Exploring if and how evidence-based practice of occupational and physical therapists evolves over time: A longitudinal mixed methods national study

Abstract

Background Occupational therapists (OTs) and physiotherapists (PTs) are expected to provide evidence-based services to individuals living with disabilities. Despite the emphasis on evidence-based practice (EBP) by professional entry-level programs and professional bodies, little is known about their EBP competencies upon entry to practice and over time or what factors impact EBP use. The aim of the study was to measure and understand how EBP evolves over the first three years after graduation among Canadian OTs and PTs, and how individual and organizational factors impact the continuous use of EBP. Methods A longitudinal, mixed methods sequential explanatory study. We administered a survey questionnaire measuring six EBP constructs (knowledge, attitudes, confidence, resources, use of EBP and evidence-based activities) annually, followed by focus group discussions with a subset of survey participants. We performed group-based trajectory modeling to identify trajectories of EBP over time, and a content analysis of qualitative data guided by the Theoretical Domains Framework. Results Of 1700 graduates in 2016–2017, 257 (response rate = 15%) responded at baseline (T0) (i.e., at graduation), and 83 (retention rate = 32%), 75 (retention rate = 29%), and 74 (retention rate = 29%) participated at time point 1 (T1: one year into practice), time point 2 (T2: two years into practice, and time point 3 (T3: three years into practice) respectively. Group-based trajectory modeling showed four unique group trajectories for the use of EBP. Over 64% of participants (two trajectories) showed a decline in the use of EBP over time. Fifteen practitioners (7 OTs and 8 PTs) participated in the focus group discussions. Personal and peer experiences, client needs and expectations, and availability of resources were perceived to influence EBP the most. Conclusions Though a decline in EBP may be concerning, it is unclear if this decline is clinically meaningful and whether professional expertise can offset such declines. Stakeholder-concerted efforts towards the common goal of promoting EBP in education, practice and policy are needed.

Identifying candidate items for a prototype index on propensity to integrate research evidence into clinical decision-making in rehabilitation

“…This decrease in scores may speak to a mechanism whereby clinical experience gained over time offsets the difference between professions as forms of knowledge other than that derived from empirical research become paramount. 32 The decrease in EBP over time (as measured by the P-PIRE-CDMI and the five EBP measures) may be, in part, explained by variations in the definition of evidence. 65,66 For new graduates, evidence may be closely related to knowledge gleaned from research articles and textbooks.…”

“…There exists a well-articulated body of knowledge with respect to the influence of certain individual and organizational factors on the integration of research evidence into CDM and the measurement of those factors. 3,[5][6][7][8][9][10][13][14][15][16][17][18][19][20][21][22]26,29,31,32,42 This study will use the previously identified six core EBP domains in rehabilitation as the propensity variables (knowledge, use of research evidence, self-efficacy, resources, attitudes, and activities related to EBP). 26 The underlying measurement model for the construct of propensity is a formative one (i.e., individual and organizational factors collectively produce the latent phenomenon).…”

“…28,30 This work is part of a larger longitudinal study which aimed to measure and understand the evolution EBP competencies in OT and PT students from graduation and three years into practice. 26,31,32,33 Given the limitations in the measurement of EBP competencies and the many existing measures of separate constructs, our research team conducted additional measurement work to develop a robust measurement approach for constructs around EBP including practice, individual (e.g. knowledge, attitudes, confidence, behaviors), and contextual factors (e.g.…”

“…The measure was them used in a four-year longitudinal study of OTs and PTs in Canada. 31,32,33 Despite these recent developments in the measurement of EBP, separate values are generated for each domain, without the possibility of having one value covering the multidimensional nature of EBP. Considering that there is always a need for parsimony in measurement, a concise yet comprehensive measure able to generate an overall index of EBP in rehabilitation is needed.…”

Refining and adapting the measurement properties of evidence-based practice measures for physiotherapy students

“…As one of their core responsibilities and central to most professional competency standards, health care providers, including physiotherapists, are expected to use EBP in their daily practice [ 4 , 5 ]. It is widely recognised that for clinicians to embrace and apply EBP, they must be exposed to what EBP is and how to operationalise it in practice during entry-level education [ 6 , 7 ]. The Sicily statement on EBP recommended that all health-care education programs incorporate EBP training into their curricula [ 8 ].…”