Barriers to Evidence-based Practice

In all branches of health science, there is a widespread drive toward evidence-based care. It signifies a shift in the way practice is approached, emphasizing judgement over blind adherence to rules and evidence over opinion, bridging the gap between research and patient care. At its general meeting, the World Confederation of Physical Therapy approved a number of “Declarations of principles” concerning evidence-based practice (EBP), as physiotherapists and students in this field have a duty and responsibility to use methods and tools that have undergone scientific evaluation.

Sackett et al.’s definition of EBP as “the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of the individual patient” served as the foundation for the original EBP. It entails fusing the finest clinical data that is currently available from organised research with individual clinical knowledge. The Sicily declaration claims that the EBP comprises of these five steps: (1) Converting ambiguity into a question that can be answered (2) Looking for and methodically gathering the greatest available evidence (3) A critical evaluation of the evidence’s reliability, clinical application, and validity (4) Putting evaluated evidence to use in practice (5) Performance assessment.

The inability to perform any of the aforementioned tasks could be a hindrance to using evidence. Therefore, it is essential to incorporate these stages into clinical education for healthcare students so that EBP is integrated with lifelong learning and patient care. It has been discovered that the actual clinical care and the best practice as defined by scientific evidence differ significantly. It is now essential to reflect on implementation failures in order to fully comprehend the barriers. Students appear to have difficulty putting the foundations of EBP into practice in clinical settings. This underlines the responsibility of academicians and places of learning.

Understanding the obstacles to EBP could boost compliance with the effort and give guidance on how to create viable interventions for its successful implementation. Studies from various health disciplines including physiotherapy from across the globe including India have identified several common perceived barriers to the understanding of and implementation of EBP. These include training-related barriers, organizational barriers, and personal barriers. Under personal barriers, in India there might be the issue of language due to the absence of scientific literature in Indian languages. The argument that higher education is conducted in English and therefore published literature in English should be comprehensible to the Indian audience is not pragmatic due to the various levels of and interpretation of English by Indian users and the often parallel meanings extracted from technical language.

It is therefore not surprising to note that despite research methodology and biostatistics being introduced as subjects in the final year curriculum, with final year students undertaking research projects under the mentorship of faculty members and also appearing for a theory examination in the final university examinations, they demonstrate a lack of research skills. It begs the question of whether research should be included as a subject in university exams and if projects must be made mandatory.

At this juncture, it is relevant to consider what Burger and Louw claim, that teaching research technique is more likely to focus on teaching students how to do research than how to use research for EBP. Students are aware of the idea of EBP, and its theoretical constructs according to a study from Mumbai, on final-year undergraduate students, but they don’t appear to be integrating it into clinical practice. The almost complete lack of EBP in clinical practice observed in those with a postgraduate degree contradicts the years of rigorous research training they underwent in terms of seminars, journal clubs, required attendance of research methodology workshops, and the two years of intense effort they put in to submit their thesis. Regrettably, this appears to be the case of academicians as well, who are year after year churning out student research under their tutelage without appearing to have imbibed the essence of it.

Ilic et al., had emphasized an important point regarding the widespread practice of teaching EBP content in the form of “one-off” workshops or short courses. They raised a valid argument that these methods do not result in a notable improvement in EBP-relevant skills in non-medical undergraduate students. This observation was based on a review of randomized and nonrandomized trials. This unequivocally confirms the observations in physiotherapy practice in India.

Additionally, although postgraduate students spend a significant amount of time talking with their professors about different case studies and research updates and also provide current data during case presentations, in day-to-day practice it appears that they are more bound by “recipes” provided by senior physiotherapists. These could all be plausible explanations for why there is a disconnect between theory learned in classrooms and practice in the clinic.

Students in their last-minute frenzy prior to exams seem to depend on a well-stocked library’s physical resources in terms of textbooks rather than current digital resources. This may imply that they are unaware of the library’s function in terms of offering various research-related services, such as access to paid articles and institutionally subscribed research journals in addition to standard textbooks. The apparent lack of access to paid publications and a lack of time are oft repeated hurdles that prevent the use of EBP in India.

Numerous researchers from other nations have previously reported on the hurdles found in their countries. It can be said with confidence that regardless of different geographical locations, different professions, and different levels of experience, everyone perceives the same obstacles to effective use of EBP, such as a lack of time, a lack of access to library resources, and a lack of knowledge of research tools. But perhaps it is the resistance to change that drives other barriers. All of us are now well versed in the use of digital resources but somehow when it comes to PT practice, the wellthumbed books of yesteryears seem to hold sway. Soapbox talks of EBP are not adequate to change mindsets and practices. Academic institutions and their staff have a commitment to bring about evolution in academics. The time is well-nigh right for this revolution to happen in physiotherapy in India.