Perceived barriers to evidence-based practice among Physiotherapy students

Aim: To determine the awareness and attitude on evidence-based practice (EBP) among physical therapists in Ilocos and identify the barriers to implementation in clinical practice. Method: This study employed a descriptive cross-sectional research design using a pilot-tested and validated questionnaire on awareness, attitude, and barriers in EBP and conducted a key informant interview (KII). A total of 48 practicing physical therapists (hospital = 21; clinic = 18; homecare = 9) in Ilocos Norte and Ilocos Sur participated in the study considering ethical guidelines. Descriptive statistics such as frequency, percentage, and mean were used to analyze the collected data. Results: The majority of the respondents were recent graduates with less than five years of clinical experience. The respondents were moderately aware (𝑋̅ = 4.11) of the use of EBP and had a positive attitude (𝑋̅ = 4.34) on using it on a day-to-day basis. The top three barriers that hindered the use of EBP is lack of time (37.5%) due to heavy workload, inability to apply research findings to patients with unique characteristics and (20.8%) and lack of research skills, lack of understanding of statistical analysis and lack of interest (12.5%). Conclusion and Implications: There is an increasing awareness of EBP among physical therapists in Ilocos, which positively influenced clinical practice. Results of the study may further encourage the daily practical application of EBP among physical therapists in clinical practice.

Existing studies have identified specific factors influencing some dimensions of evidence-based practice (EBP) competence and use. However, the way these factors interact still needs to be clarified. The purpose of the study was to test a model based on the Determinant Frameworks that explain the relationships and the direct pathways between the characteristics of the nurses, the context, and the implementation strategies and the dimensions of EBP competence, attitude, knowledge, skills, and use of EBP. A cross-sectional study was carried out in Spain during January and February 2020, involving 2,370 nurses employed in public health centers across all autonomous communities within the National Health System. An online survey was administered to gather data, addressing various topics related to the nurses' characteristics, the context in which they worked, the implementation strategy, and their competence in evidence-based practice (EBP). As depicted in the conceptual framework, a structural equation model was constructed to test the hypothesized relationships among key study variables. The model obtained showed a good fit (χ 2/df = 3.20, p < 0.001; RMSEA = 0.030 [90% CI 0.025, 0.036]; CFI = 0.989; GFI = 0.990; TLI = 0.983). The context, more specifically, the dimensions of nurse participation in the center's affairs, nursing foundations for quality of care, nurse manager ability leadership and support of nurses, and implementation strategy have a direct and positive effect on EBP use. Training in EBP, reading scientific articles, and having a doctorate are associated with higher competence and knowledge in EBP. The final fit shows the #Evidencer model for the use of EBP (#EvidencerMUSEBP) with two main components: the contextual and strategic factors that influence the implementation of EBP and the characteristics of the professionals, such as their training and reading of articles, which have an impact on EBP competence. This model could guide healthcare organizations in proposing comprehensive interventions to improve EBP use and the competency of nurses.

Background: The evidence-based practice movement has spread globally, prompting calls for evidence-based policymaking and public health. Health care being the dynamic discipline with research, is, intended to improve practice through evidence-based novel approaches. As evidence based practice (EBP) among nurses is essential for improving the quality of care, fewer pieces of evidence are available in Nepal. This study aimed to assess the perception of evidence-based practice among nurses of a tertiary hospital in Nepal. Methods: We conducted a quantitative cross-sectional study among the 100 nurses of Bir Hospital in Kathmandu. The self-administered questionnaires were applied using the survey instrument by Upton and Upton. A purposive sampling technique was employed. We calculated the mean score to assess the nurses’ perceptions in the three sub-scales of knowledge, attitude, and use of evidence-based practice. Bivariate analysis was performed to examine the relationship between subscales. Results: The majority (89.0%) of nurses did not receive training on evidence-based practices. The mean score of knowledge on EBP was 4.47±1.11, the mean score of attitude on EBP was 4.45±1.06, and the mean score of EBP use was 4.18±1.42. EBP knowledge, attitude, and use were not significantly associated with the selected demographic variables (age, work experience, EBP training and marital status). Conclusion: Nurses’ perceptions of evidence-based practice were moderate. The implementation of EBP use needs to be strengthened among the nurses. Nurses need to be more involved in the implementation of EBP. To incorporate evidence in practice, nurses require training and support from high authorities.

