Nurses' perceived knowledge, beliefs, skills, and needs regarding evidence-based practice: implications for accelerating the paradigm shift. The propensity to adopt evidence-based practice among physical therapists Fostering Evidence-Based Practice to Improve Nurse and Cost Outcomes in a Community Health Setting: A Pilot Test of the Advancing Research and Clinical Practice Through Close Collaboration Model Evaluation of an evidence-based practice initiative: outcomes, strengths and limitations of a retrospective, conceptually-based approach. Protocol: Adaptive Implementation of Effective Programs Trial (ADEPT): cluster randomized SMART trial comparing a standard versus enhanced implementation strategy to improve outcomes of a mood disorders program Strengthening organizations to implement evidence-based clinical practices. Implementation of evidence-based practice across medical, nursing, pharmacological and allied healthcare professionals: a questionnaire survey in nationwide hospital settings Evidence-based practice profiles of physiotherapists transitioning into the workforce: a study of two cohorts Knowledge and use of evidence-based practice by allied health and health science professionals in the United Kingdom. A KT intervention including the evidence alert system to improve clinician’s evidence-based practice behavior—a cluster randomized controlled trial Evaluation of a tailored, multi-component intervention for implementation of evidence-based clinical practice guidelines in primary care physical therapy: a non-randomized controlled trial The State of Evidence-Based Practice in US Nurses: Critical Implications for Nurse Leaders and Educators Evidence-based practice: beliefs, attitudes, knowledge, and behaviors of physical therapists. Effectiveness of the tailored EBP training program for Filipino physiotherapists: A randomised controlled trial Rapid critical appraisal of randomized controlled trials (RCTs): an essential skill for evidence-based practice (EBP). Do physiotherapists' attitudes towards evidence-based practice change as a result of an evidence-based educational programme? Building a primary care/research partnership: lessons learned from a telehealth intervention for diabetes and depression. An organizational readiness intervention and randomized controlled trial to test strategies for implementing substance use disorder treatment into primary care: SUMMIT study protocol Perspectives on research evidence and clinical practice: a survey of Australian physiotherapists. Can psychological models bridge the gap between clinical guidelines and clinicians' behaviour? A randomised controlled trial of an intervention to influence dentists' intention to implement evidence-based practice A Guide for applying a revised version of the PARIHS framework for implementation Understanding facilitators and barriers to reengineering the clinical research enterprise in community-based practice settings. Addressing the threat of evidence-based practice to qualitative inquiry through increasing attention to quality: a discussion paper.
BACKGROUND The paradigm shift to evidence -based nursing practice in the United States has been slow . Although multiple barriers to evidence -based practice ( EBP ) have been identified through prior studies , there is a gap in the literature specifically identifying key variables ( e.g. , belief that EBP produces quality outcomes ) that are correlated with the extent to which nurses engage in EBP . AIM The primary aims of this study were to ( 1 ) describe nurses ' knowledge , beliefs , skills , and needs regarding EBP ; ( 2 ) determine whether relationships exist among these variables ; and ( 3 ) describe major barriers and facilitators to EBP . METHODS A descriptive survey was conducted with a convenience sample of 160 nurses who were attending EBP conferences or workshops in four states located within the Eastern Region of the United States . RESULTS Although participant beliefs about the benefit of EBP were high , knowledge of EBP was relatively low . Significant relationships were found between the extent to which the nurses ' practice is evidence -based and ( 1 ) nurses ' knowledge of EBP , ( 2 ) nurses ' beliefs about the benefits of EBP , ( 3 ) having an EBP mentor , and ( 4 ) using the Cochrane Data base of Systematic Review s and the National Guideline Clearinghouse . CONCLUSION AND IMPLICATION S Health care systems need to implement interventions that not only increase nurses ' EBP knowledge and skills , but also strengthen their beliefs about the benefit of evidence -based care . EBP mentors may be key in accelerating a more rapid shift toward evidence -based nursing practice . Theoretically driven r and omized controlled trials are urgently needed to test the effectiveness of interventions on advancing evidence -based care Background Many authors , as well as the American Physical Therapy Association , advocate that physical therapists adopt practice patterns based on research evidence , known as evidence -based practice ( EBP ) . At the same time , physical therapists should be capable of integrating EBP within the day-to-day practice of physical therapy . The purpose of this study was to determine the extent to which personal characteristics and the characteristics of the social system in the workplace influence the propensity of physical therapists to adopt EBP . Methods The study used a 69 item mailed self-completion question naire . The question naire had four major sections . The first three sections were each drawn from a different theoretical framework and from different authors ' work . The instrument was developed to capture the propensity of physical therapists to adopt EBP , characteristics of the social system in the workplace of physical therapists , personal characteristics of physical therapists , and selected demographic variables of physical therapists . The eligible population consisted of 3,897 physical therapists licensed by the state of Georgia in the United States of America . A r and om sample of 1320 potential participants was drawn . Results 939 question naires were returned for a response rate of 73 % . 