Evidence-Based Practice among Physiotherapists - Essay Example

Evidence Based Practice amongst Physiotherapists. Attitudes, Knowledge, and Barriers. This literary critique is divided into three parts and is an attempt to explore the perceptions, knowledge and attitudes of physiotherapists towards EBP. The perceptions, knowledge and attitudes of physiotherapists towards evidence based practice. The journal article-‘What do Swedish physiotherapists feel about research? A survey of perceptions, attitudes, intentions and engagement.’ by Kamwendo, K mainly deals with the topic of increased rate of research in physiotherapy, and further goes on to describe the reason behind its fewer outcomes to clinical practice field. The main concern of the study is an investigation to the perceptions and attitudes towards research, in which Swedish physiotherapists are used as sample. The result of the study states that most of the physiotherapists consider research has an important role in their profession. Moreover, they consider reading of research literature as an important activity in their profession. But it is pointed out that there are some barriers which keep them away from reading research journals. In the concluding part, Kamwendo points out: “A cultural change within the profession, allowing more time for reading and discussing research reports should be encouraged.”(Kamwendo K, 2002) effective changes can be implemented in physiotherapy by allowing more time for reading and discussing research reports. Most of the Swedish physiotherapists like to read journals and other works in their own language. This prevents them to exploit the positive sides of EBP, because most of the journals published on EBP are in English. To conclude, it is important that most of the Swedish physiotherapists value EBP and research in physiotherapy. The research conducted by Diane U Jette, Kimberly Bacon, Cheryl Batty, Melissa Carlson, Amanda Ferland, Richard D Hemingway, Jessica C Hill, Laura Ogilvie and Danielle Volk, namely ‘Evidence-Based Practice: Beliefs, Attitudes, Knowledge, and Behaviors of Physical Therapists’, states that the physical therapist members of American Physical Therapy Association (APTA) strongly supports the Evidence Based Practice (EBP) in their field. The hypothesis points out the close relation between quality and individual practice characteristics of physiotherapists. The respondents supported the importance of evidence in practice because they like to rely upon evidence than theory. The theories are applicable for the general field of medical care. But when it is applied to physiotherapy, practitioner had to consider so many individual factors related to the patient. Rich literature in EBP helps physiotherapists to provide better patient care. It is a fact that younger and recently licensed practitioners rely on research works and EBP to improve their skills. Furthermore, most of the physiotherapists, newly licensed or experienced, have access to online information to update knowledge in their field. Jette, et al remarks that: “Seventy-four percent of the respondents reported using professional literature in the process of clinical decision making 5 or fewer times per month.”(Jette, et al., 2003) majority of respondents agreed that they rely upon professional literature to improve their decision making skills. They feel interested to accept EBP in their professional life as a physiotherapist and are ready to improve their skill and competency. Moreover, EBP helps the physiotherapists to have real time experience. So, younger and recently licensed physiotherapists strongly support EBP. By summing up, EBP possess strong influence among physiotherapists and they agree that it is necessary. The article-‘Evidence-Based Practice: Knowledge, Attitudes And Beliefs Of Physiotherapists In Nigeria’ by SRA Akinbo, D.O. Odebiyi, T.E. Okunola,& O.T. Aderoba, attempts to prove the influence of scientific evidence on EBP, and eventually on physiotherapy. This study is an endeavour to describe the knowledge, attitudes and beliefs of physiotherapists in Nigeria. This research traces the relation between attributes and practice in Nigeria. The data collection for the research was through distribution of questionnaires and its result points out the importance of EBP in physiotherapy. But insufficiency of time hinders the effective implementation of EBP in Nigerian health care scenario. Even if, the change in attitude towards EBP shows a positive trend and it will reflect in future development. Most of the respondents agreed that EBP is so helpful in decision making. Akimbo et al points out that: “The majority of the respondent belief that incorporating evidence into practice may lead to improvement in clinical skills.”