Factors influencing evidence-based practice in prosthetics and orthotics

Abstract

Background: The importance of evidence-based practice is being recognized across a broad range of healthcare disciplines as a means for improving patient outcomes and also efficiently managing healthcare resources.

Objective: The objective of this work was to obtain information from clinicians about the underlying barriers and facilitators relating to evidence-based practice in prosthetics and orthotics.

Study design: Cross sectional survey.

Methods: An internet survey was developed and distributed to 300 prosthetists and orthotists currently practicing in Canada.

Results: A principal component factor analysis of the survey results revealed ten primary factors affecting evidence-based practice. These include time constraints, workload and system demands, limited relevant evidence from research, and gaps in skills and knowledge required to perform evidence-based practice.

Conclusions: Clinicians value research as a means of improving clinical practice, but they are faced with a number of practical barriers in performing evidence-based practice.

Clinical relevance

This study provides empirical data about the underlying barriers and facilitators relating to evidence-based practice in prosthetics and orthotics. Such data are essential in order to inform those involved in improving existing clinical practices, including educators, professional organizations, and governing bodies.

Keywords

Evidence-based evidence-based practice clinical practice clinical care prosthetics orthotics survey rehabilitation research

Introduction

Evidence-based practice (EBP) refers to the process of ‘integrating individual clinical expertise with the best available external clinical evidence from systematic research’¹ so as to provide the best clinical care possible. The importance of EBP is being recognized across a broad range of healthcare disciplines as a means to improve patient outcomes while efficiently managing healthcare resources.¹ Moreover, steps are being taken to develop an understanding of the inhibitors and facilitators of EBP in the various healthcare areas, so that measures can be taken to ensure its effective utilization.^2–9

In the field of prosthetics and orthotics (P&O), EBP is similarly receiving increasing attention. In the early 1990s, a number of publications began to elucidate some of the underlying components of EBP in P&O, including aspects relating to researching published information,¹⁰ making inferences from research,^11,12 training and education related to EBP,^13,14 and participation of clinicians in research.^15,16 Subsequently, a review by Ramstrand and Brodtkorb¹⁷ has highlighted the importance of EBP in the development and growth of the P&O industry, cautioning that inaction in this respect may cause P&O practice standards to fall behind those being implemented in allied healthcare areas such as physical therapy.¹⁷ To facilitate EPB, the authors stress that a cultural shift in the P&O profession is vital in the way that clinicians perceive and utilize clinical research. And while they describe the factors that are likely to play a role in the adoption of EPB, such as lack of expertise, time and motivation, there is currently limited empirical data specific to the P&O field that can further aid our understanding of these underlying factors.

Allied healthcare areas have taken initiatives to address these gaps in knowledge about EBP in their respective areas. In physiotherapy, for example, Jette et al.² and more recently Salbach et al.^4,5 used survey questionnaires to examine the EBP-related barriers, beliefs, attitudes, knowledge and behaviours of practising physical therapists. To gain similar insights, comparable approaches have been utilized in nursing.^7,9 For example, using a survey instrument, Nagy et al.⁷ established six factors contributing to evidence-based nursing, which include (1) the availability of support to develop EBP, (2) belief in the value of EBP, (3) skills in locating and evaluating research reports, (4) clinical usefulness of research, (5) knowledge of research language and (6) time constraints.⁷

Similarly, in order to develop an understanding of the factors that facilitate or inhibit EBP in P&O, empirical data are needed about existing practices as well as clinicians’ attitudes and beliefs relating to EBP. The purpose of this work was to gain information from clinicians about the various aspects of EBP, including current practices, their beliefs about the value and usefulness of EBP in P&O, and the limitations associated with training, time and facility support that are needed to perform EBP effectively.

Methods

Study overview

A cross-sectional email/internet survey study was conducted of certified prosthetists and orthotists providing services in Canada. A web-based questionnaire was prepared based on an initial review of literature and pilot testing, and the consideration of protocols outlined by Dillman.¹⁸ The survey was administered via an email invitation, with two follow-up emails and one phone call at two to three week intervals to encourage response. Prior to its commencement, the study was approved by the Holland Bloorview Kids Rehabilitation Hospital Human Research Ethics Committee. Consent was considered implied by clinicians who submitted the questionnaire.

