Training in evidence-based practice may reduce barriers to implementation

Competency in evidence-based practice can be enhanced with training, especially when training is multifaceted, clinically integrated, and includes an assessment component. However, training programs incompletely address the five steps of evidence-based practice (ask, acquire, appraise, apply, assess), with a disproportionate focus on appraising the evidence. To address the incomplete coverage of the five steps in evidence-based practice in training programs, a set of core competencies has been established.

Traditional classroom teaching, where participants listen to lectures in face-to-face sessions and complete homework after the class, is the most common educational style used in evidence-based practice training programs. A flipped classroom approach, where participants watch pre-recorded lectures before attending face-to-face sessions that focus on practical tasks, may be superior to traditional teaching methods for health professional education.

A recent single-group, pre-post study aimed to quantify knowledge, skills and barriers for evidence-based practice in physiotherapy clinicians. The study also evaluated the impact of a flipped classroom training program that addresses the core competencies for the teaching of evidence-based practice.

Physiotherapists from a large health district in Sydney, Australia were invited to participate. The primary outcome was the Assessing Competency in Evidence-based Medicine scale (range 0-15; 15 is high knowledge and skill) to quantify knowledge and skills. The secondary outcomes were the four subscales of the BARRIERS scale (range 1-4; 4 is high barrier) to quantify barriers. Outcomes were collected at baseline and after a 3-month evidence-based practice training program. Training involved a flipped classroom approach that addressed the core competencies for teaching evidence-based practice. The study was prospectively registered and the training program was fully reported using the TIDieR checklist.

104 physiotherapists completed baseline data and 94 completed post-training data. At baseline, they had a reasonable level of knowledge and skill in evidence-based practice, scoring an average of 9.5 out of 15 on the Assessing Competency in Evidence-based Medicine scale. The largest barriers were in the Presentation and Setting subscales of the BARRIERS scale (both had a mean score of 2.6 out of 4), with “insufficient time on the job to implement new ideas”, “physiotherapist does not have time to read research” and “physiotherapist does not feel capable of evaluating the quality of the research” being the greatest barriers.

The training program did not change knowledge and skills (mean change 0.1; 95% confidence interval -0.2 to 0.5) but did reduce barriers by -0.1 (-0.2 to 0.0; Setting subscale) to -0.2 (-0.3 to -0.1; Healthcare Provider subscale). An exploratory analysis suggested that this reduction in barriers was particularly evident in the subgroup of participants who had previously received university-based training in evidence-based practice.

Physiotherapists have knowledge and skill in evidence-based practice that is comparable to other allied health professionals, medical students and medical doctors, but experience barriers to applying these skills into practice. A comprehensive training program that used the flipped classroom approach did not change knowledge and skills, but did reduce barriers. More research is needed to develop and test the outcome measures and training program in order to embed evidence-based practice into clinical practice.

Harrison L, et al. Knowledge, skills and barriers to evidence-based practice and the impact of a flipped classroom training program for physiotherapists: an observational study. Physiother Theory Pract 2021 Oct 27:Epub ahead of print

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