Promoting physical therapists' of research evidence to inform clinical practice: part 1--theoretical foundation, evidence, and description of the PEAK program

Clinical Instructor's Self-reported Modeling of Evidence-Based Practice During Student Clinical Experience

INTRODUCTION

Having clinical instructors (CIs) model evidence-based practice (EBP) may enhance physical therapist student engagement in the EBP process and learning. However, the extent of EBP modeling by CIs at present is not known. The purpose of this survey was to assess the modeling of EBP by CIs during physical therapist student clinical education experiences (CEs).

REVIEW OF LITERATURE

The literature focuses on the impact of CIs on the students including the significance of CIs modeling behaviors for students during a CE. Not much is known about if EBP concepts are modeled by the CIs during the CE.

SUBJECTS

Three hundred and eight CIs affiliated with the Physical Therapist program.

METHODS

A 37-item anonymous e-survey that included CI demographic data, questions about EBP modeling by CI during CEs, and resources and policies surrounding the use of EBP in the clinical setting.

RESULTS

The results of this survey indicate that CIs' modeling of EBP varies by domain. CIs successfully model EBP by asking relevant clinical questions and acquiring relevant literature. The modeling of critical appraisals and the use of EBP metrices during the diagnostic and intervention planning were not done by most CIs.

DISCUSSION AND CONCLUSION

It is important that CIs model the use of EBP concepts during a physical therapist student's CE to develop future evidence-based practitioners. However, this modeling may be limited by CIs' familiarity with EBP. The results of this survey indicate an uneven modeling of EBP concepts, with certain domains being modeled more than the others. The findings of the survey may be used to develop refresher/reference materials specifically designed for busy CIs.

Development and Implementation of an Evidenced-Based Practice (EBP) Educational Program for a Multidisciplinary Rehabilitation Department

OBJECTIVE

Describe the development and implementation of an evidence-based practice (EBP) training program for occupational and physical therapists in a large pediatric hospital.

CONTEXT

EBP is valued, but a known knowledge-to-practice gap between academic training and clinical practice limits routine use. This gap was addressed through an academic-clinical partnership to develop an EBP training program.

RESULTS

Sixty-one therapists completed the program. Therapists demonstrated improved EBP skills, knowledge, and confidence following training and a positive trend in change score for clinical outcomes and decision-making scores was noted.

CONCLUSION

Academic-clinical partnerships have a unique and valuable role to support professional EBP knowledge and skill development. Stakeholder support and engagement supported program development, execution, and meaningful outcomes.

IMPACT STATEMENT

The knowledge-to-practice gap for EBP is a challenge to regular EBP use. The described program addressed this challenge and improved therapists' knowledge, skills, and confidence. It provides a model for professional development.

Rehabilitation professions' core competencies for entry-level professionals: a thematic analysis

Rehabilitation services are essential interventions designed to optimize functioning and reduce disability in individuals with health conditions. Eight core professions offer rehabilitation services: audiology, occupational therapy, physical and rehabilitation medicine, physiotherapy, psychology, prosthetics and orthotics, rehabilitation nursing, and speech-language pathology. These professions often work together to provide patient-centered care. Each rehabilitation profession has developed its own international or national document to describe entry-level competencies. However, it is not evident in the literature whether rehabilitation professions share the same core competencies. Therefore, we explored the international standards for rehabilitation professions to identify commonalities and differences in entry-level professionals' required core competencies. A thematic analysis of current, published, international, or national entry-level competencies documents was conducted to determine commonalities and differences in the core competence requirements for the eight rehabilitation professions. The following four themes were evident across all professions: (a) evidence-based clinical practice knowledge and skills; (b) culturally competent communication and collaboration; (c) professional reasoning and behaviors; and (d) interprofessional collaboration. This thematic analysis highlighted the commonalities among rehabilitation professionals and may be used to provide a greater understanding of how rehabilitation professionals can support and work together on interprofessional teams.