Participants

Certified prosthetists and orthotists were considered eligible as long as they were currently practising in Canada. The database of clinicians in Canada was obtained from the Canadian Board for Certification of Prosthetists and Orthotists (CBCPO), a publicly available website that includes email addresses and phone numbers (http://www.cbcpo.ca/). The original list of 324 names was reviewed and duplicate listings were eliminated. The exclusion of invalid email addresses as well as seven clinicians originally involved in pilot testing resulted in a final list of precisely 300 names.

Instrument

A questionnaire was designed to identify clinician and institutional factors influencing EBP. The items in the surveys were based on EBP studies performed in related fields, including nursing,⁷ physical therapy⁵ and medicine,¹⁹ and were adapted to ensure relevance to the P&O field. Items in the survey were broadly categorized into three sections, including (1) demographics, (2) information sources and (3) barriers and beliefs. More specifically, the ‘demographics’ section consisted predominantly of respondents’ demographics and information about work settings (11 items). The 21 items in the ‘information sources’ section aimed to identify the sources of information clinicians have access to, and which of these sources they are most likely to use. The ‘barriers and beliefs’ section consisted of 34 items aimed to identify factors relating to self-efficacy to perform EBP (skills, knowledge and training), peer and organizational support, time constraints, access to information sources, perceived value of EBP in clinical and patient care, system and financial constraints, and general perceptions about the quality of the evidence currently available. Moreover, two questions were included to assess the respondents’ understanding of the hierarchy of evidence in published literature. All questions in these latter sections were in the form of statements to which respondents expressed their level of agreement on a 5-point Likert scale, with the options (1) strongly disagree, (2) disagree, (3) neutral, (4) agree and (5) strongly agree. Statements were phrased positively and negatively so as not to reflect preferences toward EBP. For the analysis, the scores for the negatively phrased items were reversed so that scores could be aggregated. Moreover, the term evidence-based practice (or EBP) was not used except when explicitly defined within the item, as not all clinicians may be familiar with it.

An electronic version of the survey was developed using the Fluid Surveys online survey tool. The survey was initially pilot tested with a convenience sample of seven prosthetists and orthotists to evaluate comprehension and readability. Feedback during pilot testing was collected by providing an input form after each of the three main sections. Based on the feedback, minor changes were made to the survey, which included the removal of several items that were felt to be too redundant. Moreover, it was established that the survey took about 10 to 15 minutes to complete and that this was acceptable. The questionnaire content was finalized and professional translation services were used to develop a French version. The questionnaire content can be found in tables 1 and 3. Table 1 includes the questions relating to ‘demographics’ and ‘information sources’, and table 3 to ‘barriers and beliefs’.

Table 1.

Summarized questions and response options for the demographics and information sources part of the questionnaire.

Question	Response Options
Gender	Male/female
Age (years)	<30, 30–39, 40–49, 50–59, 60+
Number of years practicing	<5, 5–9, 10–19, 20–29, 30+
Please indicate your prosthetic and orthotic credentials	Certified orthotist, Certified prosthetist, Certified orthotist and prosthetist, Other
Please check off each academic degree or diploma that you have earned	Undergraduate degree, Master’s degree, Doctoral (PhD) degree, College diploma, other
Practice setting	Public, Private, Other
Number of clinicians (prosthetic or orthotic) at your facility (including yourself)	1, 2, 3, 4, 5+
Practice location	Maritime provinces, Quebec, Ontario, Manitoba, Saskatchewan, Alberta, British Columbia, Northern Canada
In the past ten years have you held an executive position within a provincial, national or international organization in prosthetics and orthotics?	Yes/No
Have you ever been the author or co-author of an article in a peer reviewed publication?	Yes/No
Please state if you are an owner (or co-owner) of your practice	Owner (co-owner), Not an owner
Please state whether or not you have the means to access the following sources of information: Peer reviewed journal articles (e.g. Gait and posture), Industry conferences (e.g. ISPO), Industry courses/seminars, Industry publications (e.g. ACPOC newsletter)	Have access to, Do not have access to*
You said that you do not have access to the following sources of information through your practice. Please indicate whether or not you would use them if you did have access: Peer reviewed journal articles (e.g. Gait and posture), Industry conferences (e.g. ISPO), Industry courses/seminars, Industry publications (e.g. ACPOC newsletter)	Would use if I had access to, Would not use if I had access to*
Please indicate the likelihood of using each source of information to seek out an answer to a specific question you may have during practice: Peer reviewed journal articles (e.g. Gait and posture), Industry conferences (e.g. ISPO), Industry publications (e.g. ACPOC newsletter), Online message board/listserve, Online keyword search, Colleagues	Very likely to use, Somewhat likely to use, Neither likely nor unlikely, Somewhat unlikely to use, Very unlikely to use*
In the past month please indicate approximately how many times you have used each source of information: Peer reviewed journal articles (e.g. Gait and posture), Industry conferences (e.g. ISPO), Industry publications (e.g. ACPOC newsletter), Online message board/listserve, Online keyword search, Colleagues	0, 1, 2, 3–4, 5–9, 10+ *
In the past year approximately how many days have you spent attending industry conferences?	0, 1, 2, 3–4, 5–9, 10+

Note: these choices are provided individually for each source.