831 of the participants ' question naires were useable and became the basis for the study . There was a moderate association between desire for learning ( r = .36 , r2 = .13 ) , highest degree held ( r = .29 , r2 = .08 ) , practicality ( r = .27 , r2 = .07 ) and nonconformity ( r = .24 , r2 = .06 ) and the propensity to adopt EBP .  A negative correlation was found between age , years licensed and percentage of time in direct patient care . The findings demonstrated that the best three variables for predicting the propensity to adopt EBP  in physical therapy were : desire for learning , highest degree held , and practicality . Conclusion The study confirms there is no single factor to facilitate research evidence into day-to-day practice . Multiple practice change strategies will be needed to facilitate change in practice Although evidence -based practice ( EBP ) improves health care quality , decreases costs , and empowers nurses , there is a paucity of intervention studies design ed to test models of how to enhance nurses '  use of EBP .  Therefore , the specific aim of this study was to determine the preliminary effects of implementing the Advancing Research and Clinical practice through close Collaboration ( ARCC ) model on nurses ' EBP beliefs , EBP implementation behaviors , group cohesion , productivity , job satisfaction , and attrition/turnover rates . A 2-group r and omized controlled pilot trial was used with 46 nurses from the Visiting Nurse Service of New York . The ARCC group versus an attention control group had stronger EBP beliefs , higher EBP implementation behaviors , more group cohesion , and less attrition/turnover . Implementation of the ARCC model in health care systems may be a promising strategy for enhancing EBP and improving nurse and cost outcomes BACKGROUND AND PURPOSE Making evidence -based practice ( EBP ) a sustained reality is a difficult endeavor . This relates , among other factors , to lack of sufficient research upon which to base implementation efforts . Alternative sources of evidence therefore need to be considered , particularly where organizational level EBP is the goal . In this article a brief evaluation of a service-based initiative with the aim of obtaining insights regarding multiple types and levels of EBP-related outcomes is described . METHODS A structured , retrospective improvement evaluation was conducted . Semi-structured interviews and available documents were chosen to obtain information regarding outcomes , perceived spread of reported individual changes , and factors related to the degree of progress . Underlying the method is an evaluation model that shows a progressive set of EBP outcomes at both individual and group levels . FINDINGS Evaluative results , although limited by several factors , provided credible and sufficient internal evidence for this organization 's leadership team to build upon past efforts and refine their approach to integrating research utilization ( RU ) throughout the department of nursing . For example , the evaluation indicated a set of RU outcomes at the individual nurse level not previously considered and also indicated limitations and challenges to full achievement of initial project-related goals . DISCUSSION AND IMPLICATION S The evaluation provided suggestive internal evidence regarding potential benefits of one component of a long-term , valued EBP initiative . However , the evaluation also raised questions regarding structural aspects of this initiative ; identified barriers to progress ; provided information for dialogue and planning ; and highlighted future needs for a proactive , systematic evaluation and a documented trail of data related to all EBP program goals . For those in setting s with similar characteristics and aims that have not built in such a prospect i ve evaluation for EBP initiatives , this evaluative project can be assessed for its applicability Background Despite the availability of psychosocial evidence -based practice s ( EBPs ) , treatment and outcomes for persons with mental disorders remain suboptimal . Replicating Effective Programs ( REP ) , an effective implementation strategy , still result ed in less than half of sites using an EBP . The primary aim of this cluster r and omized trial is to determine , among sites not initially responding to REP , the effect of adaptive implementation strategies that begin with an External Facilitator ( EF ) or with an External Facilitator plus an Internal Facilitator ( IF ) on improved EBP use and patient outcomes in 12 months . Methods / Design This study employs a sequential multiple assignment r and omized trial ( SMART ) design to build an adaptive implementation strategy . The EBP to be implemented is life goals ( LG ) for patients with mood disorders across 80 community-based outpatient clinics ( N N = 1,600 patients ) from different U.S. regions . Sites not initially responding to REP ( defined as < 50 % patients receiving ≥3 EBP sessions ) will be r and omized to receive additional support from an EF or both EF/IF . Additionally , sites r and omized to EF and still not responsive will be r and omized to continue with EF alone or to receive EF/IF . The EF provides technical expertise in adapting LG in routine practice , whereas the on-site IF has direct reporting relationships to site leadership to support LG use in routine practice . The primary outcome is mental health-related quality of life ; secondary outcomes include receipt of LG sessions , mood symptoms , implementation costs , and organizational change . Discussion This study design will determine whether an off-site EF alone versus the addition of an on-site IF improves EBP uptake and patient outcomes among sites that do not respond initially to REP . It will also examine the value of delaying the provision of EF/IF for sites that continue to not respond despite EF.Trial registration Clinical Trials.gov identifier : OBJECTIVES Despite recognition that implementation of evidence -based clinical practice s ( EBPs ) usually depends on the structure and processes of the larger health care organizational context , the dynamics of implementation are not well understood . This project 's aim was to deepen that underst and ing by implementing