In light of the need to prepare reflective and effective teachers who can differentiate their instruction to support the learning of all students in inclusive classrooms, this article describes the collaborative process faculty have used to incorporate universal design for learning (UDL) and evidence-based practice (EBP) into an inclusive teacher education program’s curriculum and practicum experiences. Initially, faculty mapped the curriculum by agreeing upon a common definition of UDL and EBP, reviewing the research to create EBP documentation charts, which were used to constructing self-assessment tools known as innovation configurations (IC). Faculty used the IC to identify and address the strengths and gaps within the program’s courses and clinical experiences and align courses with online interactive instructional resources related to UDL and EBP. To bridge the gap between research and practice and guide educators in making evidence-informed decisions, faculty developed a 10-step practice-based evidence assessment and instructional model to collect and analyze classroom-based data about the efficacy, acceptability, and fidelity of one’s instructional practices and use of UDL and EBP. Faculty revised and field-tested a lesson plan template that prompted educators to personalize their instruction and make it more explicit by addressing such factors as student diversity and collaboration, and employing UDL, EBP, instructional and assistive technology and formative and summative assessment. Faculty also redesigned the program’s lesson observation form used to better evaluate preservice teachers working in inclusive classrooms and provide them with feedback related to their effective use of EBP, UDL, instructional and assistive technology, and assessment and classroom management strategies. The lesson observation form also was revised to make it more reflective of the program’s curriculum reform efforts related to the use of UDL and EBP, and to align it with the national teacher education accreditation standards, national and statewide teacher evaluation, curriculum and teacher education certification standards.

Implementation of evidence-based practice (EBP) is a complex task. This study, conducted in an acute geriatric setting, aims to compare self-reported capability beliefs on EBP between health professionals and students, and to compare the use of EBP between health professional groups. Occupational therapists, physicians, physiotherapists and registered nurses with three or more months’ employment, and all students from the occupational therapy, medical, physiotherapy and nursing programs, who had conducted workplace learning at the department, were invited. Data on capability beliefs and use of EBP were collected using the Evidence-based Practice Capabilities Beliefs Scale assessing six activities of EBP: formulate questions; search databases; search other sources; appraise research reports; participate in implementation in practice; and participate in evaluation. Descriptive and inferential statistics were used. Capability beliefs on EBP: The health professionals (n = 101; response rate 80%) reported high on search other sources but less on appraise research reports. The students (n = 124; response rate 73%) reported high on all EBP activities. The health professionals reported significantly higher on search other sources than the students. The students reported significantly higher on formulate questions and appraise research reports than the health professionals. No significant differences were identified between the health professional groups or between the student groups. Use of EBP: Health professionals reported wide-ranging use from several times each month to once every six months. The physicians reported significantly more frequent use than registered nurses and occupational therapists. Health professionals supervising students reported more frequent use of appraise research reports than the non-supervising group. There is a need for improving the use of EBP, particularly among registered nurses and occupational therapists. Supervision of students might enhance the motivation among staff to increase the use of EBP and students’ high EBP capability beliefs might inspire staff in this matter.

Research on the adoption of evidence-based practice (EBP) in health care has been focused mainly on hospital settings and primary care; little is known about EBP adoption and implementation among school nurses in the United States (US). The objectives of this study were to (1) describe the prevalence of EBP use among school nurses, (2) describe demographic, individual, and organizational factors associated with EBP use, and (3) identify resources needed to enhance EBP use. A survey designed for this study was mailed to all school nurses in Iowa in the US, with a response rate of 56.8% (n= 386). Descriptive statistics and t-tests were used to indicate and compare the variables of interest. Multiple regression and analysis of variance (ANOVA) methods were used to identify variables explaining the variance in the use of EBP. Information sources, professional membership, and district size explain 22% of the variance in current use of EBP. Identified resources needed to increase the use of EBP included networking opportunities, predeveloped EBP guidelines, and education on outcome evaluation. This study indicates important information on variables that affect current practice in school nursing and also shows requested resources for increasing EBP use. These results can be used to develop translation strategies to increase the use of EBP in the school setting. Because only 22% of the variance was explained, further research is needed to identify additional variables.

Urologists frequently treat patients for tobacco-related conditions but infrequently engage in evidence-based practices (EBPs) that screen for and treat tobacco use. Improving the use of EBPs will help to identify smokers, promote cessation, and improve patients' health outcomes. A prospective type I hybrid effectiveness-implementation study was performed to test the feasibility and effectiveness of using a multilevel implementation strategy to improve the use of tobacco EBPs. All urology providers at outpatient urology clinics within the Veterans Health Administration Greater Los Angeles and all patients presenting for a new urology consultation were included. The primary outcome was whether a patient was screened for tobacco use at the time of consultation. Secondary outcomes included a patient's willingness to quit, chosen quit strategy, and subsequent engagement in quit attempts. In total, 5706 consecutive veterans were seen for a new consultation during the 30-month study period. Thirty-six percent of all visits were for a tobacco-related urologic diagnosis. The percentage of visits that included tobacco use screening increased from 18% (before implementation) to 57% in the implementation phase and to 60% during the maintenance phase. There was significant provider-level variation in adherence to screening. Of all screened patients, 38% were willing to quit, and most patients chose a "cold turkey" method; 22% of the patients elected referral to a formal smoking cessation clinic, and 24% chose telephone counseling. Among those willing to quit, 39% and 49% made a formal quit attempt by 3 and 6months, respectively. A strategy that includes provider education and a customized clinical decision support tool can facilitate provider use of tobacco EBPs in a surgery subspecialty clinic.