Evidence-based practice confidence and behavior throughout the curriculum of four physical therapy education programs: a longitudinal study

BACKGROUND

Evidence-based practice (EBP) is a foundational process taught in health professional education, yet it is unclear when EBP confidence and skills are obtained. Increases in EBP confidence and behaviors from the start of physical therapy programs to post graduation have been reported in studies that evaluated a single program or used non-valid questionnaires. This study aimed to describe changes in EBP confidence and behavior using validated questionnaires of students from four physical therapy education programs throughout their curriculum and one year post graduation.

METHODS

One hundred and eighty-one students from a potential pool of 269 (67.3%) consented to participate. Students completed the Evidence-Based Practice Confidence (EPIC) Scale and the Evidence-Based Practice Implementation Scale (EBPIS) at 6 timepoints: start of the program, prior to first clinical experience, after first clinical experience, at the end of classroom instruction, graduation, and one year post. Medians (Mdn) and 25th and 75th percentiles (P25, P75) were calculated for 42 (23.2%) students with complete data across all timepoints. Change between timepoints was assessed using Friedman's test and Wilcoxon signed rank test with a Bonferroni correction for post hoc analysis.

RESULTS

There were significant changes in EPIC scores (p < 0.001) from enrollment (Mdn 50.0, P25, P75 35.5, 65.9) to prior to first clinical experience (Mdn 65.5, P25, P75 57.3, 72.5) and after the first clinical experience (Mdn 67.3, P25, P75, 58.9, 73.2) to the end of classroom instruction (Mdn 78.6, P25, P75, 72.0, 84.1). Significant increases on the EBPIS (p < 0.01) were only seen from after the first year of training (Mdn 15, P25, P75, 10.0, 22.5) to end of the first clinical experience (Mdn 21.5, P25, P75 12.0, 32.0).

CONCLUSIONS

EBP confidence increased significantly after classroom instruction but remained the same after clinical experiences and at one year post graduation. EBP behavior significantly increased only after the first clinical experience and remained the same through graduation. Confidence and behavior scores were higher than were previously reported in practicing professionals. Ongoing assessment of EBP confidence and behavior may help instructors build appropriate curricula to achieve their outlined EBP objectives.

Accelerating the Implementation of Evidence-Based Practice in Physical Medicine and Rehabilitation

Over the last three decades, a substantial number of studies were published with the purpose of improving the effectiveness and efficiency of rehabilitation clinical practice. Clinicians and researchers face considerable challenges in successfully implementing these research findings into routine clinical practice. Knowledge translation includes the synthesis, dissemination, exchange and ethically sound application of knowledge to improve health, provide more effective health services and products, and strengthen the healthcare system. An aim of knowledge translation research is to identify strategies to accelerate implementation of evidence into practice. A recent citation analysis on a commonly used knowledge translation framework, the Knowledge-to-Action Framework, identified implementation activities performed in physical medicine and rehabilitation. While this citation analysis describes activities performed and outcomes assessed while conducting knowledge translation projects, successful knowledge translation also requires a robust social and physical infrastructure. In this commentary, we offer several observations that appear related to the increased likelihood of implementation success. Funders, higher education institutions, healthcare payers, and healthcare organizations contribute to successful implementation and must embrace their roles in implementation. Administrators, clinicians, and consumers of physical medicine and rehabilitation also have essential roles in knowledge translation.

Knowledge Translation Research to Promote Behavior Changes in Rehabilitation: Use of Theoretical Frameworks and Tailored Interventions: A Scoping Review

OBJECTIVE

To describe knowledge translation (KT) research as a means of changing practice behaviors in rehabilitation. We specifically aimed to explore how theories, models, and frameworks (TMFs) are used to guide KT, guide methods to tailor KT interventions, and evaluate outcomes. We hypothesized these methods would have increased over the past 10 years.

DATA SOURCES

We identified articles through searches conducted using databases Cumulative Index to Nursing and Allied Health, MEDLINE, PubMed, Academic Search Premier, and previous reviews from January 2000 to April 2020. Search terms included physical therapy, occupational therapy, speech-language pathology, knowledge translation, and knowledge-to-action (KTA).

STUDY SELECTION

Two authors interpedently screened titles, abstracts, and full-text articles. Studies were included if behavior change of rehabilitation practitioners was measured. Systematic reviews, protocols, and capacity-building interventions were excluded.

