Aim: This study aimed to identify Australian exercise physiologists and physiotherapists barriers and enablers to implementing evidence-based practice (EBP) for people with chronic low back pain (CLBP).
Methods: Before study participation, participants completed a questionnaire which gathered data about demographics, further education, biomedical/biopsychosocial beliefs and two vignettes. This data was analysed using descriptive statistics. The study’s research question was addressed through a critical realist ontological perspective and incorporated elements of a constructivist epistemology. When contemplating sample size, authors reviewed previous related studies and considered various factors, such as the desired diversity of the sample. A sample size of 20 exercise physiologists and 20 physiotherapists was deemed adequate to provide sufficient information power for generating rich insights. Semi-structured interviews explored clinicians’ definition of EBP, understanding of EBP in CLBP management, barriers and enablers and the impact of these factors on their EBP implementation. Data analysis was conducted using the 6-stage reflexive thematic analysis approach, with analysis following an iterative process, including re-visiting transcripts, generating and reanalysing codes, and creating and reviewing themes. This ensured the analysis provided meaningful interpretation of the data and addressed the research question.
Results: A complex interplay among clinician factors, systemic factors, and patient interactions was identified. Clinicians encountered challenges stemming from their misconceptions about EBP, which influenced their perspective(s) on its implementation. Clinicians expressed the challenges of implementing EBP when navigating patient expectations and beliefs, experiencing external pressures from funders and business models, and the subsequent impacts on their well-being. Further education, support from community, and workplaces that prioritised EBP enhanced clinicians’ ability to make decisions that accommodate for the complexities of CLBP and better align with EBP.
Conclusion: A variety of factors and their interconnected dynamics impact exercise physiologists’ and physiotherapists’ implementation of EBP. Similarities in these factors between the two professions suggest systemic influences outweigh profession-specific influences. To improve the implementation of EBP, both clinician factors and deeper systemic factors must be addressed.