Evidence-based practice amongst physiotherapists in Malta.

Abstract

Evidence-Based Practice (E.B.P.) is the explicit ~se of current best evidence in making decisions about the care of individual patients and is a concept of growing importance for physiotherapy and allied health professions. E.B.P. is still evolving and the literature now describes Evidence-Based Healthcare, to extend the application of evidence-based medicine to all professions associated with healthcare including purchasing and management. Through E.B.P., the healthcare industry strives to provide the most effective care possible. While there is generally no disagreement about the importance and necessity of E.B.P., there are ongoing concerns about the implementation and sustainability of such initiatives.

This study was designed to get feedback from the major stakeholders relevant to physiotherapy services in Malta, namely all the practicing physiotherapists, the . manager of Physiotherapy Services and a sample of the patients. A questionnaire survey was sent to Maltese physiotherapists' to investigate self-reported practice, skills and knowledge of E.B.P. It examined differences between recent and experienced graduates, physiotherapists with low and high levels of training and physiotherapists working in private practice and hospital settings. Interviews with the Management of Physiotherapy Services and eight patients were conducted. The study combined the patients' and management's perspectives regarding their roles in the implementation of the concept, with the results from the questionnaire. Physiotherapists showed positive attitudes towards E.B.P. Recent graduates perceived they are more confident in Research and LT. than their more experienced colleagues,

but inadequate research resources and inability to effect change at their place of work, hinders their uptake of B.B.P. Physiotherapists working privately felt more confident in managing the research evidence and could accommodate E.B.P activities better than public service physiotherapists due to fewer issues with time and workload management. In contrast, physiotherapists working in the public service perceived they have better access to research resources at their place of work. Physiotherapists with a higher level of education felt more technically knowledgeable in managing the research evidence, but perceived lack of time and pressure from doctors and patients as barriers to E.B.P. Findings from the interviews indicated that although patients may feel safer with evidence-based treatment, they tend to adopt a passive stance to information and ultimately leave their care in the 'expert' hands of their physiotherapist. The culture of actively involving patients in their treatment plan is still in a very early stage and this may be due to lack of organisational support or interest from the patients' side.

In view of these findings, recommendations pertaining to the clinicians themselves, the professional bodies and the management, as well as the consumers of physiotherapy services were put forward. The implications for adopting the strategies suggested to foster the uptake of B.B.P. amongst physiotherapists in Malta were also discussed.