DATA EXTRACTION

Three authors extracted information on study design, theoretical frameworks, intervention strategies, and outcome evaluation.

DATA SYNTHESIS

Fifty-six studies were included in the review. Sixteen (29%) reported the use of a theoretical framework to guide the KT process. Since 2013, the KTA framework was used 35% of the time. Twenty-two studies (39%) reported barrier assessments to tailor interventions, and 82% were published after 2013. However, barrier assessment in the local context was only conducted 64% of the time. Outcomes of tailored interventions were most frequently measured using chart audits (50%) and questionnaires (41%). Further, the link between KT theory, specific barriers, and selection of intervention strategies was not consistently described.

CONCLUSIONS

Over the past 7 years, there has been an increase in the use of KT TMFs and tailored interventions. Recommendations for future research include the use of TMFs to guide local barrier assessment, KT strategy selection, intervention development, and overall KT process and mapping barriers to selected intervention strategies.

Knowledge Translation in Physical Medicine and Rehabilitation: A Citation Analysis of the Knowledge-to-Action Literature

OBJECTIVES

To (1) provide an overview of the use of the Knowledge-to-Action Cycle (KTA) to guide a clinical implementation project; (2) identify activities performed in each phase of the KTA; and (3) provide suggestions to improve KTA activities in physical medicine and rehabilitation.

DATA SOURCES

Google Scholar and PubMed were searched through December 31, 2019.

STUDY SELECTION

Two reviewers screened titles, abstracts, and full-text articles to identify published studies that used the KTA to implement a project.

DATA EXTRACTION

Two reviewers examined full-text articles. Data extraction included activities performed in each phase of the KTA, including measurements used to evaluate the project's effectiveness.

DATA SYNTHESIS

Commonly performed KTA activities were identified and country of study, area of rehabilitation, and other factors related to the use of the KTA in rehabilitation were described. A total of 46 articles that met the study's inclusion criteria provided an overview of the use of the KTA in rehabilitation. Strengths and weaknesses of the articles are discussed and recommendations for improved KTA use are provided.

CONCLUSIONS

Implementation of evidence-based practice requires focused engineering and efforts. This review provides an overview of the knowledge translation activities occurring in physical medicine and rehabilitation and considerations to improve knowledge translation research and practice.

Changes in physiotherapists' perceptions of evidence-based practice after a year in the workforce: A mixed-methods study

BACKGROUND

Few studies have explored evidence-based practice (EBP) knowledge, attitudes and behaviours of health professional graduates transitioning into the workforce. This study evaluated changes in these EBP domains in physiotherapists after one year of working.

METHOD

A mixed methods design was used. Participants completed two psychometrically-tested EBP questionnaires at two timepoints. The Evidence-Based Practice Profile questionnaire collected self-report EBP data (Terminology, Relevance, Confidence, Practice, Sympathy) and the Knowledge of Research Evidence Competencies collected objective data (Actual Knowledge). Changes were calculated using descriptive statistics (paired t-tests, 95% CI, effect sizes). Qualitative interview data collected at one timepoint were analysed using a descriptive approach and thematic analysis, to examine the lived experience of participants in the context of their first employment. The aim of the mixed methods approach was a broader and deeper understanding of participants' first year of employment and using EBP.

RESULTS

Data were analysed from 50 participants who completed both questionnaires at the two timepoints. After one year in the workforce, there was a significant decrease in participants' perceptions of Relevance (p<0.001) and Confidence with EBP (p<0.001) and non-significant decreases in the other domains. Effect sizes showed medium decreases for Relevance (0.69) and Confidence (0.57), small decreases in Terminology (0.28) and Practice (0.23), and very small decreases in Sympathy (0.08) and Actual Knowledge (0.11). Seven themes described participants experience of using EBP in their first working year.

CONCLUSIONS

After a year in the workplace, confidence and perceptions of relevance of EBP were significantly reduced. A subtle interplay of features related to workplace culture, competing demands to develop clinical skills, internal and external motivators to use EBP and patient expectations, together with availability of resources and time, may impact early graduates' perceptions of EBP. Workplace role models who immersed themselves in evidence discussion and experience were inspiring to early graduates.