(Akimbo et al, 2009) the majority of respondents to their questionnaire agreed that EBP leads to improvement in their clinical skills and they are really in need of improvement in their profession. By summing up, EBP is plays a vital role to improve the decision making capacity of physiotherapists. The Research article- ‘The propensity to adopt evidence-based practice among physical therapists’, by Patricia H Bridges, Laura L Bierema, & Thomas Valentine, deals with the effectiveness of EBP in physiotherapy. The purpose of this study was to find out the influence of EBP on personal and social characteristics in work place atmosphere. Self-completion method was used for this research for data collection. The result was positive and it says that respondents are in favour of EBP in their profession. From another point of view, there exists a negative correlation between age, years licensed and percentage of time in direct patient care. Bridges et al points out: “The findings demonstrated that the best three variables for predicting the propensity to adopt EBP in physical therapy were: desire for learning, highest degree held, and practicality.” (Bridges et al, 2007) the change in attitude leads to a positive movement in the field of physical therapy and it is ready to accept EBP as its part. The study shows that there are three variables that predict this positive result. They are: desire for learning, highest degree held, and practicality. Moreover, the findings of this research are applicable to other health professions also. The suggestion put forth by this research is, EBP must become more users friendly so that it may not hinder patient care. Influence of levels of experience and higher educational level attained by physiotherapists towards integrating evidence in their practice. Most of the recent physiotherapy graduates show acceptance to new ideas and they own professional behaviour. They show openness towards information and communication technologies in health care scenario. The learning experience at the stage of graduation and higher education helps them to change their attitude towards integrating evidence in their practice. In the work-‘Learning Outcomes and Curriculum Development in Australian Physiotherapy Education’, Joan McMeeken, Gillian Webb, Kerri-Lee Krause, Ruth Grant & Robin Garnett, deals with the topic of employer satisfaction and influence of EBP on newly licensed physiotherapists in Australia. It further goes on to deal with the influence of experience and higher educational level in clinical practice and EBP. It is pointed out that EBP acts as a guide to newly licensed physiotherapists to excel in their profession. The employers feel satisfaction because the physiotherapists show excellent communication skills and are able to take decision by their own. Another finding is that this positive attitude towards EBP helps them to save time and to render quality patient care. Moreover, EBP helps them to work in any big institution without much confusion on decision making. McMeeken et al points out that: “Recent graduates’ capacity for independent critical thought and ability to participate in collaborative learning as a team-member scored similar satisfaction levels among employers.”(McMeeken et al, 2005, P. 56) the reason behind employer satisfaction is that newly licensed graduates possess the capacity to be efficient members in a team at a collaborative learning session. This efficiency determines their unique place in a multi- professional team. For instance, physiotherapy is connected with other branches of medical science. So, a physiotherapist must be ready to act different roles within his or her profession. The ready access to electronic information and EBP helps them to have a wider outlook and this helps them in future practice. With this change in attitude and newly acquired skills, physiotherapists are ready to work as members of multidisciplinary health teams. By summing up, it is evident that EBP is helpful to change the attitude of physiotherapists and it nourishes the attitude of sharing and co-operation. The book- ‘Innovations in Rehabilitation Sciences Education: Preparing Leaders for the Future’, by Patricia Solomon & Sue Baptiste, deals with the subject of curriculum reform experiences of physiotherapy and occupational therapy programs at Mc Master University, Canada. The book highlights the key aspects of professional preparation in physiotherapy. Solomon & Baptiste points out that: “Evidence-based practice is dependent on clinicians to incorporate the principles into their clinical decision making.” (Solomon &Baptiste, 2005, P. 61) most of the clinicians rely upon evidence-based practice to superimpose the principles into their profession. Rehabilitation sciences accepted EBP but clinical practice shows a low tendency of progress in EBP. As the role of the physiotherapist is undergoing a tremendous change, the scope of physiotherapy is wide. For instance, the change in medical technology reduced hospital stay, cut outpatient services and it increased private practice in physiotherapy. The changed role expects more from a physiotherapist and it changes the attitude towards profession. This tends the physiotherapists in Canada to inculcate integrative evidence practice in their field and to rely upon EBP. The journal article- ‘Evidence based practice: a survey of physiotherapists current practice’, by Iles R,& Davidson M, investigates Australian physiotherapists’ self reported practice, skills and knowledge of EBP. The aim of the work is to examine the difference between recent licensed and experienced physiotherapists. It also examines the effectiveness of extended training in physiotherapy. The work points out the difference between physiotherapists working in hospitals and in private practice. The method used in this research is a survey, which was circulated among physiotherapists working in hospitals and in private practice. The result supports the popularity