Table 2.

Respondent characteristics from ‘demographics’ section of the questionnaire (n = 114).

Respondent Characteristics	n	%
Sex
Male	76	66.7%
Age (years)
<40	32	28.1%
40–49	42	36.8%
50+	40	35.1%
Years practicing
<10	24	21.1%
10–19	36	31.6%
20–29	32	28.1%
30+	22	19.3%
Credentials
Orthotist	60	53.6%
Prosthetist	37	33.0%
Both	15	13.4%
Highest degree
Diploma/certificate	44	38.6%
Bachelor's	56	49.1%
Master’s	7	6.1%
Other	7	6.1%
College Diploma	92	80.7%
Facility
Public	49	43.0%
Private	63	55.3%
Other	2	1.8%
No. of clinicians at facility
1–2	47	41.2%
3–4	26	22.8%
5+	41	36.0%
Practice location
Maritime provinces	14	12.3%
Quebec	8	7.0%
Ontario	53	46.5%
Manitoba	6	5.3%
Saskatchewan	7	6.1%
Alberta	17	14.9%
British Columbia	9	7.9%
Member of professional organization
Yes	52	45.6%
No	62	54.4%
Journal article author/co-author
Yes	32	28.1%
No	82	71.9%
Owner or co-owner
Yes	39	62.0%
No	24	38.0%

Table 3.

Questions, responses and analysis results from the ‘barriers and beliefs’ section of the questionnaire. Factors predicted by varimax rotation factor analysis and given a descriptive label. In this table only, responses were collapsed similar to Nagy et al. 2001⁷ so that ‘Agree’ includes both ‘Strongly agree’ and ‘Agree’ (scores 4 and 5) and ‘Disagree’ includes ‘Strongly disagree’ and ‘Disagree’ (scores 1 and 2). The ‘Neutral’ category includes scores of 3.

