Perceptions of Evidence-Based Practice Adoption By Physical Therapy Clinical Educators: A Qualitative Study
Purpose/Hypothesis: Evidenced-based practice (EBP) utilizes clinical expertise, healthcare research, and patient preferences to inform decisions; and places a greater focus on research evidence linked to patient-centered care.4 Historically, clinicians have relied on their experiences and expert opinion, but effective use of EBP should help clinicians realize fewer errors in judgment while improving patient outcomes.5,6 This study investigates the extent to which physical therapy clinical instructors (CIs) and site coordinators of clinical education (SCCEs) feel prepared to adopt and use EBP in everyday practice. Specific aims are to gain a deeper understanding utilizing 2 interview questions: “To what extent do you believe EBP will improve/not improve the effectiveness of physical therapy?” and “Based on your education and training, how well prepared do you feel to use EBP in daily practice?” Number of Subjects: Ten CIs/SCCEs were recruited from a sample that participated in a quantitative survey assessing the propensity to adopt EBP. It included 257 CIs/SCCEs licensed as PTs in the United States, and listed in the APTA Clinical Site Information Form database as employees at clinical sites affiliated with Emory University. Purposeful sampling ensured equal distribution by gender, type of degree held, and clinical settings. Materials and Methods: A single investigator asked 2 standardized questions followed by probe questions. A within and cross-case, qualitative, descriptive, content analysis was used to analyze the interview transcripts.1 Coding was performed by all researchers individually, and then the group reached consensus on meaning statements, categories and themes. Results: Interview responses produced four themes regarding EBP: 1) level of effectiveness, 2) perceived barriers, 3) level of preparedness, and 4) perceived promoters. Fifty-three percent of responses stated benefits of EBP; although 47% identified challenges to implementing it in clinical practice. Conclusions: Analysis described a deeper understanding of the benefits and challenges related to implementation of EBP in daily practice by physical therapy clinical educators. Level of effectiveness, level of preparedness, perceived barriers, and perceived promoters were identified themes. Most participants believed EBP to be important to justify services; however, some expressed concerns that it can threaten the art of individualized services and time constraints can interfere with implementation. Having sufficient time in a therapist’s day, a supportive organization, and appropriate education in EBP can further propel its use. Clinical Relevance: The 2009 goal of the National Academy of Medicine was: “By the year 2020, 90% of clinical decisions will be supported by accurate, timely, and up-to-date clinical information, and will reflect the best available evidence.4,5” This study identifies barriers to the physical therapy profession reaching this goal, and concludes that ongoing education regarding accessing and assessing evidence, as well as having a supportive organizational culture are necessities.