and evaluating an organizational model hypothesized to strengthen the ability of health care organizations to facilitate EBPs . CONCEPTUAL MODEL : The model posits that implementation of EBPs will be enhanced through the presence of three interacting components : active leadership commitment to quality , robust clinical process re design incorporating EBPs into routine operations , and use of management structures and processes to support and align re design . STUDY DESIGN In a mixed- methods longitudinal comparative case study design , seven medical centers in one network in the Department of Veterans Affairs participated in an intervention to implement the organizational model over 3 years . The network was selected r and omly from three interested in using the model . The target EBP was h and -hygiene compliance . Measures included ratings of implementation fidelity , observed h and -hygiene compliance , and factors affecting model implementation drawn from interviews . FINDINGS Analyses support the hypothesis that greater fidelity to the organizational model was associated with higher compliance with h and -hygiene guidelines . High-fidelity sites showed larger effect sizes for improvement in h and -hygiene compliance than lower-fidelity sites . Adherence to the organizational model was in turn affected by factors in three categories : urgency to improve , organizational environment , and improvement climate . IMPLICATION S Implementation of EBPs , particularly those that cut across multiple processes of care , is a complex process with many possibilities for failure . The results provide the basis for a refined underst and ing of relationships among components of the organizational model and factors in the organizational context affecting them . This underst and ing suggests practical lessons for future implementation efforts and contributes to theoretical underst and ing of the dynamics of the implementation of EBPs Background Implementation of evidence -based practice ( EBP ) is regarded as core competence to improve healthcare quality . In the current study , we investigated the EBP of six groups of professionals : physicians , nurses , pharmacists , physical therapists , technicians , and other allied healthcare personnel . Methods A structured question naire survey of regional hospitals throughout Taiwan was conducted by post in 2011 . Question naires were mailed to all healthcare workers of 11 r and omly selected hospitals .  Linear and logistic regression models were used to examine predictors for implementing EBP . Results In total , 6,160 returned question naires , including 645 from physicians , 4,206 from nurses , 430 from pharmacists , 179 from physical therapists , 537 from technicians , and 163 from other allied healthcare professionals , were valid for the analysis . Physicians and pharmacists were more aware of EBP than were the other professional groups ( p < 0.001 ) . Positive attitudes toward and beliefs in EBP were significantly lower among nurses than in the other groups ( p < 0.001 ) . Physicians had more sufficient knowledge and skills of EBP than did the other professionals ( p < 0.001 ) ; in addition , they implemented EBP for clinical decision-making more often and perceived fewer personal barriers to EBP ( p < 0.001 ) . Multivariate logistic regression analyses showed that EBP implementation was associated with the following characteristics of participants : EBP training , having a faculty position , academic degree , one 's profession , and perceptions ( beliefs , attitudes , knowledge , skills and barriers ) . Conclusions This study depicts various levels of EBP implementation among medical , nursing , pharmacological , and allied healthcare personnel . There were significant differences in their implementation of EBP . We observed that certain factors were associated with EBP implementation , including personal background s and perceptions toward EBP . The data suggest that strategies for enhancing EBP implementation should differ for various groups of professionals Background Training in the five steps of evidence -based practice ( EBP ) has been recommended for inclusion in entry-level health professional training . The effectiveness of EBP education has been explored predominantly in the medical and nursing professions and more commonly in post-graduate than entry-level students . Few studies have investigated longitudinal changes in EBP attitudes and behaviours . This study aim ed to assess the changes in EBP knowledge , attitudes and behaviours in entry-level physiotherapy students transitioning into the workforce . Methods A prospect i ve , observational , longitudinal design was used , with two cohorts . From 2008 , 29 participants were tested in their final year in a physiotherapy program , and after the first and second workforce years . From 2009 , 76 participants were tested in their final entry-level and first workforce years . Participants completed an Evidence -Based Practice Profile question naire ( EBP2 ) , which includes self-report EBP domains [ Relevance , Terminology ( knowledge of EBP concepts ) , Confidence , Practice ( EBP implementation ) , Sympathy ( disposition towards EBP ) ] . Mixed model analysis with sequential Bonferroni adjustment was used to analyse the matched data . Effect sizes ( ES ) ( 95 % CI ) were calculated for all changes . Results Effect sizes of the changes in EBP domains were small ( ES range 0.02 to 0.42 ) . While most changes were not significant there was a consistent pattern of decline in scores for Relevance in the first workforce year ( ES -0.42 to -0.29 ) followed by an improvement in the second year ( ES + 0.27 ) . Scores in Terminology improved ( ES + 0.19 to + 0.26 ) in each of the first two workforce years , while Practice scores declined ( ES -0.23 to -0.19 ) in the first year and improved minimally in the second year ( ES + 0.04 ) . Confidence scores improved during the second workforce year ( ES + 0.27 ) . Scores for Sympathy showed little change . Conclusions During the first two years in the workforce , there was a transitory decline in the self-reported practice and sense of relevance of EBP , despite increases in