Abstract:

Introduction:
Background: Evidence Based Practice (EBP) is defined as the conscientious use of current best evidence in making decisions about patient care. It is composed of three components: clinical expertise, patient preference, and the best available external evidence. These three components should all be considered by clinicians as they attempt to provide the best care to their patients. Little knowledge exists as to how clinicians balance and value the three different components of EBP. Barriers to EBP include the lack of access to research, lack of time to read the increasing amounts of research and to determine how to apply the research to clinical situations. Current literature is aware of these problems in health care. A literature review did not find any studies that identified how Physical Therapists value and utilize the different components of EBP in their own clinical practice.

Purpose:
To determine how clinicians are valuing and utilizing the different components of EBP within their own clinical practice.

Hypothesis:
There will be variance in the way EBP is utilized among current clinicians.

Methods:
Participants included current physical therapists from across the country. A Qualtrics survey was developed and distributed to directors of clinical education which was then forwarded to their colleagues via email for a total of 75 responses. Questions from the survey range from whether clinicians know what evidence based practice is, to how one applies and implements evidence into their daily practice.
Data collection took place in May 2019.

Results:
Total number of subjects n=75. Figure 1 represents EBP according to the Sackett model. The results of this study suggests that PT’s mostly commonly rely on clinical expertise when treating the majority of their patients . Only when therapists treat chronic pain was there a difference between use of the parts of EBP, as compared to other scenarios.

Discussion:
The results suggest that clinical expertise is valued as most important when treating a patient, while patient preference is valued as least important. However, when treating a chronic condition, therapists were more likely to incorporate the patient’s preference into the treatment. Treatment of chronic cases most closely represented the expected model as seen in figure 3 compared to the actual model, figure 2.

Despite the increased focus on external evidence in PT education, there was no difference in willingness to base an intervention on external evidence over the PTs own expertise, regardless of the number of years a clinician has been practicing and PT degree. However, PTs were more likely to search for external evidence if the patient was not improving. Searching for external evidence when a patient does not improve makes sense since the PT’s clinical expertise has not resolved the patient’s concerns. No therapist reported they would search for external evidence based on a patient suggestion.

These results should call into question the way PT curriculums implement the components of EBP into the curriculum and how that emphasis is translated into clinical practice.

Conclusion:
Clinicians utilize clinical expertise most often compared to external evidence and patient preference, REGARDLESS OF EDUCATIONAL LEVEL, years of practice and treatment scenario. Further research is needed to determine how EBP is taught in PT curriculums and how EBP is translated into clinical practice.

Keywords:

Curriculum, Evidence based practice, Educational Level.