The use of the PARIHS framework in implementation research and practice-a citation analysis of the literature

BACKGROUND

The Promoting Action on Research Implementation in Health Services (PARIHS) framework was developed two decades ago and conceptualizes successful implementation (SI) as a function (f) of the evidence (E) nature and type, context (C) quality, and the facilitation (F), [SI = f (E,C,F)]. Despite a growing number of citations of theoretical frameworks including PARIHS, details of how theoretical frameworks are used remains largely unknown. This review aimed to enhance the understanding of the breadth and depth of the use of the PARIHS framework.

METHODS

This citation analysis commenced from four core articles representing the key stages of the framework's development. The citation search was performed in Web of Science and Scopus. After exclusion, we undertook an initial assessment aimed to identify articles using PARIHS and not only referencing any of the core articles. To assess this, all articles were read in full. Further data extraction included capturing information about where (country/countries and setting/s) PARIHS had been used, as well as categorizing how the framework was applied. Also, strengths and weaknesses, as well as efforts to validate the framework, were explored in detail.

RESULTS

The citation search yielded 1613 articles. After applying exclusion criteria, 1475 articles were read in full, and the initial assessment yielded a total of 367 articles reported to have used the PARIHS framework. These articles were included for data extraction. The framework had been used in a variety of settings and in both high-, middle-, and low-income countries. With regard to types of use, 32% used PARIHS in planning and delivering an intervention, 50% in data analysis, 55% in the evaluation of study findings, and/or 37% in any other way. Further analysis showed that its actual application was frequently partial and generally not well elaborated.

CONCLUSIONS

In line with previous citation analysis of the use of theoretical frameworks in implementation science, we also found a rather superficial description of the use of PARIHS. Thus, we propose the development and adoption of reporting guidelines on how framework(s) are used in implementation studies, with the expectation that this will enhance the maturity of implementation science.

Twenty-five years after the introduction of Evidence-based Medicine: knowledge, use, attitudes and barriers among physiotherapists in Italy - a cross-sectional study

OBJECTIVES

To explore the knowledge, use, attitudes towards Evidence-based Medicine, also known as Evidence-based Practice (EBP), and perceived barriers to its dissemination among physiotherapists.

DESIGN

Cross-sectional study.

SETTING AND PARTICIPANTS

Members of the Italian Association of Physiotherapists (n=2000) were invited to participate in an online survey about EBP knowledge and use.

PRIMARY OUTCOME MEASURES

The survey questionnaire comprised four sections: (1) respondent characteristics; (2) knowledge of EBP principles; (3) attitude, use and perceived effectiveness of EBP; (4) perceived barriers to implementing EBP in clinical practice.

RESULTS

Out of 2000 physiotherapists, 1289 participated in the survey (64.5% response rate). Overall, 90% perceived EBP as useful and necessary for their clinical practice. More than 85% stated that they were familiar with the principles of EBP, 75% reported that they were able to search online databases for relevant information and 60% reported that they were able to understand statistical analyses. However, 56% believed that patient preferences and 39% that clinical expertise are not part of the EBP model. Half stated that they understood and could explain the term 'meta-analysis' but only 17% knew what a forest plot is and just 20% correctly judged the finding of a given meta-analysis. Lack of time was reported as the main barrier to EBP.

CONCLUSION

The majority of Italian physiotherapists overrated their knowledge about EBP, demonstrating a gap between perceived and actual knowledge of EBP in this population.

The impact of a small-group educational intervention for allied health professionals to enhance evidence-based practice: mixed methods evaluation

BACKGROUND

Healthcare professionals are recommended to use evidence-based practice (EBP) principles to update and improve clinical practice. Well-designed educational initiatives, together with practice and feedback opportunities can improve individuals' EBP knowledge, skills and attitudes.

