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Embracing Evidence-based Physiotherapy: Exploring Physiotherapists' Experiences
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Embracing Evidence-based Physiotherapy: Exploring Physiotherapists' Experiences S Barnard, R Wiles University of Southampton The need for evidence-based practice (EBP) by all clinicians has become high priority for those commissioning and delivering healthcare within the NHS (Bury, 1998). A study investigating the understanding and impact of EBP on 56 physiotherapists within a single Region found differences in definitions, views and experiences between grades and between workplace cultures (Wiles and Barnard, 1998). Focus groups, group and individual inter views were conducted with junior physiotherapists, senior physiotherapists and physiotherapy superintendents and managers from three types of workplace setting. These were hospitals with strong university and academic links, district general hospitals, and community and domiciliary units. Participants were selected using stratified randomisation methods from participating trusts across the Region. Although the Local Research Ethics Committee advised that ethical approval was not necessary, permission to access physiotherapists was obtained from the senior physiotherapy managers group in the Region, who all agreed to participate. The research found that junior physiotherapists had a better understanding of what comprised EBP and were more likely to
Preliminary Studies to Examine the Validity and Reliability of the Portuguese Functional Status Questionnaire for Rural Elderly People M Gomes da Silva, S S Kitchen Physiotherapy Group – Guy's, King's and St Thomas School of Biomedical Sciences, King’s College London J Askham Age Concern Institute of Gerontology, King's College London Introduction: The elderly population of the world is increasing and so is the need for effective high quality care. The assessment of clients is a key aspect contributing to such effectiveness. It requires quality tools with high levels of validity and reliability. Functional status has been used, as an indicator of disability or handicap for elderly people, in the assessments of physiotherapy (Kelly-Hayes et al, 1992). Currently there is no such measure in Portuguese. As elderly people often live in traditional rural areas, instruments designed for urban populations may not be appropriate. The aim of this study is to develop a functional status tool, adapted to rural elderly people and written in Portuguese, and examine its validity and reliability. Methods: The Functional Status Questionnaire developed by Jette and Cleary (1987) is used as a basis. It covers physical, emotional and social (includes work) function. A rigorous Physiotherapy January 2000/vol 86/no 1
have the skills, but not the experience, to assess and implement it. Seniors had a greater concern for the impact of EBP on patient choice and professional autonomy, while superintendents/managers were more likely to consider the wider impact on delivery of physiotherapy services. Departments which had academic links with universities were found to facilitate evidence-based physiotherapy practice through a departmental culture of training and the expectation that interventions would be based on more than clinical experience. The role of key committed physiotherapists was seen to be a driving force towards EBP, particularly by seniors in clinical roles and superintendents/managers in managerial roles. The consensus conference discussing this research saw the allocation of responsibility for EBP development within departments to key physiotherapists as a means of facilitating EBP within the profession. References Bury, T (1998). ‘Evidence-based healthcare explained’ in: Bury, T and Mead, J (eds) Evidence Based Healthcare: A practical guide for therapists, Butterworth-Heinemann, Oxford. Wiles, R and Barnard, S (1998). Evidence Based Practice and Physiotherapy: A report of an investigation into chartered physiotherapists' understanding and implementation of evidence based practice in part of the NHSE South and West Region, Health Research Unit, School of Occupational Therapy and Physiotherapy, University of Southampton.
process of translation and back translation was carried out by certified translators. Content and face validity of the translation were examined by six experienced professionals and eight rural elderly clients. Inter- and intra-obser ver reliability was investigated using Pearson’s Correlation Coefficient (n = 8). Inter-rater reliability involved three observers and the intra-rater assessment of three different moments. Results: The Portuguese version of the instrument shows satisfactory content and face validity. The investigation of the inter-observer reliability shows very strong correlations (r = 0.97; r = 0.98; r = 0.99) as that of intra-observer reliability (r = 0.99; r = 0.98; r = 0.97). Conclusions: The translated and adjusted Functional Status Questionnaire presents satisfactory content and face validity and very good intra- and inter-observer reliability. The primary limitation of this study was the size of the samples used. Further work is required to confirm these results, using larger samples. The authors acknowledge the grant support from the Fundação para a Ciência e Tecnologia.
References Jette, A and Cleary, P (1987). ‘Functional disability assessment’, Physical Therapy, 67, 1854-59. Kelly-Hayes, M, Jette, A M and Wolf, P A (1992). ‘Functional limitation and disability among elders in Framingham study’, American Journal of Public Health, 82, 841-845.
