Deretti Lorenzo ((Bachelor’s Degree in Physiotherapy, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy))
Negri Alessandro (Bachelor’s Degree in Physiotherapy, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy)
Bertoni Gianluca (Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genova, Italy; Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy; Training Unit, Azienda Sociosanitaria Territoriale di Cremona, Cremona, Italy)
Guidetti Matteo (“Aldo Ravelli” Center for Neurotechnology and Experimental Brain Therapeutics, Department of Health Sciences, University of Milan, Milan, Italy)
‘Evidence-based practice’ (EBP) refers to the conscientious, explicit, and judicious use of the best available evidence aimed at decision-making in patient care [1]. Pragmatically, it results in the integration of clinical expertise, the best evidence from the scientific literature, patient’s clinical condition and preferences [2]. Being physiotherapists (PTs) healthcare professionals, the Italian physiotherapist’s code of ethics mandates continuing professional education, beside the practice of good clinical practice according to research evidence – therefore, an EPB approach to professional practice (Art. 12 “Qualità ed appropriatezza delle cure e Art. 22 “Aggiornamento e formazione continua”) [3]. However, to date, there remain some critical issues in the fulfilment of this requirement [4], especially among Italian PTs [5]. Expanding previous knowledge [5], in this work we aim to investigate the attitude of Italian PTs towards EBP principles through a web questionnaire (Evidence Based Practice Questionnaire – EBPQ) [6].
In the present study, practice, opinions, skills, barriers, and facilitators of EBP in physiotherapy practice were investigated through the Italian EBPQ, consisting of 24 items with a Likert scale (scale from 1 to 7) [6]. The questionnaire was submitted to regularly registered Italian physiotherapists by Computer Assisted Web Interviewing (CAWI) method. In addition, demographic factors, such as gender (M, F), age (20-29, 30-39, 40-49, and > 50 years), region of work (northern Italy, other), years since graduation (<5; 6-10; >10 years), highest academic degree (bachelor’s, master’s and doctoral, master’s), field of activity (musculoskeletal, other), and time of actual activity (< 5, 6-20, > 20 years), were requested for analysis. After descriptive analysis, differences in EBPQ subscores between levels of demographic variables were considered. Since EBPQ subscores were found to be non-normally distributed (Kolmogorov-Smirnov test: p < 0.05), independent-samples Kruskal-Wallis (KW) analysis was used.
139 PTs completed the survey with valid responses. Most of the participants were male (53.9%), young (45.3% < 29 yo) and working as freelancer (45.3%), in clinical care (100%), mostly with musculoskeletal diseases (72.6%). 64.6% of the responders have held the PT bachelor for <10 years (64.6%), which was the highest academic degree for the 62.5% of the sample (87, 62.5%). KW analysis to assess difference of EBPQ subitems scores across the levels of “years from the bachelor” showed significative differences for question on “how often I share new information with my colleagues” (χ2 [2] = 17.86, p < 0.001) and “ability to apply information to individuals” (χ2 [2] = 12.37, p = 0.002). Post hoc comparisons revealed that younger holders of PT bachelor (< 5yy) share new information significantly more often (for all comparisons, p < 0.005), and they can apply it significantly better to individuals (for all comparisons, p < 0.005) than older holders. KW analysis to assess difference of EBPQ subitems scores across the levels of “highest academic title” showed significative differences for question on “knowledge of how to retrieve evidence” (χ2 [2] = 20.76, p < 0.001), “ability to critically analyse evidence against defined standards” (χ2 [2] = 11.33, p = 0.003), “ability to determine the clinical applicability of the found material” (χ2 [2] = 7.34, p = 0.025). Post hoc comparisons revealed that PTs holding a level of education beyond bachelor’s degree show a greater knowledge on where to search for new information (for all comparisons, p < 0.005) and how to critically analyse it (for all comparisons, p < 0.005). Those holding the master’s degrees are statistically more able to determine the clinical validity of new research, compared to those holds a bachelor’s degree (p = 0.027).
In this study, we assessed the practice, opinions and skills of EBP in physiotherapy clinical practice among PTs through a web version of the EBPQ. Our results suggest that “young PTs” (i.e., those holding a PT bachelor for <5 years) are more likely to share information found in the scientific databases, and to integrate them in the clinical practice. This could be explained by the short time since graduation, since university training lately is making the effort to focus on EBP concepts and practice, and by the short time to create a personal established clinical practice. Not surprisingly, PTs holding an academic grade higher than the bachelor’s degree (e.g., Master) reported a greater ability to search for and critically analyse new scientific information. This is in line with the greater research skills that higher academic courses are supposed to provide. Despite the limits of this study (e.g., little sample size and sample fairly representative of the general PT population), our results could serve as hint for further investigations and reflections on the use of EBP among Italian PTs – for example, how to bridge the generational gap.
[1] Sackett DL, Rosenberg WMC, Gray JAM, Haynes RB, Richardson WS. Evidence based medicine: what it is and what it isn’t. BMJ 1996;312:71–2. https://doi.org/10.1136/bmj.312.7023.71.
[2] Haynes RB, Devereaux PJ, Guyatt GH. Clinical expertise in the era of evidence-based medicine and patient choice. BMJ Evidence-Based Medicine 2002;7:36–8. https://doi.org/10.1136/ebm.7.2.36.
[3] Dalla A. CODICE DEONTOLOGICO DEI FISIOTERAPISTI n.d.
[4] Paci M, Faedda G, Ugolini A, Pellicciari L. Barriers to evidence-based practice implementation in physiotherapy: a systematic review and meta-analysis. Int J Qual Health Care 2021;33:mzab093. https://doi.org/10.1093/intqhc/mzab093.
[5] Castellini G, Corbetta D, Cecchetto S, Gianola S. Twenty-five years after the introduction of Evidence-based Medicine: knowledge, use, attitudes and barriers among physiotherapists in Italy – a cross-sectional study. BMJ Open 2020;10:e037133. https://doi.org/10.1136/bmjopen-2020-037133.
[6] Fernández-Domínguez JC, De Pedro-Gómez JE, Jiménez-López R, Romero-Franco N, Bays Moneo AB, Oliva-Pascual-Vaca Á, et al. Physiotherapists’ Evidence-Based Practice profiles by HS-EBP questionnaire in Spain: A cross-sectional normative study. PLoS One 2022;17:e0269460. https://doi.org/10.1371/journal.pone.0269460.
