The essential structure of evidence based practice (EBP): a phenomenological investigation into physiotherapists application of critical appraisal - Abstract

Relevance: EBP is predicated on a fundamental principle that therapeutic knowledge should be appraised and applied into practice. Investigating the impact of EBP education programmes is an important area of study: first, it is not known how physiotherapists put into practice the different domains of EBP after receiving training; and second, it is not known how they connect their EBP knowledge with clinical practice. This phenomenological investigation aimed to explore and understand the practice of critical appraisal to gain further insight into this important domain of EBP. Purpose: Educationalists need to explore and understand the nuances and idiosyncrasies of EBP from the perspectives of physiotherapists themselves. Physiotherapy research, to date, has not explored how the principles of appraisal are applied in practice and theoretical frameworks that underpin appraisal have not been explained. The aim of this research was to gain in-depth understanding of how physiotherapists apply critical appraisal in the real and complex world of clinical practice. Methods/analysis: The philosophy and methodology of descriptive phenomenology was used to underpin the research approach to this study. Twelve physiotherapists took part and were selected based on key criteria that included having taken part in an EBP programme of study. In-depth interviews were used to explore physiotherapists’ experiences and findings were analysed using an adapted version of Colaizzi's method of phenomenological analysis. Rigour was maintained by adhering to phenomenological principles such as phenomenological reduction, free imaginative variation and defining the essence of the findings by participant validation. Results: Four key themes emerged from the analysis: ‘evidence preference’ the type of evidence important to the participants; ‘the process of critical appraisal’ how participants moved through a continuum of appraisal from the conscious use of checklists towards a tacit almost intuitive approach to appraisal; and ‘connecting evidence with self’ describing how the appraisal process internalised evidence leading to meaningful action in practice. Discussion and conclusions: Physiotherapists preferred type of evidence related to the empirico-analytical paradigm rather than the interpretive or qualitative paradigm. Some rejected the use of such evidence in favour of experiential evidence when adopting a patient centred approach. As appraisal experience increased understandings of appraisal concepts became learnt and internalised and this predicated a move towards the use of appraisal knowledge and a move away from the use of checklists. The critical appraisal process connected the therapist with the evidence; critical appraisal was the conduit by which findings from research were incorporated into the personal knowledge base ready for use in clinical practice. Impact and implications: The following recommendations are made: • Reaffirm the importance of and encourage the use of critical appraisal checklists to develop understandings of appraisal concepts. • Use qualitative critical appraisal tools to engage physiotherapists with qualitative research. • Educators need to explain the importance of critical appraisal not just as a tool for understanding the validity of articles but also to enable physiotherapists to connect with the content of research articles. • Encourage the use of appraisal tools to boost memory of appraisal principles and to prevent appraisal from becoming tacit.