| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
Research Reports |
DU Jette, PT, DSc, is Professor and Program Director, Physical Therapy Program, Simmons College, 300 The Fenway, Boston, MA 02115 (USA) (diane.jette{at}simmons.edu).
K Bacon, PT, DPT, is Physical Therapist, Brigham and Women's Hospital, Boston, Mass
C Batty, PT, DPT, is Physical Therapist, Bellingham Physical Therapy, Bellingham, Wash
M Carlson, PT, is a self-employed physical therapist, Watertown, Mass
A Ferland, PT, DPT, is Physical Therapist, Physician's Physical Therapy, Phoenix, Ariz
RD Hemingway, PT, DPT, is Physical Therapist, Cambridge Health Alliance at Somerville Hospital, Somerville, Mass
JC Hill, PT, DPT, is Physical Therapist, HealthSouth Braintree Rehabilitation Center, Harvard, Mass
L Olgivie, PT, DPT, is Physical Therapist, Shaughnessy-Kaplan Rehabilitation Hospital, Salem, Mass
D Volk, PT, DPT, is Physical Therapist, Massachusetts General Hospital, Boston, Mass
Address all correspondence to Dr Jette
Submitted February 14, 2003;
Accepted May 9, 2003
 | Abstract |
|---|
Key Words: Evidence-based practice • Physical therapy • Professional role behaviors
| Introduction |
|---|
 TopAbstract Introduction MethodResultsDiscussionConclusionAppendixReferences |
|---|
The concept of evidence-based medicine, or, more broadly, EBP, marks a shift among health care professionals from a traditional emphasis on actions based on the opinions of authorities to guide clinical practice to an emphasis on data-based, clinically relevant studies and research. To effectively apply evidence in practice, in addition to skills in taking a history, conducting an examination, determining a diagnosis, and determining appropriate options for intervention, Guyatt and colleagues5 maintained that a clinician must have the ability to: (1) identify gaps in knowledge, (2) formulate clinically relevant questions; (3) conduct an efficient literature search; (4) apply rules of evidence, including a hierarchy of evidence, to determine the validity of studies; (5) apply the literature findings appropriately to the patient problem; and (6) understand how the patient's values affect the balance between potential advantages and disadvantages of the available management options, and appropriately involve the patient in the decision.5
The inability to carry out any of these functions may constitute a barrier to the application of evidence in practice. Haynes and Haines,6 analyzing the gap between research and evidence, suggested that the problems in implementing evidence included the size and complexity of the research base, poor access to evidence, organizational barriers, and ineffective education. Researchers studying physicians and nurses7–13 have identified a number of factors believed to inhibit the use of EBP in the clinic. Limited time for retrieving and interpreting research and for applying research to individual patients has been cited by numerous authors7–9,12–14 as a major reason clinicians do not incorporate evidence in their practices. Many health care professionals have argued that they lack the expertise to assess the validity of evidence or the knowledge of how to obtain relevant information.7,9,12,13 Limited access to information also has been shown to be a problem.7,13 Additional barriers to EBP have been determined, including inadequacy of data sources,8,10,13,14 perceived conflict with patient preferences,11 and economic pressures.14
To date, little research has been done regarding the attitudes toward and use of evidence among physical therapists. Those studies that have focused on physical therapists largely examined their use of evidence, including journal readership and application of literature, in determining patient management.15–19 The primary purpose of this study was to describe physical therapists' self-reported: (1) attitudes and beliefs about EBP; (2) education, knowledge, and skills related to obtaining and evaluating evidence; (3) attention to the literature relevant to practice; (4) access to and availability of information; and (5) perceptions of the barriers to EBP. Our secondary purpose was to describe associations among the elements listed and characteristics of physical therapists and their practice environments.