METHODS

A concurrent mixed methods assessment was designed to evaluate the effectiveness and feasibility of four monthly workshops on allied health professionals' knowledge, skills, self-efficacy and behaviour. In between workshops, professionals were encouraged to practice and integrate EBP learnings with colleagues in their workplace. Participants completed three pre and post intervention assessments: Evidence-based Practice Confidence Scale; adapted Fresno test; and an adapted EBP Implementation Scale. A purpose designed satisfaction questionnaire was completed immediately after the educational intervention and follow up focus groups were conducted after 3 months. Mean change in assessment data was quantitatively assessed and comments from the clinician satisfaction questionnaire and focus groups were thematically analysed and interpreted together with quantitative data using the Classification Rubric for EBP Assessment tools in Education (CREATE).

RESULTS

Sixteen allied health professionals participated in the EBP workshops and completed all baseline and post intervention assessments. Seven clinicians participated in follow up focus groups. All clinicians reported a positive reaction to the learning experience, preferring short monthly workshops to a full day session. They self-reported improvements in self-efficacy (mean change 15 p < 0.001) and implementing EBP behaviours (mean change 7, p < 0.001) from pre- to post-intervention. Although the positive change in EBP knowledge measured by the adapted Fresno test was not statistically significant (mean change 10, p = 0.21), clinicians described examples of improved knowledge and skills across all five key steps of EBP during the focus groups. A further, post hoc analysis of individual questions in the two self-reported scales indicated consistent improvement across key EBP knowledge and skills.

CONCLUSIONS

A tailored small group EBP education intervention can enhance AHPs' self-efficacy to develop answerable questions, search the literature, critically appraise, apply and evaluate research evidence. Through practicing these behaviours and sharing new learning with their peers, allied health professionals can enhance their capability and motivation to use research evidence to potentially improve clinical practice.

Key components of knowledge transfer and exchange in health services research: Findings from a systematic scoping review

AIMS

To identify the key common components of knowledge transfer and exchange in existing models to facilitate practice developments in health services research.

BACKGROUND

There are over 60 models of knowledge transfer and exchange designed for various areas of health care. Many of them remain untested and lack guidelines for scaling-up of successful implementation of research findings and of proven models ensuring that patients have access to optimal health care, guided by current research.

DESIGN

A scoping review was conducted in line with PRISMA guidelines. Key components of knowledge transfer and exchange were identified using thematic analysis and frequency counts.

DATA SOURCES

Six electronic databases were searched for papers published before January 2015 containing four key terms/variants: knowledge, transfer, framework, health care.

REVIEW METHODS

Double screening, extraction and coding of the data using thematic analysis were employed to ensure rigour. As further validation stakeholders' consultation of the findings was performed to ensure accessibility.

RESULTS

Of the 4,288 abstracts, 294 full-text articles were screened, with 79 articles analysed. Six key components emerged: knowledge transfer and exchange message, Stakeholders and Process components often appeared together, while from two contextual components Inner Context and the wider Social, Cultural and Economic Context, with the wider context less frequently considered. Finally, there was little consideration of the Evaluation of knowledge transfer and exchange activities. In addition, specific operational elements of each component were identified.

CONCLUSIONS

The six components offer the basis for knowledge transfer and exchange activities, enabling researchers to more effectively share their work. Further research exploring the potential contribution of the interactions of the components is recommended.

Changes in physiotherapy students' knowledge and perceptions of EBP from first year to graduation: a mixed methods study

BACKGROUND

Dedicated Evidence-Based Practice (EBP) courses are often included in health professional education programs. It is important to understand the effectiveness of this training. This study investigated EBP outcomes in entry-level physiotherapy students from baseline to completion of all EBP training (graduation).

METHODS

Mixed methods with an explanatory sequential design. Physiotherapy students completed two psychometrically-tested health professional EBP instruments at baseline and graduation. The Evidence-Based Practice Profile questionnaire collected self-reported data (Terminology, Confidence, Practice, Relevance, Sympathy), and the Knowledge of Research Evidence Competencies instrument collected objective data (Actual Knowledge). Focus groups with students were conducted at graduation to gain a deeper understanding of the factors impacting changes in students' EBP knowledge, attitudes, behaviour and competency. Descriptive statistics, paired t-tests, 95% CI and effect sizes (ES) were used to examine changes in outcome scores from baseline to graduation. Transcribed focus group data were analysed following a qualitative descriptive approach with thematic analysis. A second stage of merged data analysis for mixed methods studies was undertaken using side-by-side comparisons to explore quantitatively assessed EBP measures with participants' personal perceptions.

