A critical evaluation of evidence-based practice of physiotherapy in musculoskeletal medicine

Abstract

Research and evidence-based practice (EBP) is vital to the development of musculoskeletal medicine. The purpose of this report is to evaluate EBP in physiotherapy and to identify barriers to its implementation that exist in musculoskeletal physiotherapy. These findings are likely to have meaning for the other disciplines working in musculoskeletal medicine. We have used a personal selection of 44 relevant papers to reach our assessment and conclusions.O Ob bj je ec ct ti iv ve e: : To evaluate evidence-based practice (EBP) in musculoskeletal physiotherapy and to identify barriers that exists to its implementation. M Ma at te er ri ia al ls s a an nd d M Me et th ho od ds s: : A personal selection of 44 relevant papers were used to undertake this assessment. R Re es su ul lt ts s: : The literature questions whether the sole driver for EBP must be randomised controlled trials, or whether anecdotal evidence or pragmatic trials should contribute. Barriers to the implementation of EBP have been identified including clinicians' appraisal skills and the necessary organisational changes required. C Co on nc cl lu us si io on ns s: : Despite EBP having a significant influence on health policy in the UK, practitioners face various challenges when introducing and sustaining appropriate changes to practice.

Patient-perceived barriers and enablers to adherence to physiotherapist prescribed self-management strategies

“…Furthermore, patient adherence may be promoted by the belief that the self-management strategy will be effective as well as the belief that the patient is capable of following the requirements of the strategy (Medina-Mirapeix et al, 2009;Picorelli et al, 2014). Therefore, physiotherapists should seek to enable patient adherence through education and enhancing patient self-efficacy (Wesch et al, 2012) via best-practice communication which is purposeful, goal orientated and based on research from empirical studies, practitioner experience and theoretical paradigms (Chan & Clough, 2010;Hiller, Guillemin, & Delany, 2015;Isaac & Franceschi, 2008). One established model of communication is the patient-centred model which emphasises the need to gather information and tailor selfmanagement strategies according to the patient's needs, which may ultimately lead to improved patient outcomes through sustained adherence (Hiller et al, 2015).…”

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“…Furthermore, patient adherence may be promoted by the belief that the self-management strategy will be effective as well as the belief that the patient is capable of following the requirements of the strategy (Medina-Mirapeix et al, 2009;Picorelli et al, 2014). Therefore, physiotherapists should seek to enable patient adherence through education and enhancing patient self-efficacy (Wesch et al, 2012) via best-practice communication which is purposeful, goal orientated and based on research from empirical studies, practitioner experience and theoretical paradigms (Chan & Clough, 2010;Hiller, Guillemin, & Delany, 2015;Isaac & Franceschi, 2008). One established model of communication is the patient-centred model which emphasises the need to gather information and tailor selfmanagement strategies according to the patient's needs, which may ultimately lead to improved patient outcomes through sustained adherence (Hiller et al, 2015).…”

Implementation of guidelines

“…1 In this connection, the acceptance of some guidelines appears to be reasonable. Annette Bishop and Nadine E Foster address this in their paper, 'The implementation of guidelines for the management of patients with low back pain: the role of practitioner's attitudes and perceptions'.…”