The evidence-based practice profiles of academic and clinical staff involved in pre-registration nursing students' education: A cross sectional survey of US and UK staff

Primary and acute care settings are the focus of a concerted effort to implement evidence-based practice (EBP) in health care; yet, little attention has been given to use of EBP among school nurses. The aims of this study were to (a) describe current use of EBP among school nurses attending a national school nurse conference, (b) describe demographic, individual, and organizational factors associated with EBP use, and (c) identify resources needed to enhance EBP use. A survey designed for this study was distributed during a national school nurse conference. Descriptive statistics, correlations, and independent t tests were used to analyze respondent data regarding the current level of EBP use, awareness, skills, and information sources. Respondents also identified resources needed to increase use of EBP, which included networking opportunities, predeveloped EBP guidelines, and education on outcome evaluation. The results from this study will be used to develop strategies to increase the use of EBP in the school setting.

Emergency care clinicians are expected to use the latest research evidence in practice. However, emergency nurses do not always consistently implement evidence-based practice (EBP). An educational intervention on EBP was implemented to promote emergency nurses' use of EBP, and the effectiveness of it was evaluated. This study aimed to evaluate the effectiveness of an EBP educational intervention on emergency nurses' EBP attitudes, knowledge, self-efficacy, skills, and behavior. The study also examined learners' satisfaction with the EBP educational intervention. A randomized controlled trial with parallel groups with evaluations before the education, immediately after it, and 6 and 12months after the education was conducted at four emergency departments in two university hospitals. The experimental group (N=40) received EBP education while the control group (N=40) completed self-directed EBP education. The primary outcomes were emergency nurses' EBP attitudes, knowledge, self-efficacy, skills, and behavior, while the secondary outcome was satisfaction with the EBP education. Thirty-five participants of an experimental and 29 participants of a control group completed the study. There were no statistically significant (p<.05) improvements and differences between groups in EBP attitude, self-efficacy, or behavior immediately after the EBP education. At the 6-month measurement point, the experimental group showed significantly better EBP attitudes, behavior, knowledge, and self-efficacy than the control group. At the 12-month measurement point, the improvements began to decrease. The groups also differed significantly in terms of participant satisfaction with how the teacher encouraged learners to ask clinical questions. The EBP educational intervention implemented in this study had a positive effect on emergency nurses' EBP attitudes, knowledge, self-efficacy, skills, and behavior. The effects of the education appeared the best 6months after the education. After this point, the results began to decrease and approached baseline levels. EBP educational interventions designed for emergency nurses should apply various teaching strategies to improve their EBP attitude, knowledge, self-efficacy, skills, behavior, and satisfaction with the education.

Decision-making in health care delivery should be based on the best available current, valid and relevant evidence. Healthcare professionals should therefore be well versed with the skills required to make evidence based clinical decisions in patient care. The aims of this study were to investigate the attitudes of physiotherapists towards utilisation of evidence-based practice (EBP) during patient care, identify barriers to the use of EBP and strategies to improve utilisation of EBP. A descriptive cross sectional study was conducted using a survey questionnaire. Fifty five questionnaires were administered to randomly selected physiotherapists, working in either private or public hospitals in Zimbabwe. The questionnaire collected information on demographics, utilisation of EBP, factors affecting use of EBP and recommendations. The response rate was 91 % (n = 50). Majority of respondents (n = 30; 60.0 %) were female, mean age of respondents was 36.4 years (SD = 9.8) and median years of experience was 8.5 (IQR = 5–15). A positive attitude towards EBP was displayed by 18 of 31 respondents (58.1 %) from private hospitals and 14 of 19 respondents (73.4 %) from public hospitals. All participants indicated that the knowledge obtained through undergraduate training was their major source of evidence-based information whilst a combined 19 respondents (38.0 %) indicated reading of journals and carrying out research as their main source of evidence. Lack of time was indicated as the major factor influencing utilisation of EBP by respondents. Limited access to online information was reported by 15 of 19 respondents from public hospitals (78.9 %) to be a major factor affecting their EBP. Respondents recommended training for physiotherapists to improve their skills in critical evaluation of research as a way to promote EBP and highlighted the need for organisational support to facilitate access to online sources of EBP in the clinical environment. Physiotherapists in Zimbabwe seem to rely on knowledge obtained from undergraduate training to guide them in patient care with a few highlighting the importance of research activities to guide clinical practice and their involvement in them. There is need to for physiotherapists to make time to acquire information on evidence based treatment methods in order to improve the quality of clinical practice and ultimately the standard of health care delivery.