RESULTS

Data were analysed from 56 participants who completed both instruments at baseline and graduation, and from 21 focus group participants. Large ES were reported across most outcomes: Relevance (ES 2.29, p ≤ 0.001), Practice (1.8, p ≤ 0.001), Confidence (1.67, p ≤ 0.001), Terminology (3.13, p ≤ 0.001) and Actual Knowledge (4.3, p ≤ 0.001). A medium ES was found for Sympathy (0.49, p = 0.008). Qualitative and quantitative findings mostly aligned but for statistical terminology, participants' self-reported understanding was disparate with focus group reported experiences. Qualitative findings highlighted the importance of providing relevant context and positive role models for students during EBP training.

CONCLUSIONS

Following EBP training across an entry-level physiotherapy program, there were qualitative and significant quantitative changes in participants' knowledge and perceptions of EBP. The qualitative and quantitative findings were mainly well-aligned with the exception of the Terminology domain, where the qualitative findings did not support the strength of the effect reported quantitatively. The findings of this study have implications for the timing and content of EBP curricula in entry-level health professional programs.

Attitudes, knowledge and behavior of Japanese physical therapists with regard to evidence-based practice and clinical practice guidelines: a cross-sectional mail survey

[Purpose] This study aimed to investigate Japanese physical therapists’ attitudes of evidence-based practice and clinical practice guidelines. [Subjects and Methods] In 2014, a cross-sectional postal mail survey using a self-administered questionnaire was conducted. Of 2,982 physical therapists belonging to the Chiba Prefecture Physical Therapist Association, 1,000 were randomly selected. The questionnaire comprised 42 items pertaining to the attitudes of and behavior toward evidence-based practice and clinical practice guidelines. It was investigated to reveal the relationship between clinical practice guidelines/evidence-based practice and therapist characteristics. [Results] The response rate was 39.6%, and 384 questionnaires were available. The main results were as follows: 83.3% participants agreed to the importance of evidence-based practice, 77.1% agree to that evidence-based practice supports clinical decision of physical therapists, and about 11% agreed to have been educated about evidence-based practice. Then, 29.2% used, 54.9% agreed to the importance of, and 13.3% agreed to the utility of clinical practice guidelines. An important factor related mostly to a positive attitude, knowledge and behavior of evidence-based practice and clinical practice guidelines was participating in research activities. [Conclusion] Many of physical therapists do not use and understand the importance of clinical practice guidelines. Participating in research activities may partially contribute to improving these conditions.

How Do Physical Therapists Treat People with Knee Osteoarthritis, and What Drives Their Clinical Decisions? A Population-Based Cross-Sectional Survey

Purpose: It is unclear how physical therapists in Florida currently treat people with knee osteoarthritis and whether current best evidence is used in clinical decision making. Methods: We conducted a survey of physical therapists in Florida. We assessed the perceived effectiveness and actual use of physical therapy (PT) interventions and quantified the association between the actual use of interventions and different characteristics of physical therapists. Results: A total of 413 physical therapists completed the survey. Most respondents perceived therapeutic exercise (94%) and education (93%) as being effective or very effective. Interventions least perceived as effective or very effective were electrotherapy (28%), wedged insole (20%), and ultrasound (19%). Physical therapists who followed the principles of evidence-based practice were more likely to use therapeutic exercise (OR 3.89; 95% CI: 1.21, 12.54) and education (OR 3.63; 95% CI: 1.40, 9.43) and less likely to use ultrasound (OR 0.32; 95% CI: 0.16, 0.63) and electrotherapy (OR 0.32; 95% CI: 0.17, 0.58). Results also indicated that older physical therapists were more likely to use ultrasound (OR 3.57; 95% CI: 1.60, 7.96), electrotherapy (OR 2.53; 95% CI: 1.17, 5.47), kinesiology tape (OR 3.82; 95% CI: 1.59, 9.18), and ice (OR 1.95; 95% CI: 1.02, 3.73). Conclusions: In line with clinical guidelines, most physical therapists use therapeutic exercise and education to treat people with knee osteoarthritis. However, interventions that lack scientific support, such as electrotherapy and ultrasound, are still used. A modifiable therapist characteristic, adherence to evidence-based practice, is positively associated with the use of interventions supported by scientific evidence.