Factor and corresponding items	n	Agree	Neutral	Disagree
FACTOR 1: VALUE of research in improving clinical practice (Cronbach’s alpha = 0.866)
I am sure that using results from research in clinical practice will improve the care that I deliver to my patients	99	74.7%	18.2%	7.1%
I believe that evidence based practice results in the best clinical care for patients	99	71.7%	24.2%	4.0%
I am enthusiastic about using research to improve my practice	99	69.7%	25.3%	5.1%
I would feel confident about changing policy at my facility if there were well defined processes to do so	99	66.7%	25.3%	8.1%
Seeing other people using research findings to change clinical practice motivates me to do the same	99	68.7%	27.3%	4.0%
Evidence derived from research that I have learned about helps me fulfil the responsibilities of my job	99	82.8%	14.1%	3.0%
Utilizing prosthetic and orthotic research is an important way of improving the quality of patient care	99	92.9%	5.1%	2.0%
FACTOR 2: System LIMITATIONS and constraints in applying EBP (Cronbach’s alpha = 0.729)
The process of adapting research results into practice DOES NOT place other demands on already overloaded clinicians	108	25.0%	20.4%	54.6%
The research generated does not produce many contradictory results	99	25.3%	45.5%	29.3%
I believe that I can overcome barriers in implementing research results into daily clinical practice	99	52.5%	39.4%	8.1%
I believe incorporating the results found in research into daily clinical practice is NOT difficult	99	30.3%	26.3%	43.4%
It DOES NOT take too much time to implement evidence found in research into daily clinical practice	99	40.4%	42.4%	17.2%
Research articles DO NOT take so long to get published that they are out of date when you get to read them	99	55.6%	37.4%	7.1%
FACTOR 3: SKILLS and abilities to perform EBP (Cronbach’s alpha = 0.742)
I DO feel I have the skills to properly use an online database to search for articles	108	73.1%	16.7%	10.2%
I have the necessary skills to evaluate research reports	108	68.5%	17.6%	13.9%
I DO NOT need more skills in evaluating research before I can use it to change practice	108	45.4%	29.6%	25.0%
I am able to generate changes in practice based on recent research findings	108	73.1%	21.3%	5.6%
FACTOR 4: FACILITY support and attitudes about EBP (Cronbach’s alpha = 0.697)
Clinicians in my facility have shown that it is possible to change practice on the basis of research findings	108	67.6%	22.2%	10.2%
My facility has a climate which encourages staff to pursue new ideas	108	86.1%	7.4%	6.5%
My facility encourages me to carry out research	108	38.9%	48.1%	13.0%
Prosthetic and orthotic research is of interest to clinicians	99	87.9%	10.1%	2.0%
FACTOR 5: TIME to devote to EBP (Cronbach’s alpha = 0.736)
I feel I can read and implement research generated evidence into practice in a time efficient manner	108	45.4%	30.6%	24.1%
I have the time to read research articles	108	37.0%	29.6%	33.3%
I believe that I can search for the best evidence to answer clinical questions in a time efficient way	99	35.4%	25.3%	39.4%
I am sure about how to measure the outcomes of clinical care	99	36.4%	24.2%	39.4%
FACTOR 6: KNOWLEDGE and understanding of EBP (Cronbach’s alpha = 0.716)
I understand the language and terms of research articles	108	69.4%	24.1%	6.5%
I know how to utilize the results found in research sufficiently enough to make practice changes	99	59.6%	26.3%	14.1%
I understand the procedure necessary in implementing evidence based practice	99	65.7%	25.3%	9.1%
FACTOR 7 : RELEVANCE of research to clinical practice (Cronbach’s alpha = 0.481)
I believe that the care that I deliver is supported by evidence found in research	99	50.5%	37.4%	12.1%
Most prosthetic and orthotic research is relevant to clinical practice	99	37.4%	43.4%	19.2%
FACTOR 8: ACCESS to research information (Cronbach’s alpha = 0.654)
I DO have access to the journal articles that I would like to read	108	71.3%	13.9%	14.8%
I have access to an online database to search for journal articles	108	63.0%	15.7%	21.3%
FACTOR 9: Research PRESENTATION format
I find the typical journal/research presentation method (introduction, methods, results, discussion) adequate	99	54.5%	31.3%	14.1%
FACTOR 10: FINANCIAL support for conferences
Financial support to attend conferences is available if I apply to my facility	108	79.6%	13.0%	7.4%

Note: Questions with terms in CAPITAL letters have been rephrased from negative to positive statements.

Analysis

To facilitate the grouping of related items in the ‘barriers and beliefs’ section, an exploratory factor analysis with variax rotation was performed.²⁰ The criterion for the existence of a factor was an eigenvalue of greater than 1.0. The common theme of each resulting factor was assessed and a descriptive label attached to each factor based on a consensus of the authors. The internal consistency of factors was subsequently assessed using Cronbach’s alpha coefficient. Statistical analyses were performed in SAS statistical software.

Results

Demographics

The survey was emailed to 300 addresses and after follow-up contact, 114 surveys were returned. Fifteen of these surveys were partially completed, but included complete demographic information and full information in either the ‘information sources’ section or the ‘barriers and beliefs’ section. This represents a 38% response rate. The actual number of respondents for each item can be found in tables 2 and 3. The respondents’ characteristics are summarized in table 2. Male respondents outnumbered females by two to one, which is likely representative of a profession that has traditionally been male dominated. Only two respondents were under the age of 30 years, while five were over 60 years old. The majority of respondents (93.8%) were between 30 and 60 years old with a relatively even distribution across those ranges. The majority (59.7%) had been practicing for 10 to 30 years.

A slight majority (55.3%) of respondents worked in private facilities, while the remainder were employed in public institutions. Most (41.2%) worked in small clinics of one to two clinicians and about 36.0% of respondents worked in clinics with five or more clinicians. The highest representation of respondents came from the province of Ontario (46.5%), which appears reasonable given that 39% of Canada’s total population resides in Ontario.²¹

Nearly half (49.1%) of all respondents reported having a bachelor’s degree as their highest degree, and 38.6% a college diploma. Overall, 80.7% of all respondents had a college diploma, which was expected since a college program is mandatory for certification in most Canadian provinces. Only seven respondents (6.1%) had earned a master’s degree and none a doctoral degree.

