Regional physiotherapists’ opinions, barriers, and enablers to providing evidence-based care: a mixed-methods study

Abstract Background Physiotherapists deliver evidence-based guideline recommended treatments only half of the time to patients with musculoskeletal conditions. Physiotherapist’s behaviours in clinical practice are influenced by many cognitive, social and environmental factors including time and financial pressures. Many initiatives aimed at improving physiotherapists’ uptake of evidence-based care have failed to appreciate the context involved in clinical decisions and clinical practice. Therefore, we aimed to describe: i) the opinions of regional physiotherapists toward evidence in relation to their clinical decision making; ii) how regional physiotherapists access evidence; iii) the factors influencing regional physiotherapists’ evidence access; iv) the factors influencing regional physiotherapists’ evidence application.MethodsWe used a mixed-methods study with online survey and focus groups. Quantitative and qualitative data were used to inform all research objectives. We used eight domains of the Transtheoretical Domains Framework to design survey questions. We analysed quantitative and qualitative data in parallel, then integrated both sources through by developing a matrix while considering the Transtheoretical Domains Framework domains to generate themes. Results57 physiotherapists participated in the study (survey only n = 41; focus group only n = 8; both survey and focus group n = 8). Participants reported that evidence was important, but they also considered patient expectations, colleagues’ treatment choices, and business demands in clinical decision making. Physiotherapists reported they access evidence on average 30 minutes or less per week. Accessing evidence may not be prioritised among competing demands like business administration. Participants reported that patient expectations were a major barrier to applying evidence-based care. Environmental and systemic factors, like funding structures or incentives for evidence-based care, and social factors, like lacking or having a culture of accountability and mentorship, were reported as both barriers and enablers to evidence application.ConclusionsIn this study, we provide a description of contextual considerations for the provision of evidence-based care and suggest some potentially modifiable targets for future strategies aimed at improving evidence uptake. Physiotherapist’s provision of evidence-based care may be improved by enhancing structural support from workplaces to access and apply evidence and exploring discrepancies between physiotherapists’ perceptions of patient expectations and actual patient expectations.