Barriers to evidence-based practice implementation in physiotherapy: a systematic review and meta-analysis

Abstract

Background To review and meta-analyse the evidence about the prevalence of barriers to evidence-based practice (EBP) reported in physiotherapy. Methods Two independent investigators conducted an extensive electronic search in EMBASE, PubMed, Scopus, Web of Science and CINAHL databases from their inception to July 2020 and included the retrieved articles if they investigated barriers to EBP among physiotherapy professionals. Subsequently, they extracted data and assessed the methodological quality using a scale described in a similar previous study. Outcome for meta-analysis was frequency of each reported barrier. Sub-analyses were performed grouping studies based on countries where surveys were performed, classified as either developed or developing countries. Results Twenty-nine articles were included in the systematic reviews and meta-analysis. Risk of bias assessment of included studies showed a median score: 4 points (interquartile range: 3-4). The findings of meta-analysis revealed that lack of time was the most frequently reported barrier (53.0% [95%CI 44.0-62.0]), followed by language (36.0% [95%CI 16.0-62.0]), lack of access (34.0% [95%CI 23.0.27]) and lack of statistical skills (31.0% [95%CI 20.0-44.0]). Lack of skills and lack of generalizability were declared as a barrier by 27.0% [95%CI 18.0-38.0] and 23.0% [95%CI 15.0-33.0] of responders, respectively. Lack of support and lack of interest are less frequent, with 16.0% [95%CI 11.0-24.0] and 9.0% [95%CI 6.0-15.0] of responses, respectively. Barriers reported in investigations performed in developed countries were less frequent when compared to those performed in developing countries. Conclusion Organizational issues and methodological skills seem key issues to allow the implementation of EBP, suggesting the need to adopt or enhance organizational and training strategies to facilitate the implementation of the EBP. Quantitative synthesis showed high heterogeneity for all analyses and, therefore, pooled data should be interpreted with caution.

Evidence-Based Physiotherapy Practice in Paediatric Subdiscipline: A Cross-Sectional Study in Saudi Arabia

“…Several studies have investigated the effectiveness of EBP learning theories for undergraduate students; however, there is no conclusive evidence for the most effective theory for developing and supporting EBP capability [ 5 , 6 ]. Although cumulative evidence indicates that physiotherapists have a positive attitude regarding EBP and its implementation, further education and training are required in this field [ 3 , 7 , 8 ]. A recent systematic review (2021) identified barriers to implementing EBP in physiotherapy.…”

“…A recent systematic review (2021) identified barriers to implementing EBP in physiotherapy. In addition to the language barrier, commonly reported barriers include lack of time to discover and appraise evidence; skills to search, identify, and apply the best evidence; and access to the evidence [ 8 ]. Further barriers include a low perception of EBP, lack of interest or support from employers, statistical understanding [ 7 ], and educational barriers [ 8 ].…”

Tailored GuideLine Implementation in STrokE Rehabilitation (GLISTER) in Germany. Protocol of a Mixed Methods Study Using the Behavior Change Wheel and the Theoretical Domains Framework

“…As a restricted implementation of recommended interventions can contribute toward avoidable disabilities and indeed harm ( 77 ), guideline implementation is relevant for any health condition ( 78 , 79 ) and for any healthcare profession ( 80 , 81 ). Barriers to guideline-compliant practice have been found to be individual, external, or guideline related, and these have been studied both in general ( 82 – 84 ) and in specific circumstances ( 85 , 86 ). Knowledge of existing barriers, as well as the use of theoretical underpinning of behavioral change, is recommended to develop promising strategies for addressing the factors that determine guideline adherence ( 87 ).…”

Enablers and barriers to evidence implementation in complementary medicine: A systematic review

“…Structural factors represent major barriers to evidence implementation for most health professions 64 , 65 , 66 , 67 ; this was no exception for CM practitioners. Consistent with other professions, 64 , 65 , 66 , 67 ‘availability’ of time and ‘availability’ of clinical evidence were amongst the most frequently reported structural barriers.…”

“…Structural factors represent major barriers to evidence implementation for most health professions 64 , 65 , 66 , 67 ; this was no exception for CM practitioners. Consistent with other professions, 64 , 65 , 66 , 67 ‘availability’ of time and ‘availability’ of clinical evidence were amongst the most frequently reported structural barriers. Notwithstanding, few studies in this review reported enablers specifically targeting this barrier (with suggestions limited to supporting the generation of CM evidence and CM guidelines).…”