Impact of a Multifaceted and Clinically Integrated Training Program in Evidence-Based Practice on Knowledge, Skills, Beliefs and Behaviour among Clinical Instructors in Physiotherapy: A Non-Randomized Controlled Study

Background and Purpose: Physiotherapists practicing at clinical placement sites assigned the role as clinical instructors (CIs), are responsible for supervising physiotherapy students. For CIs to role model evidence- based practice (EBP) they need EBP competence. The aim of this study was to assess the short and long term impact of a six-month multifaceted and clinically integrated training program in EBP on the knowledge, skills, beliefs and behaviour of CIs supervising physiotherapy students. Methods: We invited 37 CIs to participate in this non-randomized controlled study. Three self-administered questionnaires were used pre- and post-intervention, and at six-month follow-up: 1) The Adapted Fresno test (AFT), 2) the EBP Belief Scale and 3) the EBP Implementation Scale. The analysis approach was linear regression modeling using Generalized Estimating Equations. Results: In total, 29 CIs agreed to participate in the study: 14 were invited to participate in the intervention group and 15 were invited to participate in the control group. One in the intervention group and five in the control group were lost to follow-up. At follow-up, the group difference was statistically significant for the AFT (mean difference = 37, 95% CI (15.9 -58.1), p<0.001) and the EBP Beliefs scale (mean difference = 8.1, 95% CI (3.1 -13.2), p = 0.002), but not for the EBP Implementation scale (mean difference = 1.8. 95% CI (-4.5-8.1), p = 0.574). Comparing measurements over time, we found a statistically significant increase in mean scores related to all outcome measures for the intervention group only. Conclusions: A multifaceted and clinically integrated training program in EBP was successful in improving EBP knowledge, skills and beliefs among CIs. Future studies need to ensure long-term EBP behaviour change, in addition to assessing CIs’ abilities to apply EBP knowledge and skills when supervising students

A reimbursement-based historical analysis of primary care physiotherapists practice in an evidence-based and financial perspective during 1984-2008

Research question: Has primary care physiotherapists changed their pattern of reimbursement , and are these changes correlated to financial or scientific changes in reimbursement rates and frequencies ? Design: Longitudinal study with descriptive statistics analysis Method: Historical development of reimbursement rates and their correlation with their respective reimbursement frequencies. Material: Historical data for reimbursement rates from 1988 to 2008, and reimbursement frequencies from 1998 to 2008. Results: This analysis shows that physical therapists examine less and deliver less individual treatment than before. Nearly one in four patients is now treated in groups. Major changes (>20%) in reimbursement rates were significantly associated with changes in clinical physiotherapy practice. Regulatory intervention stopping overlap between patient treatments, resulted in fewer treatments delivered per physiotherapist. Conclusion: Primary care physiotherapists changed their practice to less individual examinations, less individual and physical modality treatments towards increased use of group exercise treatments. Major changes in reimbursement rates seemed to initiate shifts in treatment preferences. Our data suggest an evolution of two distinctly different physiotherapist roles in primary care; the autonomous examiner/therapist working on an individual patient/therapist basis, and the exercise therapy group instructor. The physiotherapy profession may need to clarify what role future primary care physiotherapists should possess

Adapted Fresno Test, EBP Beliefs Scale and EBP Implementation scale mean scores in the intervention and the control group.

<p>^aMD within groups = estimated mean difference between scores at follow-up and pre-intervention</p><p>^bCI = confidence interval</p><p>^cMD between groups = estimated mean difference between scores in the intervention and the control group</p><p>All estimates were calculated with GEE regression with adjustment for gender and years of experience.</p><p>Adapted Fresno Test, EBP Beliefs Scale and EBP Implementation scale mean scores in the intervention and the control group.</p

Characteristics of participants (N = 29).

<p>^aSD = standard deviation</p><p>Characteristics of participants (N = 29).</p

The evidence-based practice (EBP) tool: tasks and questions.

<p>^a PICO:“P” = patients, “I” = intervention, “C” = control or comparison, and “O” = outcome</p><p>The evidence-based practice (EBP) tool: tasks and questions.</p

Flow diagram of study.

<p>Flow diagram of study.</p

Training program in evidence-based practice (EBP): workshops, assignments and objectives (6 ECTS-credits^a).

<p>^aECTS-credits = European Credit Transfer and Accumulation System,</p><p>^bPICO:“P” = patients, “I” = intervention, “C” = control or comparison, and “O” = outcome</p><p>Training program in evidence-based practice (EBP): workshops, assignments and objectives (6 ECTS-credits<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0124332#t001fn001" target="_blank">^a</a>).</p