| Method |
|---|
|
TopAbstractIntroductionMethodResultsDiscussionConclusionAppendixReferences |
|---|
|
|
Responses to most items concerning attitudes and beliefs and education, knowledge, and skills related to EBP were addressed using a 5-point Likert scale with "strongly disagree" and "strongly agree" as anchors. Several items related to access to information required "yes/no" responses. To evaluate content validity, a draft of the questionnaire was presented to a sample of 10 experienced physical therapists practicing in pediatrics (n=1), acute care (n=4), orthopedics (n=2), and rehabilitation (n=3). Slight modifications were made based on their feedback, and a final questionnaire was drafted. A small subsample of the survey respondents (n=54) completed the questionnaire twice between 2 weeks and 2 months apart in order to allow us to assess the reliability of the items. Intraclass correlation coefficients (ICC [1,k]) were determined for the ordinal items, and percentages of agreement were determined for categorical and ranked items. The ICCs ranged from .37 to .90, with 50% of the items having ICCs of >70. Percentages of agreement ranged from 68% to 93% for dichotomous items and from 59% to 80% for ranked items.
An initial mailing of the questionnaire was done in July 2002. The return rate from the first mailing was 28%. A second mailing was done in September 2002 to those who had not responded. The final return rate was 48.8%.
Data Analysis
Data were analyzed using the SPSS version 10.1 for Microsoft Windows.* Response frequencies for the survey questions were determined and displayed in tabular and graphic formats. After examining the response frequencies, and before examining the associations between variables, some variable categories were collapsed in order to allow further analysis using them as dependent measures in logistic regression analyses. For those items with a 5-point Likert scale and a positive response set (ie, agreement with the statement suggested positive regard for EBP), the "strongly agree" and "agree" categories were combined, as were the "neutral," "strongly disagree," and "disagree" categories, so that responses fell into 1 of 2 categories: "agree" or "disagree."
For items with a negative response set, the "neutral" category was combined with the "agree" and "strongly agree" categories. For the items with a "yes/no/do not know" choice set, the "do not know" category was combined with the "no" category based on our belief that lack of knowledge about whether, for example, a facility had access to the Internet was as unhelpful to a respondent as not having access. For items categorized by the number of times articles were read or databases were accessed in an average month, the lowest category (<2) was distinguished from the higher categories based on our belief that the lowest level of access represented poor attention to the literature that was inconsistent with the intent of EBP. For items that were designed to examine the degree of understanding of research terms, the "understand completely" and "understand somewhat" categories were combined so that a 2-category response was obtained: "understand at least somewhat" or "do not understand." We did not examine the item identifying knowledge of the term "heterogeneity" (item 31g), because we believe the word could be understood in multiple contexts.
For some of the demographic data, where subsamples were small, we collapsed categories in an effort to derive stable models. For example, our sample included only 8 individuals who indicated a professional (entry-level) doctorate as their first professional degree and only 10 individuals with an advanced doctorate (additional degree beyond the professional degree [eg, PhD, EdD, ScD]) as their highest degree. Categories, therefore, were created to include all postbaccalaureate professional degrees and all advanced highest degrees.
After item categories were collapsed, logistic regression analyses were conducted to examine the following univariate associations: (1) responses to items measuring attitudes and beliefs; interest and motivation; education, knowledge, and skills; and access to and availability of evidence with items measuring age, years since licensure, education level (including specialization certification), and whether a respondent was a clinical instructor; (2) responses to items measuring attitudes and beliefs with items measuring types of patient conditions seen in practice and access to information; (3) responses to items measuring attention to and use of the literature with items measuring number of physical therapists in the practice setting, number of patients seen in an average day, number of hours worked in an average day, and access to sources of evidence; and (4) responses to items measuring access to and availability of evidence with items measuring the type of practice facility and the number of physical therapists in the practice setting. An alpha level of .01 was used to determine whether a model was to be reported.
