Journal Article

Physiotherapists’ opinions, barriers, and enablers to providing evidence-based care: a mixed-methods study

Tutty, Amanda, Manvell, Joshua, Gleadhill, Connor, Robson, Emma, Manvell, Nicole, Delbridge, Andrew, Bolsewicz, Katarzyna, Da Silva, Priscilla Viana, Davidson, Simon R. E., Williams, Christopher M., Donald, Bruce, Dooley, Katherine, Kamper, Steven J.

2022

Overview

Background Physiotherapists deliver evidence-based guideline recommended treatments only half of the time to patients with musculoskeletal conditions. Physiotherapists’ behaviour in clinical practice are influenced by many cognitive, social, and environmental factors including time and financial pressures. Many initiatives aimed at improving physiotherapists’ uptake of evidence-based care have failed to appreciate the context involved in clinical decisions and clinical practice. Therefore, we aimed to describe: i) opinions toward evidence; ii) how evidence is accessed; iii) factors influencing evidence access; iv) factors influencing evidence application, for physiotherapists working in regional areas. Methods We used a mixed-methods study with online survey and focus groups. We included registered physiotherapists in the survey and physiotherapists practising in regional New South Wales in the focus groups. Quantitative and qualitative data were used to inform all research objectives. We used eight domains of the Transtheoretical Domains Framework to design survey questions. We analysed quantitative and qualitative data in parallel, then integrated both sources through by developing a matrix while considering the Transtheoretical Domains Framework domains to generate themes. Results Fifty-seven physiotherapists participated in the study (survey only n  = 41; focus group only n  = 8; both survey and focus group n  = 8). Participants reported that evidence was important, but they also considered patient expectations, colleagues’ treatment choices, and business demands in clinical decision making. Physiotherapists reported they access evidence on average 30 minutes or less per week. Competing demands like business administration tasks are barriers to accessing evidence. Participants reported that patient expectations were a major barrier to applying evidence in practice. Environmental and systemic factors, like funding structures or incentives for evidence-based care, and social factors, like lacking or having a culture of accountability and mentorship, were reported as both barriers and enablers to evidence application. Conclusions This study provides context to physiotherapists’ opinion, access, and application of evidence in clinical practice. Physiotherapists’ provision of evidence-based care may be improved by enhancing structural support from workplaces to access and apply evidence and exploring discrepancies between physiotherapists’ perceptions of patient expectations and actual patient expectations.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Behavior / Care and treatment / Clinical decision making / Data analysis / Decision-making / Evidence uptake / Evidence-Based Medicine / Evidence-based practice / Focus Groups / Health Administration / Health aspects / Health care management / Health Informatics / Health services / Humans / Implementation / Investigations / Likert scale / Medicine / Medicine & Public Health / Medicine, Rural / Mixed methods research / Mixed-methods / Musculoskeletal Diseases / Nursing Research / Objectives / Physical therapists / Physical Therapists - psychology / Physical therapy / Physiotherapy / Practice / Professional relationships / Public Health / Research Article / Research engagement / Surveys / Surveys and Questionnaires