Development and validation of the guideline for reporting evidence-based practice educational interventions and teaching (GREET)

BACKGROUND

The majority of reporting guidelines assist researchers to report consistent information concerning study design, however, they contain limited information for describing study interventions. Using a three-stage development process, the Guideline for Reporting Evidence-based practice Educational interventions and Teaching (GREET) checklist and accompanying explanatory paper were developed to provide guidance for the reporting of educational interventions for evidence-based practice (EBP). The aim of this study was to complete the final development for the GREET checklist, incorporating psychometric testing to determine inter-rater reliability and criterion validity.

METHODS

The final development for the GREET checklist incorporated the results of a prior systematic review and Delphi survey. Thirty-nine items, including all items from the prior systematic review, were proposed for inclusion in the GREET checklist. These 39 items were considered over a series of consensus discussions to determine the inclusion of items in the GREET checklist. The GREET checklist and explanatory paper were then developed and underwent psychometric testing with tertiary health professional students who evaluated the completeness of the reporting in a published study using the GREET checklist. For each GREET checklist item, consistency (%) of agreement both between participants and the consensus criterion reference measure were calculated. Criterion validity and inter-rater reliability were analysed using intra-class correlation coefficients (ICC).

RESULTS

Three consensus discussions were undertaken, with 14 items identified for inclusion in the GREET checklist. Following further expert review by the Delphi panelists, three items were added and minor wording changes were completed, resulting in 17 checklist items. Psychometric testing for the updated GREET checklist was completed by 31 participants (n = 11 undergraduate, n = 20 postgraduate). The consistency of agreement between the participant ratings for completeness of reporting with the consensus criterion ratings ranged from 19 % for item 4 Steps of EBP, to 94 % for item 16 Planned delivery. The overall consistency of agreement, for criterion validity (ICC 0.73) and inter-rater reliability (ICC 0.96), was good to almost perfect.

CONCLUSION

The final GREET checklist comprises 17 items which are recommended for reporting EBP educational interventions. Further validation of the GREET checklist with experts in EBP research and education is recommended.

Promoting physical therapists' use of research evidence to inform clinical practice: part 3--long term feasibility assessment of the PEAK program

BACKGROUND

Evidence is needed to develop effective educational programs for promoting evidence based practice (EBP) and knowledge translation (KT) in physical therapy. This study reports long-term outcomes from a feasibility assessment of an educational program designed to promote the integration of research evidence into physical therapist practice.

METHODS

Eighteen physical therapists participated in the 6-month Physical therapist-driven Education for Actionable Knowledge translation (PEAK) program. The participant-driven active learning program consisted of four consecutive, interdependent components: 1) acquiring managerial leadership support and electronic resources in three clinical practices, 2) a 2-day learner-centered EBP training workshop, 3) 5 months of guided small group work synthesizing research evidence into a locally relevant list of, actionable, evidence-based clinical behaviors for therapists treating persons with musculoskeletal lumbar conditions--the Best Practices List, and 4) review and revision of the Best Practices List, culminating in participant agreement to implement the behaviors in practice. Therapists' EBP learning was assessed with standardized measures of EBP-related attitudes, self-efficacy, knowledge and skills, and self-reported behavior at baseline, immediately-post, and 6 months following conclusion of the program (long-term follow-up). Therapist adherence to the Best Practice List before and after the PEAK program was assessed through chart review.

RESULTS

Sixteen therapists completed the long-term follow-up assessment. EBP self-efficacy and self-reported behaviors increased from baseline to long-term follow-up (p < 0.001 and p = 0.002, respectively). EBP-related knowledge and skills showed a trend for improvement from baseline to long-term follow-up (p = 0.05) and a significant increase from immediate-post to long-term follow-up (p = 0.02). Positive attitudes at baseline were sustained throughout (p = 0.208). Eighty-nine charts were analyzed for therapist adherence to the Best Practices List. Six clinical behaviors had sufficient pre- and post-PEAK charts to justify analysis. Of those, one behavior showed a statistically significant increase in adherence, one had high pre- and post-PEAK adherence, and four were change resistant, starting with low adherence and showing no meaningful improvement.

