Barreras para la implementación de la práctica basada en la evidencia (EBP): una encuesta de fisioterapeutas colombianos y españoles

In countries such as Australia, Spain, United States, Colombia, and United Kingdom, the use, teaching and evaluation of ‘evidence-based physical therapy’ (EBPT) in clinical practice has been recently included in educational curriculum. As consequence, PT have support the EBPT, proposing a series of initiatives designed to generate, evaluate and disseminate research, and to implement these results in practice. Despite most research has focused on the use of evidence, including a critical review of studies and scientific literature in clinical practice, if it is desiderate that the use of EBP becomes a reality, it is important to examine the numerous perceived barriers to using research in clinical settings, despite the paucity of studies in this topic. This is especially true for professions such as physiotherapy that has a small research base and few resources compared with other professions. Typically, barriers are context-dependent; therefore, the implementation of strategies should be tailored according to the context and the specific barriers identified. The most commonly reported barrier among PT is the limited time, which constrains the identification and interpretation of research evidence, as well as the ability to apply research findings in clinical practice

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background: Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods: The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results: A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P < 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion: Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)