Embracing Evidence-based Physiotherapy: Exploring Physiotherapists' Experiences S Barnard, R Wiles University of Southampton The need for evidence-based practice (EBP) by all clinicians has become high priority for those commissioning and delivering healthcare within the NHS (Bury, 1998). A study investigating the understanding and impact of EBP on 56 physiotherapists within a single Region found differences in definitions, views and experiences between grades and between workplace cultures (Wiles and Barnard, 1998). Focus groups, group and individual inter views were conducted with junior physiotherapists, senior physiotherapists and physiotherapy superintendents and managers from three types of workplace setting. These were hospitals with strong university and academic links, district general hospitals, and community and domiciliary units. Participants were selected using stratified randomisation methods from participating trusts across the Region. Although the Local Research Ethics Committee advised that ethical approval was not necessary, permission to access physiotherapists was obtained from the senior physiotherapy managers group in the Region, who all agreed to participate. The research found that junior physiotherapists had a better understanding of what comprised EBP and were more likely to
Preliminary Studies to Examine the Validity and Reliability of the Portuguese Functional Status Questionnaire for Rural Elderly People M Gomes da Silva, S S Kitchen Physiotherapy Group – Guy's, King's and St Thomas School of Biomedical Sciences, King’s College London J Askham Age Concern Institute of Gerontology, King's College London Introduction: The elderly population of the world is increasing and so is the need for effective high quality care. The assessment of clients is a key aspect contributing to such effectiveness. It requires quality tools with high levels of validity and reliability. Functional status has been used, as an indicator of disability or handicap for elderly people, in the assessments of physiotherapy (Kelly-Hayes et al, 1992). Currently there is no such measure in Portuguese. As elderly people often live in traditional rural areas, instruments designed for urban populations may not be appropriate. The aim of this study is to develop a functional status tool, adapted to rural elderly people and written in Portuguese, and examine its validity and reliability. Methods: The Functional Status Questionnaire developed by Jette and Cleary (1987) is used as a basis. It covers physical, emotional and social (includes work) function. A rigorous Physiotherapy January 2000/vol 86/no 1
have the skills, but not the experience, to assess and implement it. Seniors had a greater concern for the impact of EBP on patient choice and professional autonomy, while superintendents/managers were more likely to consider the wider impact on delivery of physiotherapy services. Departments which had academic links with universities were found to facilitate evidence-based physiotherapy practice through a departmental culture of training and the expectation that interventions would be based on more than clinical experience. The role of key committed physiotherapists was seen to be a driving force towards EBP, particularly by seniors in clinical roles and superintendents/managers in managerial roles. The consensus conference discussing this research saw the allocation of responsibility for EBP development within departments to key physiotherapists as a means of facilitating EBP within the profession. References Bury, T (1998). ‘Evidence-based healthcare explained’ in: Bury, T and Mead, J (eds) Evidence Based Healthcare: A practical guide for therapists, Butterworth-Heinemann, Oxford. Wiles, R and Barnard, S (1998). Evidence Based Practice and Physiotherapy: A report of an investigation into chartered physiotherapists' understanding and implementation of evidence based practice in part of the NHSE South and West Region, Health Research Unit, School of Occupational Therapy and Physiotherapy, University of Southampton.
process of translation and back translation was carried out by certified translators. Content and face validity of the translation were examined by six experienced professionals and eight rural elderly clients. Inter- and intra-obser ver reliability was investigated using Pearson’s Correlation Coefficient (n = 8). Inter-rater reliability involved three observers and the intra-rater assessment of three different moments. Results: The Portuguese version of the instrument shows satisfactory content and face validity. The investigation of the inter-observer reliability shows very strong correlations (r = 0.97; r = 0.98; r = 0.99) as that of intra-observer reliability (r = 0.99; r = 0.98; r = 0.97). Conclusions: The translated and adjusted Functional Status Questionnaire presents satisfactory content and face validity and very good intra- and inter-observer reliability. The primary limitation of this study was the size of the samples used. Further work is required to confirm these results, using larger samples. The authors acknowledge the grant support from the Fundação para a Ciência e Tecnologia.
References Jette, A and Cleary, P (1987). ‘Functional disability assessment’, Physical Therapy, 67, 1854-59. Kelly-Hayes, M, Jette, A M and Wolf, P A (1992). ‘Functional limitation and disability among elders in Framingham study’, American Journal of Public Health, 82, 841-845.