confidence and knowledge . The pattern of progression of EBP skills beyond these early professional working years is unknown Clinical  effectiveness ( CE ) and evidence -based practice ( EBP )  are the cornerstone of modern-day health care . Although many studies have explored attitudes and perceived knowledge of individual professions , few have compared these factors between professional groups , especially in the allied health professions ( AHP ) and health science services ( HSS ) . We report a study comparing the knowledge and practice of 14 different professional groups from the AHP and HSS in terms of EBP and CE . The aim was to highlight any differences between the 14 professional groups along with the needs of the groups . A postal question naire survey was completed by a r and om sample of 1,000 members of AHP and HSS across the United Kingdom . There were significant differences between professional groups with , in general , professionals from the HSS groups rating their knowledge and application of CE and EBP  as lower than members of the AHP . Differences were also noted between individual professional groups . For example , podiatrists , radiographers , and orthoptists reported having less knowledge of CE and EBP than physiotherapists , occupational therapists , dietitians , speech and language therapists , and psychologists . Barriers to implementing EBP were similar for all groups , with lack of both time and money cited as the main issues . A number of differences between professions were recorded that highlight the difference in educational and policy approach required for greater uptake of EBP Background It is difficult to foster research utilization among allied health professionals ( AHPs ) . Tailored , multifaceted knowledge translation ( KT ) strategies are now recommended but are re source intensive to implement . Employers need effective KT solutions but little is known about ; the impact and viability of multifaceted KT strategies using an online KT tool , their effectiveness with AHPs and their effect on evidence -based practice ( EBP ) decision-making behavior . The study aim was to measure the effectiveness of a multifaceted KT intervention including a customized KT tool , to change EBP behavior , knowledge , and attitudes of AHPs . Methods This is an evaluator-blinded , cluster r and omized controlled trial conducted in an Australian community-based cerebral palsy service . 135 AHPs ( physiotherapists , occupational therapists , speech pathologists , psychologists and social workers ) from four regions were cluster r and omized ( n = 4 ) , to either the KT intervention group ( n = 73 AHPs ) or the control group ( n = 62 AHPs ) , using computer-generated r and om numbers , concealed in opaque envelopes , by an independent officer . The KT intervention included three-day skills training workshop and multifaceted workplace supports to redress barriers ( paid EBP time , mentoring , system changes and access to an online research synthesis tool ) . Primary outcome ( self- and peer-rated EBP behavior ) was measured using the Goal Attainment Scale ( individual level ) . Secondary outcomes ( knowledge and attitudes ) were measured using exams and the Evidence Based Practice Attitude Scale . Results The intervention group ’s primary outcome scores improved relative to the control group , however when clustering was taken into account , the findings were non-significant : self-rated EBP behavior [ effect size 4.97 ( 95 % CI -10.47 , 20.41 ) ( p = 0.52 ) ] ; peer-rated EBP behavior [ effect size 5.86 ( 95 % CI -17.77 , 29.50 ) ( p = 0.62 ) ] . Statistically significant improvements in EBP knowledge were detected [ effect size 2.97 ( 95 % CI 1.97 , 3.97 ( p < 0.0001 ) ] . Change in EBP attitudes was not statistically significant . Conclusions Improvement in EBP behavior was not statistically significant after adjusting for cluster effect , however similar improvements from peer-ratings suggest behaviorally meaningful gains . The large variability in behavior observed between clusters suggests barrier assessment s and subsequent KT interventions may need to target subgroups within an organization . Trial registration Registered on the Australian New Zeal and Clinical Trials Registry ( ACTRN12611000529943 ) Background Clinical practice guidelines are important for transmitting research findings into practice and facilitating the application of evidence -based practice ( EBP ) . There is a paucity of knowledge about the impact of guideline implementation strategies in primary care physical therapy . The aim of this study was to evaluate the effect of a guideline implementation intervention in primary care physical therapy in western Sweden . Methods An implementation strategy based on theory and current evidence was developed . A tailored , multi-component implementation intervention , addressing earlier identified determinants , was carried out in three areas comprising 28 physical therapy practice s including 277 physical therapists ( PTs ) ( intervention group ) . In two adjacent areas , 171 PTs at 32 practice s received no intervention ( control group ) . The core component of the intervention was an implementation seminar with group discussion s. Among other components were a website and email reminders . Data were collected at baseline and follow-up with a web-based question naire . Primary outcomes were the self-reported awareness of , knowledge of , access to , and use of guidelines . Secondary outcomes were self-reported attitudes toward EBP and guidelines . Analyses were performed using Pearson ’s χ2 test and approximative z-test . Results 168 PTs ( 60.6 % ) in the intervention group and 88 PTs ( 51.5 % ) in the control group responded to the follow-up question naire . 