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

Date Presented 04/02/2022 This study consisted of an electronic survey distributed to licensed Ohio OTs and PTs, which identified the evidence-based interventions used by therapists for the treatment of children ages 0-3 with cerebral palsy (CP), the frequency of intervention use, and the facilitators and barriers to evidence-based practice (EBP) use. Overall, therapists view EBP as important and possess skills to engage in EBP but do not frequently use EBP because of several barriers. This study provides recommendations for workplaces to facilitate EBP use in practice. Primary Author and Speaker: Aminah Baig Additional Authors and Speakers: Ellie Cecala, Laney Gallagher, Elizabeth Gick Contributing Authors: Claire Morress

The implementation of evidence-based practices (EBPs) for autistic youth is a critical concern worldwide. Research examining factors facilitating the implementation of EBPs found that providers’ attitudes are an important factor. In this study, we evaluated cross-cultural differences in attitudes toward and use of EBPs. We tested socio-demographic factors as predictors of attitudes, and attitudes as predictors of EBPs use among mental health professionals working with autistic youth in Bangladesh and Germany. We used purposeful sampling. Two-hundred-ninety-two professionals who worked in a clinical setting responded to the survey and fulfilled the inclusion criteria (101 in Bangladesh, 191 in Germany). Participants were asked to respond to nine subscales of the Evidence-Based Practice Attitude Scale-36 (EBPAS-36), to indicate which of nine types of treatments they used, and to provide sociodemographic data. Measurement invariance across countries could be established for four subscales of the EBPAS-36. Comparative analyses of attitudes showed that professionals in both countries were open to using EBPs, but German practitioners were more likely to use EBPs when they appealed to them. By contrast, Bangladeshi professionals claimed to be more likely to adopt an EBP when required and to be more willing to learn EBPs to enhance job security. The relationship between caseload and attitudes varied between countries. A broader variety of EBPs was used in Germany. The findings highlight the importance of considering country-specific factors when implementing EBPs. Directions for conducting comparative studies on mental health professionals’ attitudes towards EBP including methodological considerations are discussed.

BackgroundThe adoption and sustainment of evidence-based practices (EBPs) is a challenge within many healthcare systems, especially in settings that have already strived but failed to achieve longer-term goals. The Veterans Affairs (VA) Maintaining Implementation through Dynamic Adaptations (MIDAS) Quality Enhancement Research Initiative (QUERI) program was funded as a series of trials to test multi-component implementation strategies to sustain optimal use of three EBPs: (1) a deprescribing approach intended to reduce potentially inappropriate polypharmacy; (2) appropriate dosing and drug selection of direct oral anticoagulants (DOACs); and (3) use of cognitive behavioral therapy as first-line treatment for insomnia before pharmacologic treatment. We describe the design and methods for a harmonized series of cluster-randomized control trials comparing two implementation strategies.MethodsFor each trial, we will recruit 8–12 clinics (24–36 total). All will have access to relevant clinical data to identify patients who may benefit from the target EBP at that clinic and provider. For each trial, clinics will be randomized to one of two implementation strategies to improve the use of the EBPs: (1) individual-level academic detailing (AD) or (2) AD plus the team-based Learn. Engage. Act. Process. (LEAP) quality improvement (QI) learning program. The primary outcomes will be operationalized across the three trials as a patient-level dichotomous response (yes/no) indicating patients with potentially inappropriate medications (PIMs) among those who may benefit from the EBP. This outcome will be computed using month-by-month administrative data. Primary comparison between the two implementation strategies will be analyzed using generalized estimating equations (GEE) with clinic-level monthly (13 to 36 months) percent of PIMs as the dependent variable. Primary comparative endpoint will be at 18 months post-baseline. Each trial will also be analyzed independently.DiscussionMIDAS QUERI trials will focus on fostering sustained use of EBPs that previously had targeted but incomplete implementation. Our implementation approaches are designed to engage frontline clinicians in a dynamic optimization process that integrates the use of actional clinical data and making incremental changes, designed to be feasible within busy clinical settings.Trial registrationClinicalTrials.gov: NCT05065502. Registered October 4, 2021—retrospectively registered.