A Review of the Literature on Evidence-Based Practice in Physical Therapy

The term “evidence-based practice” (EBP) has become ubiquitous in physical therapy practice. Since the mid 1990s, over 70 articles have been published in the physical therapy literature relating to EBP. Many physical therapists agree with the notion that scientific evidence should be utilized to guide practice decisions. However, for physical therapy clinicians, there are numerous barriers to EBP. Also, there appears to be a disconnect between academia and clinical practice in terms of the utilization of research evidence to inform clinical decision making. The purpose of this review of the literature is to begin to elucidate and address some of the many issues that the physical therapy profession faces with respect to evidence-based practice by providing a comprehensive synthesis and analysis of the EBP literature in Physical Therapy (PT). Introduction The term “evidence-based practice” (EBP) has become ubiquitous in the physical therapy (PT) literature. Since the mid 1990s, when the term first began to appear, more than 70 articles pertaining directly to the construct of EBP have appeared in our professional journals. Countless others are evident in our practice magazines, newsletters and other publications. In 1995, at the 13th general meeting of the World Confederation for Physical Therapy, several “Declarations of Principle” were adopted relative to EBP since “...in the interests of best practice, physical therapists have a duty and responsibility to use techniques and technologies that have been evaluated scientifically.”1 A number of authors have argued that the profession continues to be in its “infancy” relative to EBP , and that the profession needs to move more quickly toward practice that is more formally based on scientific evidence.2-7 Others have expressed concerns about some aspects EBP as they related to clinical research and practice. For example, in an editorial titled, “The End of Evidence-based practice?” Baxter has argued that “... it would appear that an increasing number of clinicians and researchers have become tired of hearing the message that their work to date has been of variable or poor quality, and that further (better designed) research is urgently needed.”8 Others have argued against the emphasis on the relative strength of randomized controlled trials (RCTs) in physical therapy clinical research.9-11 Therefore despite the high visibility of this issue within the profession, all physical therapists, including clinicians and researchers, are still faced with many questions and uncertainties about the relevance of EBP to clinical practice. The purpose of this paper is to review and synthesize the physical therapy literature in an effort to elucidate issues pertaining to EBP in PT as they have evolved over the past 15 years. In addition, the paper will attempt to identify challenges and barriers that exist relative to EBP in PT practice and begin to articulate some possible solutions to these challenges. Methods The first author conducted a literature search through CINAHL, OVID, and MEDLINE for the years 1990 to 2005. This time frame was chosen in an effort to focus the scope of the search to all relevant information on EBP, since this term first began to appear A Review of the Literature on Evidence-Based Practice in Physical Therapy 2 © The Internet Journal of Allied Health Sciences and Practice, 2005 in the medical literature in the early 1990s.