186/277 PTs ( 67.1 % ) participated in the implementation seminars , of which 97 ( 52.2 % ) responded . The proportions of PTs reporting awareness of ( absolute difference in change 20.6 % , p = 0.023 ) , knowledge where to find ( 20.4 % , p = 0.007 ) , access to ( 21.7 % , p < 0.001 ) , and frequent use of ( 9.5 % , NS ) guidelines increased more in the intervention group than in the control group . The proportion of PTs reporting frequent guideline use after participation in the implementation seminar was 15.2 % ( p = 0.043 ) higher than the proportion in the control group . A higher proportion considered EBP helpful in decision making ( p = 0.018 ) . There were no other significant differences in secondary outcomes . Conclusions A tailored , theory- and evidence -informed , multi-component intervention for the implementation of clinical practice guidelines had a modest , positive effect on awareness of , knowledge of , access to , and use of guidelines , among PTs in primary care in western Sweden . In general , attitudes to EBP and guidelines were not affected This descriptive survey assessed the perception of  evidence -based practice ( EBP ) among nurses in the United States . Although evidence -based healthcare results in improved patient outcomes and reduced costs , nurses do not consistently implement evidence -based best practice s. A descriptive survey was conducted with a r and om sample of 1015 RNs who are members of the American Nurses Association . Although nurses believe in evidence -based care , barriers remain prevalent , including resistance from colleagues , nurse leaders , and managers . Differences existed in responses of nurses from Magnet ® versus non-Magnet institutions as well as nurses with master ’s versus nonmaster ’s degrees . Nurse leaders and educators must provide learning opportunities regarding EBP and facilitate supportive cultures to achieve the Institute of Medicine ’s 2020 goal that 90 % of clinical decisions be evidence -based BACKGROUND AND PURPOSE Little research has been done regarding the attitudes and behaviors of physical therapists relative to the use of evidence in practice . The purpose s of this study were to describe the beliefs , attitudes , knowledge , and behaviors of physical therapist members of the American Physical Therapy Association ( APTA ) as they relate to evidence -based practice ( EBP ) and to generate hypotheses about the relationship between these attributes and personal and practice characteristics of the respondents . METHODS A survey of a r and om sample of physical therapist members of APTA result ed in a 48.8 % return rate and a sample of 488 that was fairly representative of the national membership . Participants completed a question naire design ed to determine beliefs , attitudes , knowledge , and behaviors regarding EBP , as well as demographic information about themselves and their practice setting s. Responses were summarized for each item , and logistic regression analyses were used to examine relationships among variables . RESULTS Respondents agreed that the use of evidence in practice was necessary , that the literature was helpful in their practice s , and that quality of patient care was better when evidence was used . Training , familiarity with and confidence in search strategies , use of data bases , and critical appraisal tended to be associated with younger therapists with fewer years since they were licensed . Seventeen percent of the respondents 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 . The majority of the respondents had access to online information , although more had access at home than at work . According to the respondents , the primary barrier to implementing EBP was lack of time . DISCUSSION AND CONCLUSION Physical therapists stated they had a positive attitude about EBP and were interested in learning or improving the skills necessary to implement EBP . They noted that they needed to increase the use of evidence in their daily practice Astract Background Evidence implementation continues to challenge health professionals most especially those from developing countries . Filipino physiotherapists represent a group of health professionals in a developing country who by tradition and historical practice , take direction from a doctor , on treatment options . Lack of autonomy in decision-making challenges their capacity to deliver evidence -based care . However , this scenario should not limit them from updating and up-skilling themselves on evidence - based practice ( EBP ) . EBP training tailored to their needs and practice was developed to address this gap . This study will be conducted to assess the effectiveness of a tailored EBP-training program for Filipino physiotherapists , in improving knowledge , skills , attitudes and behaviour to EBP . Participation in this program aims to improve capacity to EBP and engage with referring doctors to determine the most effective treatments for their patients . Methods / Design A double blind r and omised controlled trial , assessing the effectiveness of the EBP training intervention , compared with a waitlist control , will be conducted . An adequately powered sample of 54 physiotherapists from the Philippines will be recruited and r and omly allocated to EBP intervention or waitlist control . Intervention : The EBP program for Filipino physiotherapists is a one-day program on EBP principles and techniques , delivered using effective adult education strategies . It consists of lectures and practical workshops . A novel component in this program is the specially-developed recommendation form , which participants can use after completing their training , to assist them to negotiate with referring doctors regarding evidence -based treatment choices for their patients .Pre and post measures of EBP knowledge , skills and attitudes will be assessed in both groups using the Adapted Fresno Test and the Questions to EBP attitudes . Behaviour to EBP will be measured using activity diaries for a period of three months . Discussion Should the EBP-training program be found to be effective in improving EBP-uptake in Filipino physiotherapists , it will form the basis of a much needed national intervention which is context ually appropriate to Filipino physiotherapists . It will therefore form the genesis for a model for building EBP capacity of other health professionals in the Philippines as well as physiotherapists in developing countries . Trial Registration Current Controlled Trials : IS RCT Critical appraisal of research studies is the third step in evidence -based practice ( EBP ) , following step