of EBP among recent graduates. These recent graduates are with high rate of skills than experienced physiotherapists. On the other hand, physiotherapists with higher level of training agreed that EBP is effective in the field of physiotherapy. In the concluding part, Iles &Davidson points out that: “Private practice and hospital physiotherapists rated their evidence-based practice skills equally and performed most evidence-based practice activities with equal frequency.” (Iles Davidson, 2006) the physiotherapists who were in private practice and hospitals rated EBP as effective. Most of the new physiotherapists like to begin their career as practitioners. So, EBP can help them to acquire knowledge and skill in their profession. By summing up, it is evident that EBP plays an important role in educating new and experienced practitioners in Canada. The book-‘Tidys Physiotherapy’, by Stuart B. Porter, A. M. Thomson, A. T. Skinner, & Joan Piercy reflects the current changes, clinical practice and theory in physiotherapy. The book acts as a reference guide to students and practitioners in physiotherapy. It provides solid foundation to physiotherapy students to build their knowledge base in their field of practice. The qualifying programs help the individual practitioner to acquire knowledge, skill, and attributes related to the use of evidence in clinical practice. The content of the work helps to understand the need and usefulness of physiotherapy in other branches of medical science. Porter, Thomson, Skinner, & Piercy points out that: “Physiotherapists need to contribute to an ongoing debate to develop a hierarchy that reflects more appropriately a patient-centred approach to practice.” (Porter, Thomson, Skinner, & Piercy, 2003, p.9) physiotherapists need to develop a positive attitude towards patient centred approach in their practice. The knowledge and skill that is acquired by physiotherapists through EBP must benefit the patients. This newly acquired knowledge can be extended to other spheres of medical care because physiotherapy is an open ended medical branch. Moreover, physiotherapy is closely related to other branches of medical science. So, physiotherapists are supposed to co- operate with other branches in medical science. The work- ‘Becoming an Advanced Healthcare Practitioner’, by Gillian Brown, Susan A. Esdaile, & Susan E. Ryan examines advanced practice in the health professions and the importance of EBP, continuing professional development, using theory to inform practice and career planning. The work helps a practitioner to identify his or her professional needs and to extend one’s service to a wider context. It deals with a wide range of examples to describe the function of a practitioner in the field of medical care. The work is scholarly and research-focused. It puts light on the major influences on healthcare in public and private practices. Brown, Esdaile & Ryan points out that: “It might be helpful to try to identify a group of like-minded colleagues who would be interested in exploring the evidence base of their practice.”(Brown, Esdaile & Ryan, 2003, p.97) the physiotherapist must identify a likeminded group of practitioners and share the knowledge in EBP. If the group is multi professional, group members will benefit more from sharing different types of information in different fields of practice. The work deals with some new challenges to health care profession. The discussion is based on some essential aspects or qualities needed for a health care professional such as: skills in communicating with patients and colleagues, the development of teamwork, sharing mentality of knowledge across professional boundaries and leadership quality. The research work- ‘Career Satisfaction of Physical Therapy Faculty During Their Pretenure Years’, by Anne L Harrison, & Deborah G Kelly deals with the topic of career satisfaction among physiotherapists. The attempt is to compile information on the influence of career satisfaction among full-time physical therapy faculty. A self-report instrument is used for collecting the data for the research work. It includes the categories like- demographics, social supports, teaching and scholarly activity. The result of the research is, majority of junior faculty feel satisfied in their academic position, but their aim is to acquire more guidance from their seniors and colleagues. Harrison & Kelly points out that: “Thirty-six percent of the respondents indicated that they were pursuing an additional degree while employed as faculty, with 69% of this subgroup pursuing doctoral degrees.” (Harrison, & Kelly, 1996, p.1206) majority of the newly licensed practitioners like to pursue an additional degree in their field, and they are not ready to give up their education. Most young physiotherapists like to pursue doctoral degrees. This shows a positive tendency towards continuing education. The concluding part of the work deals with the relationship with senior faculty and experienced colleagues. Most of the juniors are ready to seek help to develop their skills. So, it is evident that the experienced hands in physiotherapy are ready to share knowledge and information with others. Here, EBP can play an important role of an educator. Literature published on EBP helps junior practitioners to acquire skill in their sphere of practice. The barriers to evidence based