In terms of credentials, about half of the respondents (53.6%) were orthotists, one third (33.0%) prosthetists and the remainder were certified as both. Nearly one half (45.6%) of all respondents claimed to have held an executive position in an organization within a provincial, national or international prosthetics and orthotics organization. Finally, less than one third (28.1%) of all respondents reported having authored or co-authored a peer-reviewed journal article.

Information sources

A dominant majority of clinicians had access to peer-reviewed journal articles (93.9%), industry conferences (98.2%), industry courses and seminars (97.4%), and, as expected, industry publications (96.5%). Of the minority who did not have access, most expressed that they would like to have access.

To answer a practice-related question, respondents indicated that they were most likely to inquire with their colleague (76.6%) or to perform an internet search (64.0%). Respondents were less likely to access message boards or listserves (24.3%), peer-reviewed articles (38.7%), conferences (47.7%) or industry documentation (41.4%).

When asked to rate their frequency of use of each of these sources of information, 28.8% of respondents had accessed a message board, 61.3% a peer-reviewed journal and 73.0% industry documentation at least once in the past month. Most common methods for accessing information were by internet searches and asking colleagues, with 84.7% and 91.0% of respondents, respectively, indicating that they had used these sources at least once in the past month. Furthermore, 87.4% of respondents had attended at least one conference over the past year.

Barriers and beliefs

The exploratory factor analysis produced 10 factors as outlined in table 3. Questions that were rephrased from negative to positive are identified in table 3 with the modified term(s) capitalized. Table 3 presents the computed ‘agreement scores’, which are simply the proportions of participants who ‘strongly agree’ and ‘agree’ on a particular item. Furthermore, the summary of factor scores (average score of all items within a factor) is presented in figure 1. Higher scores indicate greater positive agreement (i.e. a score of 5 indicates strong agreement and 1 indicates strong disagreement).

Figure 1.

Mean factor scores with error bars showing ± 1 standard deviation. Higher scores indicate greater positive agreement (i.e. a score of 5 indicates strong agreement and 1 indicates strong disagreement). Refer to table 3 for the elaborated descriptions of the factors.

Referring to factor 1, which assessed the value of research in improving clinical practice, there was a high level of agreement (66.7–92.9%), indicating that clinicians felt research was valuable in clinical practice. In contrast, a lower level of agreement was found in relation to having adequate time to devote to EBP (factor 5) and system limitations (factor 2), with levels of agreement ranging from 35.4% to 45.4% and 25.0% to 55.6%, respectively. That is, respondents felt that EBP would place additional demands on their overloaded clinical practices, and that it was too difficult and time consuming to implement. Moreover, many felt that research studies presented too many contradictory results and that these were out of date. Respondents felt moderately confident about their skills to apply EBP (factor 3), with agreement scores ranging from 45.4% to 73.1% and their knowledge and understanding of aspects of EBP, with scores ranging from 59.6% to 69.4% (factor 6). Access to research information was rated highly (63.0–73.1%) (factor 8). Respondents also generally felt that facility attitudes about EBP were positive (factor 4) with agreement scores of 67.6% to 87.9% for three of the four items, but clinicians felt that there was limited encouragement to undertake research activities (item 3 under factor 4) with a score of 38.9%. Factor 7 reflects the relevance of EBP to clinical practice, showing relatively low agreement scores when compared to the other factors (37.4–50.5%). However, it should be noted that internal consistency of this factor was quite low (table 3). Factor 10, which consists of a single item, shows that there is typically a high level of financial support for clinicians to attend conferences, with agreement scores of 79.6%. Finally, factor 9 demonstrates moderate agreement that the presentation format of research evidence is adequate (54.5%).

Discussion

This study represents one of the first attempts to evaluate the multi-faceted nature of EBP as it pertains to P&O using a mass-distributed questionnaire survey. First and foremost, the results indicate that while clinicians value research as a means of improving clinical practice, they are faced with a number of practical barriers in performing EBP, including time constraints, but also other system limitations that hinder them from being able to translate research results into clinical practice (table 3 and figure 1). Clinicians were moderately positive about possessing the knowledge and skills needed to perform EBP. They felt very confident in some aspects of their skills, such as searching and evaluating articles, but many also felt that certain skills could be improved. Based on the last item under factor 3 in table 3, less than half of the surveyed clinicians felt they possessed the necessary skills to evaluate and implement research findings in order to change their current practice.

