3 Tips to put Evidence into Practice
In collaboration with a physiotherapy practice based research network our team recently published this paper about the challenges of providing evidence-based practice. The following blog summarises what we found and how it applies to you – the busy clinician or clinic owner.
Why this study is important
Putting evidence into practice can be difficult. Research tells us that physiotherapists experience many barriers when trying to put evidence into practice (1, 2, 3, 4, 5, 6, 7, 8, 9, 10). But previous research has failed to be specific about the behaviours involved in putting evidence into practice, such as accessing evidence or clinical decision making. Additionally, research assessing barriers to evidence-based practice rarely uses any rigorous behavioural theory.
What did we do?
We aimed to describe:
- Opinions toward evidence
- How evidence is accessed
- Factors influencing evidence access
- Factors influencing evidence application
All for physiotherapists working in regional areas.
We did a mixed-methods study. Mixed-methods is a catch-all term for many different types of studies, with a common theme of using different types of data to answer research questions. We used quantitative data from online surveys and qualitative data from focus groups to address our aims. We focused on specific behaviours, and used behavioural theory (the Theoretical Domains Framework).
What did we find?
Participants reported that evidence is important when making clinical decisions, but is only one factor that goes into treatment decisions. We found that clinicians typically spend less than 30 minutes per week on accessing evidence. The limited time seems to be split evenly across many mediums (blogposts, podcasts, full text articles). Participants indicated that intrinsic factors like their knowledge or skills in finding and accessing evidence weren’t as problematic as contextual factors like environmental and systemic factors, like funding structures or incentives for evidence-based care, and social factors, like lacking or having a culture of accountability and mentorship.
Some of the key findings from the study were:
1. Time poor clinicians consume evidence in many different forms and often not in published manuscripts in academic journals
The ‘traditional’ academic system of publishing in journals may not work for all. Clinicians spend a small amount of time accessing evidence, and social media is an important access mechanism for many clinicians. Furthermore, paywalls are a significant barrier for most clinicians. Services that make digestible chunks of evidence available to clinicians on social media should be encouraged. Clinicians like to access evidence through multiple formats including podcasts and blogs.
2. Mentors, and practices can enable the application of evidence in practice.
Practice owners are still a significant mentor to younger clinicians. Mentors need to be available, and keep up to date. There is no evidence that a busy clinic can’t also be evidence-based. Many barriers for clinicians applying evidence relate to the lack of social and environmental support from their clinic to access evidence. To enable better access and application of evidence, it may require senior clinicians (as mentors) and clinics to place value on time to access and consume evidence. For example, paying for time during the clinical day to access evidence, or providing access to evidence platforms.
3. Clinicians often find research questions are irrelevant or treatments included in research don’t make sense in the clinic
This may stem from researchers and clinicians working silos. Researchers and clinicians should work together, and learn together about how to improve the relevance and implementability of research.
Some take-home messages for you are to:
- Consider how your clinic values time to access evidence: Is it an ‘additional extra’, or do you consider putting evidence into practice in equal partnership with your core business?
- Make sure young clinicians have access to up to date mentors: Do you connect with mentees (or mentors)?
- Help make research more clinically relevant. If a lack of relevant, implementable research is an issue for you then perhaps it is time to better connect the silos of research and clinical practice.
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