CONCLUSIONS

This study supports the feasibility of the PEAK program to produce long-term improvements in physical therapists' EBP-related self-efficacy and self-reported behavior. EBP knowledge and skills showed improvement from post-intervention to long-term follow-up and a trend toward long-term improvements. However, chart review of therapists' adherence to the participant generated Best Practices List in day-to-day patient care indicates a need for additional support to facilitate behavior change. Future versions of the PEAK program and comparable multi-faceted EBP and KT educational programs should provide ongoing monitoring, feedback, and problem-solving to successfully promote behavior change for knowledge translation.

Barriers against incorporating evidence-based practice in physical therapy in Colombia: current state and factors associated

BACKGROUND

Evidence-based practice (EBP) has been widely implemented in differing areas of physiotherapy. Nevertheless, few studies have investigated EBP-related barriers amongst Latin-American physical therapists working in primary care. The primary objective of this study was to describe the current state concerning perceived barriers engagement in EBP among physical therapy in Colombia. A secondary objective was to identify factors associated with barriers to implementation EBP.

METHODS

A cross-sectional online survey was conducted. The study involved physical therapists working in public and private hospital who were contacted through professional networks (Email, Facebook®, ResearchGate® and Linked-In®) and invited to participate. Multiple logistic regression (MLR) and multiple correspondence analysis (MCA) were used for examining factors associated with perceived barriers to including EBP in their work.

RESULTS

The final sample size was 1064 (77.2 % female). Forty-one percent of the respondents indicated that a "lack of research skills" was the most important barrier to evidence being used in practice. MLR analysis suggested that several variables were associated with perceived barriers to including EBP: i.e. hours of work per week, current main role in therapy center and undergraduate degree. The MCA model established two groups of similarities regarding the different barriers; the "lack of understanding of statistical analysis", "insufficient time" and "understanding of the English in which articles are written" barriers were weighted more heavily regarding in the first group (the second factor on MCA) and the rest barriers on the second group (first factor on the MCA).

CONCLUSIONS

Although most physiotherapists had a positive opinion regarding EBP, they considered that they needed to improve their knowledge, skills and attitudes towards EBP. Initiatives to advance EBP in Colombia with no academic or research tradition should primarily target practitioner-level factors.

Promoting physical therapists' use of research evidence to inform clinical practice: part 2--a mixed methods evaluation of the PEAK program

BACKGROUND

Clinicians need innovative educational programs to enhance their capacity for using research evidence to inform clinical decision-making. This paper and its companion paper introduce the Physical therapist-driven Education for Actionable Knowledge translation (PEAK) program, an educational program designed to promote physical therapists' integration of research evidence into clinical decision-making. This, second of two, papers reports a mixed methods feasibility study of the PEAK program among physical therapists at three university-based clinical facilities.

METHODS

A convenience sample of 18 physical therapists participated in the six-month educational program. Mixed methods were used to triangulate results from pre-post quantitative data analyzed concurrently with qualitative data from semi-structured interviews and focus groups. Feasibility of the program was assessed by evaluating change in participants' attitudes, self-efficacy, knowledge, skills, and self-reported behaviors in addition to their perceptions and reaction to the program.

RESULTS

All 18 therapists completed the program. The group experienced statistically significant improvements in evidence based practice self-efficacy and self-reported behavior (p < 0.001). Four themes were supported by integrated quantitative and qualitative results: 1. The collaborative nature of the PEAK program was engaging and motivating; 2. PEAK participants experienced improved self-efficacy, creating a positive cycle where success reinforces engagement with research evidence; 3. Participants' need to understand how to interpret statistics was not fully met; 4. Participants believed that the utilization of research evidence in their clinical practice would lead to better patient outcomes.

CONCLUSIONS

The PEAK program is a feasible educational program for promoting physical therapists' use of research evidence in practice. A key ingredient seems to be guided small group work leading to a final product that guides local practice. Further investigation is recommended to assess long-term behavior change and to compare outcomes to alternative educational models.