Odds ratios and their 95% confidence intervals were determined for each level of the independent variables in those models that were significant. Odds ratios in this context describe the likelihood of demonstrating a particular behavior (eg, understanding a research term) given a particular characteristic (eg, having more than 15 years of experience). One level of each characteristic is used as the reference group against which the odds of demonstrating the behavior at all other levels of the variable are measured. The reference group is usually chosen by the researcher when initiating the analysis to allow the most salient interpretation of results. Confidence intervals provide information about the precision of the estimated odds ratio. Confidence intervals including 1.0 are, by definition, not statistically significant. We chose to examine univariate associations rather than multivariate associations to present our information at its most simple level in order to provide a foundation for future hypothesis testing.
| Results |
|---|
|
TopAbstractIntroductionMethodResultsDiscussionConclusionAppendixReferences |
|---|
|
|
Education, Knowledge, and Skills
The respondents were diverse in expressing whether or not they had completed educational sessions either in school or through continuing education on EBP or search strategies. Forty-two percent agreed and forty percent strongly agreed that they had engaged in educational sessions in the foundations of EBP or in search strategies, respectively. Sixty-five percent of the respondents agreed or strongly agreed that they were confident they had search skills, and 70% of the respondents agreed or strongly agreed that they had knowledge about using databases such as MEDLINE and CINAHL. Sixty-seven percent of the respondents stated they were educated in critical appraisal of research literature, and 55% of the respondents stated they were confident in their abilities in this skill. Figure 2 shows the distribution of responses related to education, knowledge, and skills associated with EBP.
|
|
|
|
|
|
|
|
|
| Discussion |
|---|
|
TopAbstractIntroductionMethodResultsDiscussionConclusionAppendixReferences |
|---|
The respondents in our study were not sure that EBP could take into account the limitations in their practice settings or the preferences of their patients. Similarly, qualitative statements by physician general practitioners in the United Kingdom14 and hospital nurses in Australia12 have suggested doubts about the applicability of practice guidelines to specific patients in specific settings and the relevance of research findings to their practices. In a letter to the British Medical Journal in 1999, Main21 noted that the incorporation of evidence into practice would prove "disappointingly small" until its advocates had a better understanding of clinical realities. Proponents of EBP, however, have frequently reiterated that the evaluation of patient preferences, circumstances, and values is part of a clinician's decision in determining appropriate intervention.4–6 Such evaluation requires clinical expertise and clinical judgment, thus defining EBP as the integration of research-based evidence with clinical expertise.1
Some of the problems of accounting for the limitations in evidence in practice settings have been addressed by Haines and Donald.22 They noted that researchers may not be involved in the implementation of their findings in day-to-day practice and that research questions may not be framed and tested in relevant contexts. For this reason, we believe the responses of the physical therapists in our study may reflect a belief by practitioners that the interventions designed for research studies may not be adaptable for implementation into practice. Additionally, respondents in our survey were mixed in their beliefs about whether good evidence existed to support the interventions they provided. Their belief about whether evidence existed to support their practice was not related to the area of practice or type of patients seen by the physical therapists. The mixed responses related to beliefs about the existence of evidence to support practice reinforce the notion that more research is needed in support of our practice.
A large proportion of our respondents indicated that they were interested in improving their skills related to incorporating evidence into practice and that they needed to incorporate more evidence. McColl et al7 found that most of the physicians they surveyed were "welcoming" toward EBP. Reported motivations for using clinical practice guidelines among pediatricians included allowing uniform management and standardized care.10 In a qualitative study of physicians' implementation of evidence, Freeman and Sweeney11 provided several quotations that illustrated the range of emotions associated with increasing the use of evidence in practice. Words that were used to describe implementation of clinical evidence were "anxious," "hard work," "risky," and "hassle." The authors11 noted, however, that the physicians they interviewed wanted to implement interventions based on the evidence.
The fact that positive beliefs were more likely among younger and more recently licensed respondents than those who were older or had been licensed longer suggests a more recent focus on the topic of using evidence in practice within physical therapist education programs. The relationship of interest in improving skills with access to online databases at home, in our opinion, may be because those who have access to the Internet at home have an appreciation for its usefulness or are more able to find time at home than during the workday to seek and retrieve information.
