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Evidence Based Practice in Physiotherapy Research

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Do physiotherapists know what they are doing? Are they confident enough to treat people? Is there any evidence of their interventions or treatment? All these questions linger in the mind of society nowadays. Uncertainty will always be at the back of our instinct. This is where evidence-based Practice (EBP) comes in. Evidence-based Practice (EBP) is integration of the best available research evidence, clinical exposure as well as the patient’s belief and values to guide patient care. The significance of EBP is that it promotes shared decision-making between the Physical Therapist, the patient, their carers, and the community. As a physical therapy students, Evidence-based Practice is vital in our life. It consumes us, it lives within us. 

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Evidence-based practice (EBP) is considered as a keystone in the prevailing era of clinical practice. With other healthcare professionals, physiotherapists are also using highest quality of research evidence in their clinical practice. Based on the World Confederation of Physical Therapists, they stated an approach on EBP, in which they expressed that 'physical therapist have an obligation to utilize evidence to educate and inform practice and assure that the administration of patients/customers, carers, and communities depends on the best available evidence'. The higher the number of physiotherapy graduates, the more the trials and systematic reviews. Therefore, physiotherapists could only hope that they are developing a more powerful evidence base to inform patient care. Most and foremost, we must have the awareness on the aims of EBP, otherwise it will be futile. Therefore, the aims of EBP are to lessen variations in clinical practice, to improve the care of patients, carers and communities, to make decision-making more transparent, to integrate patient preferences into decision-making and to ensure that knowledge continues to inform practice through life-long learning activities.

The services of Physiotherapist have gained the dominant roles as a part of recovery as well as rehabilitation in most clinics all throughout Malaysia and worldwide. In that capacity, there is yet an absence of expertise in using Evidence Based Practise into the Physiotherapist service at clinics settings in Malaysia and other countries like United Kingdom and United States. Mostly, they are still unsure how to implement EBP in their treatment. In one study done by Hannah C. Yahui, she said that the implementation of EBP in any clinical setup involves five important steps. Firstly, we must raise a question to our self. For instance, “What is the most effective way to treat patient with neck pain?” or “How should we apply our services to elderly people so that they will get the best possible treatment?”. With these, we can have the basic skills to implement EBP in our life. 

Secondly, is to acquire the best evidence. Getting into the best and most significant evidence includes searching out clinical guidelines or excellent outlines of research, such those distributed in PEDro. PEDro is the Physiotherapy Evidence Database, a free database of over 43,000 randomised trials, systematic reviews and clinical practice guidelines in physiotherapy. For each trial, review or guideline, PEDro provides the citation details, the abstract and a link to the full text, where possible. All trials on PEDro are independently assessed for quality. Not only PEDro that provide these kind of information, other website such as Cochrane Library, Center for EBP, and Hooked on Evidence also plays a big contributor to this. Once you have determined the most applicable research for you, critically evaluate it for its quality. Then, apply the evidence with clinical expertise and patient values. It is the Physiotherapist’ choice to take advantage of it or not and based on their own basic skills to whom they want to apply it. Lastly is to assess the effectiveness of the process. All these five skills will help Physiotherapy graduates to grasp the proper technique to use and apply Evidence Based Practice. Without it, some may obtain an improper or insufficient evidence on clinical practice. Not only that, it will also lead to barrier in EBP.

Evidence Based Practice (EBP) guides all healthcare professions including Physiotherapist to do the best they can for their patients. EBP is like a teacher. It instructs us, it directs us, and it also advises us. In other words, EBP basically train us to perform well in clinical practice. It also furthers the development of physical therapy. However, some still might not apply EBP in their practice because they do not know the benefits of it. There are numerous perks of using EBP and the perks does not only apply to the Physiotherapist themselves, it also applies to the patients, carers and communities. It is not simply physical specialists who need practice to be founded on proof, patients themselves need to have assurance about their treatment and the decisions made by Physiotherapist. Thus, EBP can give security to the patients and subsite their scepticism. Other than that, EBP can help to boost the Physical Therapist confidence. Considering EBP is from many research papers that had been critically analyse and evaluate, it shows us that it is an acceptable practice. So, by using it, Physical Therapy can outdo themselves when doing the treatment that is acceptable by the society. This will enhance their confident level. Moreover, by using Evidence Based Practice, one will reduce medical errors. To avoid errors, the five steps of implementing EBP must be at the tip of our fingers. Without errors, the patients, carers and community will be thankful and grateful. This automatically, will create a healthy environment between Physiotherapist-patients relationship. EBP can also help balance known benefits and risks. In such a manner, Physical therapy can know the risk of doing treatment that is said to be serious or risky, so they can be careful when implementing the interventions. With Evidence Based Practice, it can also improve health care quality. In addition, EBP gives us a real method for disposing of treatments which have been appeared to be inadequate. Hence, we can use more of our services in a more appropriate way.

Despite clear benefits of the Evidence-Based Practice (EBP) approach to ensuring quality and consistency of care, its uptake within physiotherapy has been inconsistent (Scurlock-Evans et al. 2014). A few studies supervised among various healthcare professionals have identified several boundaries with EBP. One of it is the time limitation. It is said that to search for a good research paper is time consuming, it takes their time to even go through one by one to evaluate the paper. It is more convenient to use their own practice skills than to implement EBP in their interventions. Not only that, to read an article will delay their work. In one study done by the INTI International University students, it stated that Only 30% of the respondents reported that they read less than 2 articles per month and 20% of the respondents reported that they either never or rarely consulted literature and research findings for their clinical decision making. This shows that, they still practice the normal way in their treatment. 

Other common reasons for not using evidence in clinical practice is the perceived absence of knowledge and skills when searching for or appraising research. One must have the skills to critically evaluate an article. Lack in this department will contribute to inadequate data and information about EBP. Not to mention, unable to apply research findings to clinical practice has also been reported as the barrier of EBP. This is because, they are used to their hands-on practice that had been developed throughout their university days, that they tend to lean away from EBP. Understanding of the English in which articles are written is also one of the barriers. Mostly, most of the articles are hard to read as a result of several bombastic words and thus lead to insufficient understanding on that particular article. Although Physiotherapist understood the process of appraising a research article, limitation to access for search engines and journal articles still had been the issue. Even though articles are currently accessible online, some of them requires a charge or then again or membership for access 

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