Correspondence Address:
Vrushali P Panhale
Associate Professor, MGM College of Physiotherapy, Kamothe, Navi Mumbai, Maharashtra
India

Full Text

Dear Editor,

Mary Law states "The argument for evidence-based practice (EBP) is simple, if there is a better way to practice, therapists should find it."[1] The World Confederation for Physical Therapy (WCPT) believes that physical therapists have a responsibility to use evidence and ensure that the management of patients is based on the best available evidence. They also have a responsibility not to use techniques and technologies that have been shown to be ineffective or unsafe.

Unlike other health professions Physiotherapy education in India has grown rapidly over the past half century from a two-year Diploma to the current PhD program. There is no central council overseeing physiotherapy training in India; physiotherapy curriculum differs in each state and university. On the positive side, the absence of a council has given states flexibility, which has actually contributed to the growth of the profession. Academics and educators had the freedom to incorporate newer subjects, more content and achieve faster growth for the profession.

Physiotherapy is one of few professions to have an entry level clinical doctorate program. The entry level Doctorate of Physical therapy (DPT) program was first implemented in 1996 by Creighton University, Nebraska.[2] The DPT program emphasizes EBP and research right from the first year of training. A sound knowledge of research methodology and literature critical appraisal skills is required for EBP.

Knowing that the physiotherapy education in India is quite diverse, we undertook a study to explore the awareness, knowledge, understanding and perceived barriers to the use of EBP among Indian physiotherapists.

After permission from the Institutional Review Board of the Mahatma Gandhi Mission's Institute of Health Sciences, a preliminary cross-sectional survey of physiotherapy practitioners from Mumbai was conducted using a questionnaire designed explicitly for our Indian population but contained elements drawn from previous studies.[3],[4],[5],[6],[7] Data was analyzed using the IBM SPSS software for Windows, Version 16.0. Chicago, SPSS Inc.

A convenience sample of 100 physiotherapy practitioners in the suburbs of Mumbai was approached of which 60 accepted the invitation to participate. This included 78% females and 22% males. Regarding career stage, 73% were graduates, 20% postgraduates (2-year course) and 7% postgraduates (3-year course). Mean age was 27 years, and 80% had between one and five years of work experience.

A total of 98% of respondent therapists reported that they were aware of EBP, 74% agreed that EBP is necessary to practice, 38% disagreed to have learned the foundation of EBP as a part of academic training and 57% disagreed to have received any formal training in search strategies and 47% in critical appraisal of research. For other responses from participants refer [Table 1].{Table 1}

In spite of an inconsistent reporting of EBP and research being part of entry-level training, nearly all reported that they were aware of EBP (98%), and a strong majority report that they are keeping updated to improve practice by attending continuing medical education programs (82%), without any mandatory regulation from a professional body.

Nearly two-thirds (62%) agreed that EBP helps them in decision making around treatment, and 65% agreed that it improves the quality of patient care. More than two-thirds (71%) were interested in improving EBP skills, which brings a thought, "Are we gearing up for an entry level DPT program in India?" [It is indeed our quotation, to highlight that these positive events (like understanding importance of research, valuing evidence generated through such research and feeling the need to remain updated) occurring in the absence of a central council are signs that the profession is getting to its next level (DPT) in entry level education].

This brief study did not take into account the qualifying university of the respondents. Also, it did not include equal numbers of graduate and postgraduate practitioners.

It can be concluded that the clinical physiotherapy practitioners around Mumbai are aware and have positive attitudes and beliefs about EBP and research. Many agree that they need to improve their EBP skills. The inclusion of foundations of EBP in the entry level education of these practitioners was found to be inconsistent. Insufficient time, inability to apply findings to patients with unique characteristics and a lack of understanding of statistical analysis emerged as top perceived barriers.

References