What supports physiotherapists’ use of research in clinical practice? A qualitative study in Sweden

Abstract

BackgroundEvidence-based practice has increasingly been recognized as a priority by professional physiotherapy organizations and influential researchers and clinicians in the field. Numerous studies in the past decade have documented that physiotherapists hold generally favorable attitudes to evidence-based practice and recognize the importance of using research to guide their clinical practice. Research has predominantly investigated barriers to research use. Less is known about the circumstances that actually support use of research by physiotherapists. This study explores the conditions at different system levels that physiotherapists in Sweden perceive to be supportive of their use of research in clinical practice.MethodsPatients in Sweden do not need a referral from a physician to consult a physiotherapist and physiotherapists are entitled to choose and perform any assessment and treatment technique they find suitable for each patient. Eleven focus group interviews were conducted with 45 physiotherapists, each lasting between 90 and 110 minutes. An inductive approach was applied, using topics rather than questions to allow the participants to generate their own questions and pursue their own priorities within the framework of the aim. The data were analyzed using qualitative content analysis.ResultsAnalysis of the data yielded nine favorable conditions at three system levels supporting the participant’s use of research in clinical practice: two at the individual level (attitudes and motivation concerning research use; research-related knowledge and skills), four at the workplace level (leadership support; organizational culture; research-related resources; knowledge exchange) and three at the extra-organizational level (evidence-based practice guidelines; external meetings, networks, and conferences; academic research and education).ConclusionsSupportive conditions for physiotherapists’ use of research exist at multiple interdependent levels, including the individual, workplace, and extra-organizational levels. Research use in physiotherapy appears to be an interactive and interpretative social process that involves a great deal of interaction with various people, including colleagues and patients.

Developing Leadership in Managers to Facilitate the Implementation of National Guideline Recommendations: A Process Evaluation of Feasibility and Usefulness

“…[1][2][3][4] EBP involves the ethically sound application of research-based knowledge and includes the use of clinical practice guidelines (CPG) in clinical and organizational decision-making. In this study, leadership is conceptualized as "a multidimensional process of influence to enable staff members to use research evidence in clinical practice, and includes behaviors and activities of managers that exert direct or indirect influence on individuals, their environment, and organizational infrastructure" (p 128).…”

Evidence and/or Experience-Based Knowledge in Lifestyle Treatment of Patients Diagnosed as Obese?

“…4 Indeed, when evidencebased physiotherapy is debated, it is emphasized, first and foremost, as a moral and professional obligation in order to ensure effective and unbiased treatment to the benefit of the patients (Dannapfel, Peolsson, & Nilsen, 2013). For example, in their widely cited article in Physiotherapy Theory and Practice, defending evidencebased practice as "imperfect, but necessary", Herbert, Sherrington, Maher, and Moseley (2001) sum up what they consider to be the "overwhelming" strength of evidence-based physiotherapy:…”

“…This is interesting, given the emphasis on evidence-based practice (EBP) as a premise for physiotherapists' professional approach. Indeed, evidencebased practice is emphasized from the very start when students embark on their physiotherapy training, just as it is emphasized as paramount for physiotherapists as part of their professional development as clinicians (Dannapfel, Peolsson, & Nilsen, 2013). According to Sacket (1997), evidence-based practice (EBP) can be defined as:…”

“…In reality, however, a hierarchy of knowledge has come to dominate EBPa hierarchy that privileges research-based knowledge stemming from randomized controlled trials (RCT) as opposed to experience-based knowledge (Wellard & Heggen, 2011). Indeed, proponents of such a hierarchy regard randomized controlled studies as in effect the gold standard in terms of what counts as best evidence (Dannapfel, Peolsson, & Nilsen, 2013;Engebretsen, Heggen, Wieringa, & Greenhalgh, 2016;Gibson & Martin, 2003). Thanks to a quantitative research design -in which participants are randomly assigned to either an experimental group or a control group -researchers can measure the effect of the intervention itself.…”

“…Consequently, research-based knowledge stemming from randomized controlled trials increasingly came to shape clinical guidelines as well as debates concerning how to implement effective physiotherapy approaches in clinical practice. Proponents of EBP regard this pendulum shift away from clinical experience towards more emphasis on standardized procedures as paramount in legitimizing the physiotherapy profession, paving the way in terms of identifying and justifying effective interventions that will most benefit patients (Dannapfel, Peolsson, & Nilsen, 2013;Gibson & Martin, 2003;Turner, 2001). Such a stance makes sense, bearing in mind that, thanks to randomized controlled designs, physiotherapists increasingly have come to challenge established medical interventions as the most effective means of treating various conditions.…”