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Determinants of Guideline Use in Primary Care Physical Therapy: A Cross-Sectional Survey of Attitudes, Knowledge, and Behavior

Susanne Bernhardsson, Kajsa Johansson, Per Nilsen, Birgitta Öberg, Maria E.H. Larsson
DOI: 10.2522/ptj.20130147 Published 1 March 2014
Susanne Bernhardsson
S. Bernhardsson, PT, MSc, Region Västra Götaland, Närhälsan Öckerö Rehabilitation, Strandvägen 35, 475 40 Hönö, Sweden, and Department of Medical and Health Sciences, Division of Physiotherapy, Linköping University, Linköping, Sweden.
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Kajsa Johansson
K. Johansson, PT, PhD, Department of Medical and Health Sciences, Division of Physiotherapy, Linköping University.
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Per Nilsen
P. Nilsen, PhD, Department of Medical and Health Sciences, Division of Health Care Analysis, Linköping University.
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Birgitta Öberg
B. Öberg, PT, PhD, Department of Medical and Health Sciences, Division of Physiotherapy, Linköping University.
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Maria E.H. Larsson
M.E.H. Larsson, PT, PhD, Region Västra Götaland, Närhälsan Research and Development Unit, Primary Health Care, Gothenburg, Sweden, and The Sahlgrenska Academy at Gothenburg University, Institute of Neuroscience and Physiology/Physiotherapy, Gothenburg, Sweden.
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Abstract

Background Understanding of attitudes, knowledge, and behavior related to evidence-based practice (EBP) and use of evidence-based clinical practice guidelines in primary care physical therapy is limited.

Objectives The objectives of this study were: (1) to investigate self-reported attitudes, knowledge, behavior, prerequisites, and barriers related to EBP and guideline use among physical therapists in primary care and (2) to explore associations of self-reported use of guidelines with these social cognitive factors along with demographic and workplace characteristics.

Design This was a cross-sectional survey.

Methods A web-based survey of 419 physical therapists in primary care in western Sweden was performed. Multiple logistic regression analysis was performed to examine factors associated with guideline use.

Results The response rate was 64.7%. Most respondents had positive attitudes toward EBP and guidelines: 90% considered EBP necessary, and 96% considered guidelines important. Approximately two thirds reported confidence in finding and using evidence. One third reported being aware of guidelines. Thirteen percent knew where to find guidelines, and only 9% reported having easy access to guidelines. Fewer than half reported using guidelines frequently. The most important barriers to using guidelines were lack of time, poor availability, and limited access to guidelines. Young age and brief work experience were associated with positive attitudes toward EBP. A postgraduate degree was associated with higher application of EBP. Positive attitudes, awareness of guidelines, considering guidelines to facilitate practice, and knowing how to integrate patient preferences with guideline use were associated with frequent use of guidelines.

Limitations Data were self-reported, which may have increased the risk of social desirability bias.

Conclusions Use of guidelines was not as frequent as could be expected in view of the positive attitudes toward EBP and guidelines among physical therapists. Awareness of and perceived access to guidelines were limited. The identified determinants can be addressed when developing guideline implementation strategies.

Footnotes

  • Ms Bernhardsson and Dr Larsson provided concept/idea/research design, data analysis, and writing. Ms Bernhardsson provided data collection. The remaining authors also provided data analysis and critical review of the manuscript. All authors approved the final manuscript. The authors thank all participating physical therapists for completing the questionnaire and Magnus Pettersson and Henrik Magnusson for statistical assistance.

  • Preliminary results of the study were presented at the First International Conference on Evidence-Based Health Care, October 6–8, 2012, New Delhi, India, and the Guidelines International Network, August 18–21, 2013, San Francisco, California.

  • The study was partially funded by the Local Research and Development Board for Gothenburg and Södra Bohuslän. Ms Bernhardsson is partially supported by a doctoral grant from Linköping University.

  • Received April 22, 2013.
  • Accepted October 28, 2013.
  • © 2014 American Physical Therapy Association
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Vol 94 Issue 3 Table of Contents
Physical Therapy: 94 (3)

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Determinants of Guideline Use in Primary Care Physical Therapy: A Cross-Sectional Survey of Attitudes, Knowledge, and Behavior
Susanne Bernhardsson, Kajsa Johansson, Per Nilsen, Birgitta Öberg, Maria E.H. Larsson
Physical Therapy Mar 2014, 94 (3) 343-354; DOI: 10.2522/ptj.20130147

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Determinants of Guideline Use in Primary Care Physical Therapy: A Cross-Sectional Survey of Attitudes, Knowledge, and Behavior
Susanne Bernhardsson, Kajsa Johansson, Per Nilsen, Birgitta Öberg, Maria E.H. Larsson
Physical Therapy Mar 2014, 94 (3) 343-354; DOI: 10.2522/ptj.20130147
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