Education, Knowledge, and Skills
Engagement in educational sessions (either in school or through continuing education), knowledge of technical terms, and confidence in skills needed to retrieve and critically appraise information were related to age, years since licensure, and education in our sample. That both age and education level were related to knowledge, suggests that within recent years all professional education programs, regardless of the degree offered, have increased emphasis on the skills needed to implement EBP. In our sample, however, those therapists with baccalaureate degrees were less likely to claim to have the skills than those with professional master's or advanced degrees. These differences, we believe, reflect the degree of emphasis on research skills, critical appraisal skills, and scholarship in programs offering graduate degrees. Those respondents who were younger (20–29 years of age) may have reported more confidence in skills than the oldest respondents (50+ years of age) due to the fact that they are part of a generation that grew up with computers at school and in the home.
McColl et al7 reported that 16% of the physician general practitioners in the United Kingdom they surveyed had had formal training in search strategies. A study of a similar sample, however, showed that physicians admitted having a lack of technical skills to appraise the literature.9 McColl et al7 found that most of their respondents reported at least some understanding of technical terms used in the literature, similar to those we queried in our study. The terms "odds ratio" and "confidence interval" were understood by the fewest of their respondents (48% and 31% did not understand the respective terms), percentages similar to those of our sample (47% and 37%, respectively).
Attention to Literature
Seventeen percent of the physical therapists in our sample stated they read fewer than 2 articles in a typical month, and one quarter of the respondents stated they used literature in their clinical decision making less than twice per month. In studies of the reading habits of physical therapists in Australia16 and the United Kingdom,17 slightly less reading appeared to occur. In both countries, approximately three quarters of the physical therapists reported reading their primary professional journal (Australian Journal of Physiotherapy or Physiotherapy) about one time per month or less.
In our estimation, the level of attention to the literature in our sample may not be consistent with the intent of EBP. Experienced clinicians who treat patients with similar problems on a day-to-day basis may not need to refer frequently to the literature. Our data, however, did not show a relationship between the amount of time a therapist had been licensed or had achieved clinical specialist certification (possible surrogates for clinical expertise) and attention to the literature. Our finding that 65% of physical therapists reported using online databases to access literature less than twice per month is difficult to evaluate. Given that most health-related journals are published monthly, this level of review could be adequate. We also found, not surprisingly we believe, that those physical therapists with easier access to online databases were likely to perform database searches more frequently and tended to read more articles. In our opinion, these data emphasize the need for technology to assist in the use of evidence in the workplace.
Data from studies of the retrieval and reading patterns of other health care professionals do not directly correspond to our findings. Some similarities, however, may be noted. For example, in a survey conducted from July 1998 to January 2000 in Ontario, Canada, 64% of family physicians, 100% of oncologists, and 72% of nurses accessed the Internet for health information.23 Based on studies that examined the reading practices of physicians and their use of information in clinical decision making, relatively few physicians appeared to attend to important sources of relevant information. For example, McColl et al7 found that, depending on the publication, between 2% and 28% of physicians referred to sources of evidence such as the Cochrane Database of Systematic Reviews, and between 1% and 17% of the physicians used data from these sources to assist them in decision making. Prescott et al24 found that, depending on the database, 10% to 91% of a sample of general practitioners in the United Kingdom referred to sources at least occasionally. In a qualitative study of general practitioners' awareness and understanding of the results of 2 high-profile clinical trials related to treatment of hypercholesterolemia, only 7 of the 24 physicians studied reported reading at least one of the reports.9
Fairhurst and Huby9 concluded that most physicians they interviewed in Scotland used personal contacts as sources of information and changed practice based on consensus rather than on information they read and appraised. Indeed, McColl et al7 found that only 5% of physicians they surveyed in England believed that the best way to move from opinion-based to evidence-based medicine was to identify and appraise the primary literature. Similarly, the literature has shown that physical therapists in England and Australia rank colleagues ahead of the literature as sources of information about patient management.15,18,19
Access to and Availability of Literature
In our opinion, using evidence in practice is possible only when there is efficient access to information resources. Efficiency requires easy retrieval of information, use of online sources, and skill in finding relevant resources. The majority of our respondents had access to online information, although more had access at home (89%) than at work (65%). In 1990, Bohannon19 reported that only 2 of 27 clinicians interviewed mentioned computer searches as sources of information. Eight years later, McColl et al7 found that 17% of physicians had access to the Internet at work and 29% had access at home. Although there is the possibility of differences in access across health care professionals, we believe these differences likely reflect the changes occurring in the workplace and increasing access to computers and high-speed connections in the home over the past few years.
