With CMS value-based care now in place, applying evidence based principles to clinical practice is more important than ever.
While therapists may understand the importance of evidence based practice (EBP) and have possibly even explored recent research, when it comes to actually implementing the knowledge, there are often barriers within clinical settings that prevent this from occurring.
Barriers to Implementing EBP
According to a systematic review in Manual Therapy, in many cases, the major barrier is lack of training provided to health professionals in identifying and comprehending high quality studies.
The second major barrier is health policies and complexities in the standards of practice within each organization.
Barriers may include:
- Lack of time
- Misperceptions about EBP
- Lack of access to full journal articles
- Lack of skills in finding studies
- Lack of skills in understanding the studies
- Lack of support and interest from employers
- No policies or training at work to implement evidence
- Lack of resources
- Conflicting results of studies
- Inapplicable characteristics
- Lack of interest
Finding solutions for implementing EBP is a combined effort from employers and therapists alike.
How Many Therapists Use EBP?
The results overall remain a little inconsistent but show:
- Rate of formal training in EBP: 21 – 82%
- Rate of weekly database use: 8 – 32.8%
- Monthly database use: 32.8 – 65%
- Using databases to inform clinical decisions: ~50%
- Efficiency in finding and reading studies: 50 – 80%
- Critical appraisal of statistics: <50%
Although it is clear that EBP is important, it is not used as frequently as it could (or should) be, therapists preferring (most of the time) to rely on the knowledge of colleagues and even patient guidance.
5-Step Process to Evidence Based Practice
According to Evans et al., “Evidence-Based Practice is a 5 step process whereby clinicians integrate best research evidence with clinical expertise and client preferences, producing the most appropriate and effective service.”
Featured Image Credit: Department of Health Library Service
Your task as a therapist is to ask appropriate clinical questions, find supportive research, interpret the evidence and translate that into clinical practice to serve policy, standards, and patient needs.
Hierarchy of Evidence
When searching for papers to critically evaluate, look for high quality studies based on the following hierarchy.
Featured Image Credit: Evidence Based Practice in Health via University of Canberra
Locating High Quality Evidence
One of the easiest ways to keep on top of the latest research is to join an association such as the New York Physical Therapy Association, or the American Physical Therapy Association, as they often provide new research updates to members.
The Cochrane Library is considered the most reputable source for healthcare systematic reviews and randomized trials.
Find a list of manual therapy publications here.
In future we’ll explore how to put evidence based principles into practice in physical therapy, occupational therapy and speech therapy.