Evidence-based practice in clinical physiotherapy education

Project summary

Evidence-based practice (EBP) should be integrated into entry level physiotherapy undergraduate education to ensure that future graduates have the necessary EBP knowledge, skills and attitudes. The overall aim of this study was to contribute to knowledge and understanding of how to ensure use of EBP in clinical physiotherapy education. 

This study consists of three papers: a cross-sectional study (published), an interpretive description study (published) and a non-randomized controlled study (Submitted, review process). In the cross-sectional study, we compared self-reported EBP behaviour, abilities and barriers during clinical placements reported by five cohorts of final year physiotherapy students’ with different EBP exposure across a 3-year bachelor programme. The second study was an interpretive description study we explored beliefs, experiences and attitudes related to third year students’ use of evidence-based practice in clinical physiotherapy education among students, clinical instructors and visiting teachers. The third study was a non-randomized controlled study where we evaluated the short and long term impact of a six-month multifaceted and clinically integrated training program in EBP on the knowledge, skills, beliefs and behaviour of CIs. Three different self-administered questionnaires pre- and post-intervention, and at six-month follow-up was used: 1) The Adapted Fresno test, 2) the EBP Belief Scale and 3) the EBP Implementation Scale. The analysis approach was linear regression modeling using Generalized Estimating Equations.

In total, 180 out of 246 third year physiotherapy students, who had recently completed a clinical placement, filled out the questionnaire (73 %) we used in the survey. The association between the level of EBP exposure and students’ self-reported EBP behaviour, abilities and barriers was low for most items in the questionnaire, and a statistically significant association related to students’ use of research evidence in clinical settings was not found. Four integrative themes emerged from the analysis of the interviews: “attempt to apply EBP”, “novices in clinical practice”, “prioritize practice experience over EBP” and “lack role models in EBP”. Both students and clinical instructors perceived a need for role models in EBP. In total, 29 CIs agreed to participate in the intervention study: 14 were invited to participate in the intervention group and 15 were invited to participate in the control group. One in the intervention group and five in the control group were lost to follow-up. At follow-up, the group difference was statistically significant for two of the outcome measures: the AFT (mean difference=37, 95% CI (15.9 -58.1), p<0.001) and the EBP Beliefs scale (mean difference=8.1, 95% CI (3.1 -13.2), p = 0.002). Comparing measurements over time, we found a statistically significant increase in mean scores related to all outcome measures for the intervention group only.

Data from the two first studies in this study indicated that undergraduate physiotherapy students struggled with applying EBP knowledge and skills during clinical education. CIs are in a position to influence students during clinical education and are important potential role models also in EBP. Thus, a multifaceted and clinically integrated training program in EBP was evaluated among CIs. This EBP course was successful in improving EBP knowledge, skills and beliefs among CIs.

Further two papers are planned, using data collected on a process evaluation of the intervention study that involved two focus-group interview among CIs and questionnaires on satisfaction during and after EBP program (Paper 4), and quantitative data (The Adapted Fresno test, the EBP Belief Scale and the EBP Implementation Scale) among students pre- and post-intervention (Paper 5).

 

Method

Survey, Interpretive description (focus-group interview), a non randomised controlled study