Towards evidence-based physiotherapy - research challenges and needs.

143 Editorial The evidence-based practice (EBP) movement has gained ground steadily in physiotherapy over the past decade. Influential researchers and clinicians have argued that physiotherapists have a moral and professional obligation to move away from assessment and treatment methods based on anecdotal testimonies or opinion (Grimmer-Somers 2007). However, the growing volume of high-quality clinical research makes it difficult for clinicians to keep pace with the latest evidence. Simultaneously, the practice of physiotherapy has become increasingly complex due to changes in health care systems that entail higher demands on physiotherapists to provide effective and efficient management of patients amidst high patient turnover. Research on implementation of EBP in physiotherapy has established many barriers to developing a more evidence-based physiotherapy practice. Most frequently identified barriers include factors such as time restrictions, limited access to research, poor confidence in skills to identify and critically appraise research, and inadequate support from colleagues, managers and other health professionals (Jette et al 2003, Iles & Davidson 2006, Grimmer-Somers et al 2007). Limited research in some areas of physiotherapy also constitutes an obstacle to practising evidence-based physiotherapy (Fruth et al 2010). Some authors express the influences on EBP in physiotherapy as facilitators rather than barriers. For example, Bridges et al (2007) identified several personal characteristics that may facilitate EBP: self-directed learning, a postgraduate degree, a belief that research (particularly in a digested format such as clinical guidelines) can be used in everyday clinical decision-making without interfering with productivity and an efficient patient flow, and nonconformity, ie, not being afraid to diverge from traditional or common practice if newer research reveals more effective methods. Salbach et al (2011) identified online access to research summaries and systematic reviews as a potentially important facilitator because this can save time to search and critically evaluate research articles. Studies on barriers and facilitators for EBP are potentially useful for designing and implementing interventions to change these factors and increase the extent to which EBP is implemented. However, this research has certain challenges and limitations. Surveys of EBP barriers and facilitators have assessed the individual importance of a number of factors. However, there might be synergistic effects such that two seemingly minor barriers constitute an important obstacle to EBP if they interact. It is also plausible that changes in specific barriers affect other barriers, suggesting that there are no simple cause-and-effect relationships between individual factors and the extent to which EBP is implemented. …