The resulting factors relating to EBP in P&O were similar to those identified in other healthcare disciplines. Specifically, a survey evaluating evidence-based nursing revealed factors relating to value and clinical usefulness, skills and knowledge, time constrains and facility support.⁷ Nagy et al.⁷ identified major obstacles associated with EBP in nursing, including the perception among nurses that research was not relevant to practice, and that they possessed inadequate skills and had insufficient time to perform EBP.⁷ Similarly, Jette et al.² found that for physical therapists, the primary barrier to implementing EBP was a lack of time. Furthermore, time demands were identified as a major barrier to EBP in P&O in a recent review by Ramstrand and Brodtkorb.¹⁷

The present survey revealed similar obstacles relating to time constraints, as well as the questionability of relevance of existing research to clinical practice, a topic that has been of recent focus in P&O.^22,23 In addition, Ramstrand and Brodtkorb¹⁷ have suggested that clinicians lack the expertise to perform research, and this is supported here by the fact that only a few respondents held a master’s degree and none a doctoral degree. To combat this barrier, Ramstrand and Brodtkorb¹⁷ propose that ‘evidence-based practice needs to be prioritized within the profession and that a cultural change needs to be initiated which supports the need for prosthetists/orthotists to become more active in generating research rather than relying on other professional groups to contribute to their professional body of knowledge’. While facilities generally appear to promote EBP and encourage clinicians to pursue new ideas, as well as providing financial support for conferences, there does appear to be a lack of encouragement for clinicians to pursue research. This may not be surprising, given that the majority of facilities are small private organizations (table 2), likely without affiliation to a research resource, and with limited resources (time and money) to pursue research activities on their own.

One factor that did not appear to restrict EBP was access to research information. The majority (>90%) of clinicians indicated having access to sources of information including peer-reviewed journal articles, based on the results from the ‘information sources’ part of the questionnaire. This is further supported by responses to the factor relating to access. However, despite potentially adequate accessibility, fewer than 40% of all clinicians surveyed indicated that they would be very likely to use a peer-reviewed publication to answer a practice-related question. About 40% indicated that they had not used a peer-reviewed publication in the past month, and, next to message boards, peer-reviewed articles were reported as the least accessed source of information. Accessing and reviewing peer-reviewed articles is one of the more demanding methods of information acquisition, and given the findings relating to time restrictions, it is not surprising that clinicians prefer to access most of their information via less time-consuming methods, such as internet searches or asking their colleagues. The presentation method of articles may be an additional limiting factor, as evidenced in the lower score for factor 9. This reliance on non-peer-reviewed information sources raises an important concern about the quality of information potentially being used as ‘best evidence’ in clinical practice.

A number of limitations of the study are noted here. We sampled all clinicians who were registered with the CBCPO in Canada. However, our response rate was less than 40%. Non-respondents may have beliefs, views and experiences that are systematically different than the respondents. Secondly, our sample size was somewhat below that recommended for an exploratory factor analysis. However, we took the additional step of estimating the internal consistencies of the factors to demonstrate that, in general, the items were measuring similar constructs. An exception may be the results associated with factors 7 and 8, which should be interpreted with some caution since internal consistencies fell below the typically acceptable level of 0.7. Similarly, factors 9 and 10 comprise single items for which internal consistency could not be verified. Furthermore, additional validation of this instrument, including the need for evaluating test-retest reliability and validity to confirm the factor structure is suggested. This includes re-examining the wording of certain questions to ensure that they are not eliciting biased responses. Moreover, greater insights may be gained by examining the responses for various demographics strata, including education, age, authorship and professional involvement. Finally, since the survey was conducted in Canada, the generalizability of the findings to other parts of the world should be examined. Thus, the authors suggest that similar initiatives be implemented in other countries.

Conclusion

EBP refers to the utilization of research-based evidence to inform and improve clinical practice. The ‘informing’ part of the process requires that research data are available. Similarly, data about existing EBP are essential in order to inform those involved in improving existing clinical practices, including educators, professional organizations and governing bodies. This study represents one of the initial steps in acquiring empirical data to gain a better understanding of the underlying barriers and facilitators relating to EBP in P&O. The findings suggest that while clinicians perceive EBP to be highly valuable in clinical practice, barriers exist that restrict them from adequately performing EBP. These include time constraints, workload demands, limited relevant evidence from research, as well as gaps in skills and knowledge required to perform EBP.

Footnotes

Acknowledgements

We would like to thank Bryan Steinnagel, Shane Glasford and Kristen Matthews for their valuable inputs during the development of the survey.

Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

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