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Practitioner and Organizational Barriers to Evidence-based Practice of Physical Therapists for People With Stroke

NM Salbach, PhD, is Postdoctoral Fellow, Department of Physical Therapy, Faculty of Medicine, University of Toronto, 160–500 University Ave, Toronto, Ontario, Canada M5G 1V7
SB Jaglal, PhD, is Associate Professor, Department of Physical Therapy, Faculty of Medicine, University of Toronto
N Korner-Bitensky, PhD, is Associate Professor, School of Physical and Occupational Therapy, McGill University, Faculty of Medicine, Montreal, Quebec, Canada
S Rappolt, PhD, is Associate Professor, Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of Toronto
D Davis, MD, is Vice President, Continuing Health Care Education and Improvement, Association of American Medical Colleges, Washington, DC, and Adjunct Professor, Faculty of Medicine, University of Toronto

Address all correspondence to Dr Salbach at: nancy.salbach{at}utoronto.ca

Background and Purpose: The purpose of this study was to identify practitioner barriers (education, attitudes and beliefs, interest and perceived role, and self-efficacy) and organizational barriers (perceived support and resources) to physical therapists’ implementation of evidence-based practice (EBP) for people with stroke.

Subjects: The participants were 270 physical therapists providing services to people with stroke in Ontario, Canada.

Methods: A cross-sectional mail survey was conducted.

Results: Only half of respondents had learned the foundations of EBP in their academic preparation or received training in searching or appraising research literature. Although 78% agreed that research findings are useful, 55% agreed that a divide exists between research and practice. Almost all respondents were interested in learning EBP skills; however, 50% indicated that physical therapists should not be responsible for conducting literature reviews. Average self-efficacy ratings were between 50% and 80% for searching and appraising the literature and below 50% for critically appraising psychometric properties and understanding statistical analyses. Despite Internet access at work for 80% of respondents, only 8% were given protected work time to search and appraise the literature.

Discussion and Conclusion: Lack of education, negative perceptions about research and physical therapists’ role in EBP, and low self-efficacy to perform EBP activities represent barriers to implementing EBP for people with stroke that can be addressed through continuing education. Organizational provision of access to Web-based resources is likely insufficient to enhance research use by clinicians.

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This article has been cited by other articles:

				N. M. Salbach, P. Veinot, S. Rappolt, M. Bayley, D. Burnett, M. Judd, and S. B. Jaglal Physical Therapists' Experiences Updating the Clinical Management of Walking Rehabilitation After Stroke: A Qualitative Study Physical Therapy, June 1, 2009; 89(6): 556 - 568. [Abstract] [Full Text] [PDF]

				P. Q McGinnis, L. M Hack, K. Nixon-Cave, and S. L Michlovitz Factors That Influence the Clinical Decision Making of Physical Therapists in Choosing a Balance Assessment Approach Physical Therapy, March 1, 2009; 89(3): 233 - 247. [Abstract] [Full Text] [PDF]

				N. M Salbach and N. Korner-Bitensky Author Response Physical Therapy, October 1, 2007; 87(10): 1305 - 1306. [Full Text] [PDF]