We found no associations between access to the Internet at home or at work and demographic factors. Those physical therapists who practiced in subacute rehabilitation or skilled nursing facilities had less access and those who practiced in the acute hospital setting had more access to online databases at work than those who practiced in private practice settings. Our data did not allow us to determine the reason for these differences. Economic issues, complexity and amount of information for each patient, or possible beliefs about the utility of information technology in the various practice settings may have been factors.
Barriers
Other researchers7–9,12–14 found, as we did, that the primary barrier to implementing EBP was lack of time. Ely et al8 suggested that time for answering a clinical question includes modifying the question so that it is specific and answerable, selecting an effective search strategy, finding a source that covers the topic under question, determining when the relevant information has been found and the search can stop, and synthesizing multiple pieces of information to formulate an answer to the question. Although less than 20% of our participants chose lack of search skills or lack of critical appraisal skills as one of the top 3 barriers, some of the obstacles reported by Ely et al8 are particularly salient, given that 44% of our sample stated they did not feel particularly confident in their critical appraisal skills and 34% stated they did not feel confident in their search skills.
Other barriers frequently identified by our respondents were the inability to apply research findings to the types of patients seen in practice and the inability to apply the research findings from a group of patients to a specific patient. These are somewhat related problems and appear as barriers to the use of evidence by physicians and nurses as well.10,12–14 One of the reasons that some pediatricians have given for not implementing clinical practice guidelines is that the guidelines represent "cookbook medicine" and do not allow for clinical judgment.7 In a study by Cranney et al, general practitioners in England viewed clinical practice guidelines as having been developed by "enthusiasts outlining ideal practice."14(p360) Haines and Jones25 have suggested that one factor working against implementation of evidence in practice is the "cultural divide" among researchers, clinicians, and administrators.
Our respondents did not view lack of interest or lack of collegial support as a primary barrier to implementing EBP. The majority felt that they were supported in their workplace. Restas,12 however, found that 2 of the top 10 barriers cited by nurses in Australia were lack of cooperation from physicians and lack of support from colleagues. Similarly, Kajermo et al13 found that nurses in Sweden felt isolation from colleagues and lack of authority to change practice were moderate to large barriers to using research. Given the findings that among physicians information from the research literature acquires status and is implemented when local consensus reasons that it fits in the context of practice,9 support for EBP from colleagues and others within the work facility seems quite important.
Limitations
Among the limitations of our study were the relatively low response rate (48.8%), the low reliability for some items, and a lack of information about the validity of the questionnaire we used. The degree of reliability may have been affected by the relatively long period (up to 2 months) we used between responses or by a lack of clarity in item instructions or wording. The response bias cannot be assessed because data about nonrespondents were not available. Although the respondents to our survey appear to be fairly similar to a larger national sample of APTA members in terms of demographic characteristics, the results of our analysis may have been skewed by a higher response rate from those interested in EBP and, therefore, more positive about it.
Our questionnaire was developed using items to identify elements similar to those surveyed in the study of physician general practitioners by McColl and colleagues.7 It is possible that the important beliefs and attitudes about EBP are different for physicians than for physical therapists. There is evidence, for example, to suggest that the focus on use of evidence for physicians is on implementation of clinical practice guidelines and use of systematic reviews. Less of this type of evidence in summary form is available to inform physical therapist practice. Additionally, we believe EBP has been a topic of interest in the medical profession for much longer than in physical therapy. For this reason, we might suspect a different focus is needed when evaluating the attitudes, beliefs, and perceived barriers among physical therapists.
