is essential and valued, but rather how to sustainably implement it into clinical practice. A new implementation strategy of an EBP workshop in combination with a CAT (critically appraised topic) service was established and investigated.

The aim of this study was to explore post EBP Service Centre consultation effects regarding occupational therapists’ changes in service provision, professional viewpoints and attitudes and job satisfaction. The second aim was receiving feedback on the EBP Service Centre for its further development.

For the evaluation of the EBP Service Centre the qualitative approach of content analysis by Gläser and Laudel was chosen. Two focus group discussions with 13 participants were conducted.

The combination of an EBP workshop and a CAT service, as provided by the EBP Service Centre, seems to be an effective tool to facilitate EBP implementation. The service was used intensively. Participants reported changes in service provision, e.g. increased client-centredness and occupation-based practice and changed professional attitudes like increased reflection and critical questioning.

A division of resources and strengths between research staff and practitioners seems to be reasonable. Hence research staff takes over literature search and appraisal and produces CATs, whereas practitioners focus on asking clinical questions and integrating the knowledge from the CAT into their clinical decisions.

Evidence-based practice in physical therapy in Austria: current state and factors associated with EBP engagement

RATIONALE, AIMS AND OBJECTIVES

Research examining the use of evidence-based practice (EBP) in physical therapy in many countries has revealed positive attitudes, varying degrees of EBP use and barriers at practitioner, patient and organizational levels. In contrast to these countries, Austria does not have an academic or research tradition in physical therapy. Engagement in EBP in countries such as Austria is unknown. The objectives of the study were to describe the current state of EBP engagement and identify factors associated with EBP engagement among Austrian physical therapists (PTs).

METHODS

A cross-sectional online survey was conducted. Existing questionnaires and the theory of planned behaviour guided questionnaire development. Face and content validity and ease of use of the questionnaire were evaluated in pilot tests. Item-level response frequencies and percentages were determined. Simple and multiple regressions were used to identify factors associated with EBP engagement.

RESULTS

The final sample size was 588 (response rate: 17.5%). Ten percent of participants fully agreed that they regularly use guidelines and standardized assessment tools in clinical practice. While 49.9% reported not using electronic databases for literature searching, 41.9% reported reading research articles 2-5 times per month. Most frequently cited barriers to EBP engagement were lack of scientific skills, lack of time and insufficient organizational support. Research awareness, attitude, behavioural control, involvement in research and degree level were final correlates of EBP engagement.

CONCLUSION

Austrian PTs show a low level of engagement in EBP. Initiatives to advance EBP in Austria and other countries with no academic or research tradition should primarily target practitioner-level factors.