one , “ Asking clinical questions in PICO ( i.e. , population , intervention or interest area ; comparison intervention or group , and outcome of interest ) format , ” and step two , “ Search ing for evidence to answer the questions . ” Once research is found to answer a burning PICO clinical question ( e.g. , In teens , is cognitive-behavioral therapy or relaxation techniques more effective in reducing anxiety symptoms ? ) , the clinician must be able to rapidly appraise studies in order to determine their validity and applicability to clinical practice . For years , research courses in many educational curriculums have taught critiquing studies as a very detailed , time consuming process . Unfortunately , this method of teaching the appraisal process has often contributed to lasting negative attitudes about research and misperceptions by clinicians about the length of time that it takes to read and critically appraise a single research report . Many practicing clinicians also believe that critical appraisal is much too difficult or that experts in EBP and research ers are the only individuals who can be competent in the process . Therefore , this paper will present a user-friendly , efficient approach to critically appraising a published r and omized clinical trial ( RCT ) . Implementing this method of critical appraisal should contribute to enhanced confidence in clinicians ’ abilities to swiftly determine whether the findings from a RCT are valid and should be translated to their clinical practice setting RATIONALE The concept of evidence -based practice ( EBP ) encourages health care professionals to provide the most effective health care , and to be accountable for the interventions they provide . Little work has been undertaken to examine how practically allied health professionals ' encompass EBP and how they perceptive and underst and the concept of EBP . The use of opinion leaders to disseminate new evidence into practice , and thereby encourage the behaviour of health care professionals has been proposed . AIMS The aims of this study were to investigate physiotherapists ' attitudes towards EBP and to examine change in their attitudes following an education package , which utilized local opinion leaders . METHOD Thirty musculoskeletal physiotherapists from a Community Trust in North Staffordshire were cluster r and omized by location of work to two groups . The intervention group received an evidence -based programme on aspects of EBP including literature search ing and critical appraisal . The attention control group received a st and ard in-service training package on the management of common knee pathologies . The physiotherapists ' attitudes towards EBP were measured at baseline ( before r and omization ) and at 3 and 6 months follow-up . RESULTS Physiotherapists reported that they primarily relied on ' courses ' and ' in-service training ' for informing their clinical practice . Most agreed that clinical practice should be based on the best available evidence and that they would change their clinical practice if evidence suggested they should do so . However , many of the physiotherapists reported difficulty in reading journals and could not identify opinion leaders in key areas . In terms of clinical practice , literature , journals and research were ascribed low priority throughout . Differences in attitudes between the intervention and control groups were observed in relation to management support for EBP at 3 and 6 months follow-up . CONCLUSIONS In this study , physiotherapists appeared to be in favour of the idea of EBP , yet they remained reluctant to change their practice . Opinion leaders were not easily identifiable by physiotherapists , suggesting that this method alone may not be an effective method of changing attitudes in clinical practice . The process of changing attitudes in the clinical environment is a complex issue worthy of further research INTRODUCTION Evidence -based interventions are often poorly translated into primary care setting s due to inadequate integration into organizational cultures and clinical workflows . Study design s that blend evaluation of effectiveness and implementation may enhance uptake of interventions into primary care setting s. Community-Based Participatory Research ( CBPR ) models are useful for developing partnerships between research teams and primary care clinical partners to test blended study design s. METHODS We conducted a formative evaluation of partnership building between a health services research team and a primary care community in US Veterans Affairs Health System to conduct a r and omized effectiveness trial of an intervention embedded in routine primary care . The formative evaluation used qualitative data drawn from research / clinical partnership meetings . Data were coded and analysed using qualitative framework analysis . RESULTS The CBPR model guided development of a research / clinical partnership based on a facilitation team consisting of ' external facilitators ' ( research team ) , ' internal facilitators ' ( primary care leadership ) and a ' clinical advisory committee ' drawn from the primary care community . Qualitative themes focused on : how the intervention components ( ' evidence ' ) aligned with local clinical cultures , barriers and facilitators to acceptance and adoption of the intervention processes within the context of clinical workflows and identified ' facilitators ' of intervention uptake and sustainability . CONCLUSION A CBPR model can guide the development of research / clinical partnerships . Partnerships can identify barriers and craft modifications to intervention procedures that promote integration and into primary care workflows . Formative research / clinical partnerships are critical for design ing and testing interventions focused on implementation and sustainability of new evidence within routine primary care Background Millions of people who need treatment for substance use disorders ( SUD ) do not receive it . Evidence -based practice s for treating SUD exist , and some are appropriate for delivery outside of specialty care setting s. Primary care is an opportune setting in which to deliver SUD treatment