Another limitation results from our decision to dichotomize the dependent variables for analyses. Our choice of where to dichotomize the 5-point Likert scale used to measure several dependent variables was somewhat arbitrary. Fishbein and Ajzen,26 however, have suggested that the neutral category reflects a negative attitude or belief in Likert scales that have a positive response set. Additionally, information is lost when the data are reduced into simple categories of positive/negative response. Such data reduction and application of a logistic model imply an abrupt change in odds at the point chosen for distinguishing 2 different categories for the variable and no difference in the odds across those levels of the variable subsumed within each category.
A final limitation is the potential bias introduced by the sampling frame. Only APTA members were surveyed. It is unclear how APTA members are similar or dissimilar to all physical therapists. In our opinion, APTA members may be more likely to have access to evidence, at least through their paper journal, and may be more likely to have heard of EBP and read some of the related articles in both Physical Therapy and PT Magazine. We believe this exposure may lead to a positive regard for, and understanding of, EBP. Additionally, given the current professional emphasis on EBP, respondents may have addressed items in a socially acceptable manner. That is, they may have reported more positive attitudes and beliefs and higher levels of knowledge than they actually have.
Practice Implications
Our findings, in our opinion, have implications for the educational, research, and clinical communities. Furthermore, these implications likely interact. Our data suggest that, in the past few years, newly licensed practitioners have come to the profession with a belief they have skills in information retrieval and appraisal. These skills are not claimed by those who have been licensed longer or by those with baccalaureate degrees. The education community may have a role to play in providing continuing education at clinical sites or in local regions to help improve the skills of clinicians in practice who, by and large, are interested in improving their skills and increasing their use of evidence. This notion is supported by reports of nurses regarding perceived facilitators to increasing use of evidence in practice.13 Because time is said to be a major barrier to using EBP, educational programs that emphasize efficiency in searching may be particularly useful. Clinical administrators, in turn, may need to make efforts to increase the availability of computer access to research databases and to provide the time for clinicians to retrieve and read the literature or communicate research findings among their colleagues.13
A message for researchers may be that not only does a need exist for more research related to the effectiveness of interventions and diagnostic tools that are used by physical therapists, but the information generated from the research also needs to be expressed in a manner that assists clinicians in applying data to typical patients in typical clinical settings. Research also needs to be accessible in terms of being written in an understandable manner.13 Moreover, because of clinicians' lack of time, there is a need for evidence to be published in summary forms that can be accessed in one simple stop. Suggestions for future research include studies that examine the actual processes through which evidence is gathered, synthesized, and applied by physical therapists across various settings and demographic factors.
| Conclusion |
|---|
|
TopAbstractIntroductionMethodResultsDiscussionConclusionAppendixReferences |
|---|
| Appendix |
|---|
|
TopAbstractIntroductionMethodResultsDiscussionConclusionAppendixReferences |
|---|
|
| Footnotes |
|---|
All authors provided concept/idea/research design. Dr Jette provided writing and data collection and analysis.
The study was approved by the Institutional Review Board of Simmons College.
* SPSS Inc, 233 S Wacker Dr, Chicago, IL 60606. 
| References |
|---|
|
TopAbstractIntroductionMethodResultsDiscussionConclusionAppendixReferences |
|---|
CiteULike 
Complore 
Connotea 
Del.icio.us 
Digg 
Reddit 
Technorati What's this?