practice. The scope of EBP in the field of physical therapy is wide but there are some barriers which hinder its growth. The main barrier is the less use of foundation of EBP in academic preparation or training. There is a wide gap between research and practice in physiotherapy. The negative perception about research and physical therapist’s role in EBP, insufficient organizational provision of access to Web-based resources, acts as other barriers to its growth. The literature review – ‘A review of the literature on evidence-based practice in physical therapy’ by Joe Schreiber & Perri Stern, deals with the disconnection between academia and clinical practice and its relation to utilization of research evidence in clinical decision making process. The purpose of the work is to address some of issues that physical therapy profession faces with respect of EBP. It further goes on to find out the influence of EBP literature in physical therapy. Schreiber & Stern points out that: “Clinicians also face difficulties in implementing changes in practice.” (Schreiber & Stern, 2005, p.5) clinicians face internal and external pressure and conflict to implement EBP or other change in physiotherapy. In the field of continuing education, EBP helps the practitioner to enhance skills and self efficiency to search and critically evaluate research literature. But lack of valuable literary works hinders the physiotherapists to use it in an effective way. Support from the side of management plays a crucial role in the effective use of EBP. But lack of management support in terms of technology hinders the growth and popularity of EBP. Another barrier pointed out is the lack of adequate time allotted to a therapist to acquire mastery in EBP. Now, EBP related research works and journals are available through online databases and electronic publication. But lack of time keeps the practitioners away from EBP. By summing up, lack of support from the part of management and lack of adequate time allotted hinders the growth of EBP. The book- Guide to Evidence-based Physical Therapy Practice by Dianne V. Jewell is an enquiry on the effectiveness of EBP in classroom and clinical environment. This work helps the reader to have a different outlook of the philosophy and value of EBP. The work connects the reader with the valuable literature in the field of physiotherapy. This helps the physiotherapist to evaluate the findings in literature and it will lead to effective use of literary sources in EBP. Moreover, this work diagnoses the barriers of EBP in physiotherapy. Jewell points out that: “it may be difficult for a single physical therapist to incorporate the behaviour into his or her patient/client management routine.” (Jewell, 2008, p.11) only an extensive change in clinical field/department can benefit physiotherapy and it will lead to the acceptance of EBP as a course of practice. It is difficult for an individual practitioner to implement EBP in practice because EBP shows its effectiveness in group tasks. So, group mentality among physiotherapists can resolve all these barriers. So, it is evident that change in attitude leads to desire for continuing education, helps to redefine traditional theories, and to overcome the barriers in a specific field. The relation between EBP and physiotherapy prove this fact. Works cited Akinbo, SRA., Odebiyi, D.O., Okunola, T.E., & Aderoba, O.T. (2009). Knowledge, Attitudes And Beliefs Of Physiotherapists In Nigeria. The Internet Journal of Medical Informatics. Volume 4 Number 2. Brown, G., Esdaile, S. A., Ryan, S. E. (2003). Becoming an Advanced Healthcare Practitioner. Elsevier Health Sciences. Bridges, P.H., Bierema, L.L., & Valentine, T. (2007).The propensity to adopt evidence-based practice among physical therapists. BioMed Central Ltd. http://www.biomedcentral.com/1472-6963/7/103 Harrison, A. L., & Kelly, D.G. (1996). Career Satisfaction of Physical Therapy Faculty During Their Pretenure Years. Physical Therapy. Volume76.Number11. Iles, R., & Davidson, M. (2006). Evidence based practice: a survey of physiotherapists current practice. Physiother Res Int, 11(2):93-103. http://www.unboundmedicine.com/medline/ebm/record/16808090/abstract/Evidence_based_practice:_a_survey_of_physiotherapists%27_current_practice_ Jette, et al., (2003) Evidence-Based Practice: Beliefs, Attitudes, Knowledge, and Behaviors of Physical Therapists. http://www.ptjournal.org/cgi/content/abstract/83/9/786 Jewell, D.V. (2008). Guide to Evidence-based Physical Therapy Practice. Jones & Bartlett Publishers. Kamwendo, K. (2002). What do Swedish physiotherapists feel about research? A survey of perceptions, attitudes, intentions and engagement. Physiother Res Int, 7(1), 23-34. MeSHAdult Cross-Sectional Studies. McMeeken, J., Webb, G., Krause, K-L., Grant, R., & Garnett, R. (2005).Learning Outcomes and Curriculum Development in Australian Physiotherapy Education , The University of Melbourne 56. Porter, S. B., Thomson, A. M., Skinner, A. T., & Piercy, J. (2003). Tidys Physiotherapy. Elsevier Health Sciences. Solomon, P., & Baptiste, S. (2005). Innovations in Rehabilitation Sciences Education: Preparing Leaders for the Future. Birkhäuser. Schreiber, J. & Stern, P. (2005).A review of the literature on evidence-based practice in physical therapy. The Internet Journal of Allied Health Sciences and Practice, Volume 3 Number 4. Read More