because many individuals see their primary care providers at least once a year . Further , the Patient Protection and Affordable Care Act ( PPACA ) increases coverage for SUD treatment and is increasing the number of individuals seeking primary care services . In this article , we present the protocol for a study testing the effects of an organizational readiness and service delivery intervention on increasing the uptake of SUD treatment in primary care and on patient outcomes . Methods / design In a r and omized controlled trial , we test the combined effects of an organizational readiness intervention consisting of implementation tools and activities and an integrated collaborative care service delivery intervention based on the Chronic Care Model on service system ( patient-centered care , utilization of substance use disorder treatment , utilization of health care services and adoption and sustainability of evidence -based practice s ) and patient ( substance use , consequences of use , health and mental health , and satisfaction with care ) outcomes . We also use a repeated measures design to test organizational changes throughout the study , such as acceptability , appropriateness and feasibility of the practice s to providers , and provider intention to adopt the practice s. We use provider focus groups , provider and patient surveys , and administrative data to measure outcomes . Discussion The present study responds to critical gaps in health care services for people with substance use disorders , including the need for greater access to SUD treatment and greater uptake of evidence -based practice s in primary care . We design ed a multi-level study that combines implementation tools to increase organizational readiness to adopt and sustain evidence -based practice s ( EBPs ) and tests the effectiveness of a service delivery intervention on service system and patient outcomes related to SUD services . Trial registration Current controlled trials : BACKGROUND AND PURPOSE Physiotherapists ' use of research evidence with clinical decision-making has interested research ers world-wide since 1980 ; however , little is known about such practice s in Australia . The present survey sought information on Australian physiotherapists ' perceptions of the importance of research , and barriers to uptake of evidence in clinical practice , when compared with an international cohort from 2001 . METHOD An Australian-relevant version of an English ( UK ) National Health Service ( NHS ) survey instrument was used to canvass 453 physiotherapists , r and omly selected from the South Australian Physiotherapy Registration Board 2004 - 2005 records . The first survey was mailed in August 2005 , a reminder was sent two weeks later to non-responders and a follow-up survey was sent in April 2006 to non-responders whose addresses had changed since 2005 . RESULTS There was a 51 % response rate . Of the non-responders , 12 % were not contactable at their listed address , highlighting the mobility of Australian physiotherapists . Most respondents had undertaken research as students ( 59.5 % ) or as students and clinicians ( 11.5 % ) . Of these , 37.1 % were encouraged to embark on more research , and 20.5 % were discouraged . The significant predictors of positive perceived importance of research were : previous research experience ; being positive about undertaking further research ; working in hospitals and holding a postgraduate degree . Clinicians working privately were significantly less likely than managers to be positive about research importance . The only significant predictor for not perceiving barriers to uptake of evidence was being positive about undertaking future research . CONCLUSIONS The study identified constraints on uptake of evidence into practice that were related to accessing , reading and interpreting published research , and implementing findings . Found consistently across employment categories were barriers relating to lack of time , uncertainty about what the research reported , scepticism about the value of research and being isolated from peer support and literature sources . The responses indicated a positive shift towards evidence uptake since the 2001 NHS survey , suggesting an influence of increased exposure to information on evidence -based practice . A greater focus on research whilst training , the application of educational strategies for empowerment , better knowledge transfer and upskilling within the workplace , and ensuring dedicated time and organizational support for research activities are indicated Objective The lag between publication of evidence for clinical practice and implementation by clinicians may be decades . Research using psychological models demonstrates that changing intention is very important in changing behaviour . This study examined an intervention ( rehearsing alternative actions ) to change dentists ' intention to implement evidence -based practice ( EBP ) for third molar ( TM ) management . Design R and omised controlled trial / postal . Setting Primary care . Subjects and methods Dentists were r and omly selected from the Scottish Dental Practice Board Register , then r and omly allocated to intervention or control groups , and sent a question naire . The intervention group listed management alternatives to TM extraction prior to their TM extraction intention , and the control group did not . Based on psychological models for reducing a behaviour 's frequency ( EBP is weighted against TM extraction ) , prior listing of alternatives should decrease extraction intention . Main outcome measure Intention to extract TMs . Results A total of 99 dentists — 70 Males , 29 Females ; mean age = 41.42 years ( SD = 8.62 ) participated in the study . The intervention significantly influenced intention to extract TMs , as desired . Despite similar background and knowledge of management alternatives , participants in the intervention group had significantly lower intention to extract :  control group mean ( SD ) = 0.39 ( 1.99 ) ; intervention group mean ( SD ) = −0.78 ( 1.89 ) ; mean difference ( SE ) = 1.17 ( 0.42 ) ; 95 % confidence interval for the difference = 0.34 to 1.99 . Conclusion Results suggest this intervention , which successfully influenced a proximal predictor of behaviour pertinent to dental EBP , may result in improved EBP in a service-level trial . Basing implementation interventions and trial methodology on psychological models may effectively bridge the gap between clinical guidelines and practice Background Based on a critical synthesis of literature on use of the Promoting Action on Research Implementation in Health Services ( PARIHS ) framework , revisions and a companion Guide were developed by a group of research ers independent of the original PARIHS team . The purpose of the Guide is to enhance and optimize efforts of research ers using PARIHS in implementation trials and evaluations . Methods Authors used a planned , structured process to organize and synthesize critiques , discussion s , and potential recommendations for refinements of the PARIHS framework arising from a systematic review . Using a templated form , each author independently recorded key components for each review ed paper ; that is , study definitions , perceived strengths/ limitations of PARIHS , other observations regarding key issues and recommendations regarding needed refinements . After reaching consensus on these key components , the authors summarized the information and developed the Guide . Results A number of revisions , perceived as consistent with the PARIHS framework 's general nature and intent , are proposed . The related Guide is composed of a set of reference tools , provided in Additional files . Its core content is built upon the basic elements of PARIHS and current implementation science . Conclusions We invite research ers using PARIHS for targeted evidence -based practice ( EBP ) implementations with a strong task-orientation to use this Guide as a companion and to apply the revised framework prospect ively and comprehensively . Research ers also are encouraged to evaluate its use relative to perceived strengths and issues . Such evaluations and critical reflections regarding PARIHS and our Guide could thereby promote the framework 's continued evolution Solutions are employed to support clinical research trial tasks in community-based practice setting s. Using the IT Implementation Framework ( ITIF ) , an integrative framework intended to guide the synthesis of theoretical perspectives for planning multi-level interventions to enhance IT use , we sought to underst and the barriers and facilitators to clinical research in community-based practice setting s preliminary to implementing new informatics solutions for improving clinical research infrastructure . The studies were conducted in practice s within the Columbia University Clinical Trials Network . A mixed- method approach , including surveys , interviews , time-motion studies , and observations was used . The data collected , which incorporates predisposing , enabling , and reinforcing factors in IT use , were analyzed according to each phase of ITIF . Themes identified in the first phase of ITIF were 1 ) processes and tools to support clinical trial research and 2 ) clinical research peripheral to patient care processes . Not all of the problems under these themes were found to be amenable to IT solutions . Using the multi-level orientation of the ITIF , we set forth strategies beyond IT solutions that can have an impact on reengineering clinical research tasks in practice -based setting s. Developing strategies to target enabling and reinforcing factors , which focus on organizational factors , and the motivation of the practice at large to use IT solutions to integrate clinical research tasks with patient care processes , is most challenging . The ITIF should be used to consider both IT and non-IT solutions concurrently for reengineering of clinical research in community-based practice setting The current evidence -based practice ( EBP ) movement in healthcare emphasizes that clinical decision making should be based on the " best evidence " available , preferably the findings of r and omized clinical trials . Within this context qualitative research findings are considered to have little value and the old debate in nursing has been re-ignited related to whether qualitative versus quantitative research findings provides the best empirical evidence for nursing practice . In response to this crisis qualitative scholars have been called upon by leaders in the field to clarify for outsiders what qualitative research is and to be more explicit in pointing out the utility of qualitative research findings . In addition , attention to " quality " in qualitative research has been identified as an area worthy of renewed focus . Within this paper two key problems related to addressing these issues are review ed : disagreement not only among " outsiders " but also some nursing scholars related to the definition of " qualitative research " , and a lack of consensus related how to best address " rigor " in this type of inquiry . Based on this review a set of st and ard requirements for qualitative research published in nursing journals is proposed that reflects a uniform definition of qualitative research and an enlarged yet clearly articulated conceptualization of quality . The approach suggested provides a framework for developing and evaluating qualitative research that would have both defensible scholarly merit and heuristic value . This will help solidify the argument in favor of incorporating qualitative research findings as part of the empirical " evidence " upon which evidence -based nursing is founded
RESULTS Many physiotherapists hold positive attitudes towards EBP .
However , this does not necessarily translate into consistent , high- quality EBP .
Many barriers to EBP implementation are apparent , including : lack of time and skills , and misperceptions of EBP .
BACKGROUND Despite clear benefits of the Evidence -Based Practice ( EBP ) approach to ensuring quality and consistency of care , its uptake within physiotherapy has been inconsistent .
OBJECTIVES Synthesis e the findings of research into EBP barriers , facilitators and interventions in physiotherapy and identify methods of enhancing adoption and implementation .