This article has been cited by other articles:
|
|
 |
|
  D. U. Jette and R. Buchbinder PTJ Helps Clinicians Link Evidence to Patient Care Physical Therapy, January 1, 2010; 90(1): 6 - 7. [Full Text] [PDF]
|
|
|
|
 |
|
 R. Van Peppen, M. Schuurmans, E. Stutterheim, E. Lindeman, and N. Van Meeteren Promoting the use of outcome measures by an educational programme for physiotherapists in stroke rehabilitation: a pilot randomized controlled trial Clinical Rehabilitation, November 1, 2009; 23(11): 1005 - 1017. [Abstract] [PDF]
|
|
|
|
|
|
N. M. Salbach, S. J.T. Guilcher, S. B. Jaglal, and D. A. Davis Factors Influencing Information Seeking by Physical Therapists Providing Stroke Management Physical Therapy, October 1, 2009; 89(10): 1039 - 1050. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Schreiber, P. Stern, G. Marchetti, and I. Provident Strategies to Promote Evidence-Based Practice in Pediatric Physical Therapy: A Formative Evaluation Pilot Project Physical Therapy, September 1, 2009; 89(9): 918 - 933. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N. M. Salbach, P. Veinot, S. Rappolt, M. Bayley, D. Burnett, M. Judd, and S. B. Jaglal Physical Therapists' Experiences Updating the Clinical Management of Walking Rehabilitation After Stroke: A Qualitative Study Physical Therapy, June 1, 2009; 89(6): 556 - 568. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Harting, G. M. Rutten, S. T. Rutten, and S. P Kremers A Qualitative Application of the Diffusion of Innovations Theory to Examine Determinants of Guideline Adherence Among Physical Therapists Physical Therapy, March 1, 2009; 89(3): 221 - 232. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Q McGinnis, L. M Hack, K. Nixon-Cave, and S. L Michlovitz Factors That Influence the Clinical Decision Making of Physical Therapists in Choosing a Balance Assessment Approach Physical Therapy, March 1, 2009; 89(3): 233 - 247. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. M Copeland, W. J Taylor, and S. G Dean Factors Influencing the Use of Outcome Measures for Patients With Low Back Pain: A Survey of New Zealand Physical Therapists Physical Therapy, December 1, 2008; 88(12): 1492 - 1505. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. L Craik and C. Maher Still "Not Satisfied" ... Yet Physical Therapy, April 1, 2008; 88(4): 423 - 425. [Full Text] [PDF]
|
|
|
|
|
|
P. F Beattie and R. M Nelson Evaluating Research Studies That Address Prognosis for Patients Receiving Physical Therapy Care: A Clinical Update Physical Therapy, November 1, 2007; 87(11): 1527 - 1535. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N. M Salbach and N. Korner-Bitensky Author Response Physical Therapy, October 1, 2007; 87(10): 1305 - 1306. [Full Text] [PDF]
|
|
|
|
|
|
N. M Salbach, S. B Jaglal, N. Korner-Bitensky, S. Rappolt, and D. Davis Practitioner and Organizational Barriers to Evidence-based Practice of Physical Therapists for People With Stroke Physical Therapy, October 1, 2007; 87(10): 1284 - 1303. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. Dumoulin, N. Korner-Bitensky, and C. Tannenbaum Urinary Incontinence After Stroke: Identification, Assessment, and Intervention by Rehabilitation Professionals in Canada Stroke, October 1, 2007; 38(10): 2745 - 2751. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. Shaneyfelt, K. D. Baum, D. Bell, D. Feldstein, T. K. Houston, S. Kaatz, C. Whelan, and M. Green Instruments for evaluating education in evidence-based practice: a systematic review. JAMA, September 6, 2006; 296(9): 1116 - 1127. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B. J. Nail-Chiwetalu and N. B. Ratner Information Literacy for Speech-Language Pathologists: A Key to Evidence-Based Practice Lang Speech Hear Serv Sch, July 1, 2006; 37(3): 157 - 167. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Poitras, R. Blais, B. Swaine, and M. Rossignol Management of Work-Related Low Back Pain: A Population-Based Survey of Physical Therapists Physical Therapy, November 1, 2005; 85(11): 1168 - 1181. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. G Maher, C. Sherrington, M. Elkins, R. D Herbert, and A. M Moseley Challenges for Evidence-Based Physical Therapy: Accessing and Interpreting High-Quality Evidence on Therapy Physical Therapy, July 1, 2004; 84(7): 644 - 654. [Abstract] [Full Text] [PDF]
|
|
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
