Obstacles facing evidence based medicine in physical medicine and rehabilitation
From opinion and knowledge to practice
Keywords:
Physical and rehabilitation medicine, Evidence -based medicine, Iran, Attitude, KnowledgeAbstract
Background: Evidence-based medicine (EBM) is a new approach to medicine which can guide clinical services toward effective and beneficial results with the least side effects or errors. Up to now, there have been few available articles about specialists’ EBM status, specifically the status of physiatrists in the area of EBM.
Objective: To determine the present status of physiatrists’ attitudes, knowledge and skill in the area of EBM and the existing obstacles.
Methods: The cross-sectional study was performed in 2014 among physiatrists in Iran. The valid and reliable questionnaire contained 25 questions in 8 fields including demographic and professional information, point of view regarding EBM, familiarity with databases, educational history and information about EBM, use of scientific resources, scientific evidence usage, and the amount of access to resources. Final analysis of the questionnaires was done using SPSS version 16.
Results: One hundred twenty-eight questionnaires were completed (response percentage 52.2%). In total, 48.4% specialists had attended EBM workshops and 89.6% of people were familiar with medical search engines. The amount of familiarity with databases was mostly with MEDLINE/PubMed (52.3%). Respondents mainly had a positive point of view towards EBM. Those who had access to databases at work or somewhere out of home had a more positive attitude (p=0.002). Those who had attended EBM workshops and members of faculty also had more positive attitudes (p=0.003 and p=0.01, respectively). Around 70% of responders had adequate knowledge regarding EBM. Physicians, members of faculty and participants who had spent more time on research, reviewed articles and attended workshops had more knowledge (p=0.001). There were three major obstacles recognized: An insufficient amount of knowledge regarding the principles, advantages and applications of EBM, difficulty with gaining access to associated databases and an insufficient amount of activity in judging and analyzing the related articles.
Conclusion: Results from our study revealed that although there is a significant number of physiatrists who are familiar with the practicality of EBM, they are still not familiar enough with its concepts and applications.
References
Sackett DL, Rosenberg W, Gray J, Haynes RB, Richardson WS. Evidence based medicine: what it is and
what it isn't. BMJ. 1996; 312(7023): 71-2. doi: 10.1136/bmj.312.7023.71. PMID: 8555924, PMCID:
PMC2349778.
Claridge J, Fabian T. History and Development of Evidence-based Medicine. World J Surg. 2005; 29(5):
-53. doi: 10.1007/s00268-005-7910-1. PMID: 15827845.
Knebel E, Greiner AC. Health Professions Education: A Bridge to Quality: National Academies Press;
Ahmadi‐Abhari S, Soltani A, Hosseinpanah F. Knowledge and attitudes of trainee physicians regarding
evidence‐based medicine: a questionnaire survey in Tehran, Iran. J Eval Clin Pract. 2008; 14(5): 775-9.
doi: 10.1111/j.1365-2753.2008.01073.x. PMID: 19018910.
McCluskey A, Lovarini M. Providing education on evidence-based practice improved knowledge but did
not change behaviour: a before and after study. BMC Medical Education. 2005; 5(1): 40. doi:
1186/1472-6920-5-40. PMID: 16364181, PMCID: PMC1352357.
Slawson DC, Shaughnessy AF. Teaching evidence-based medicine: should we be teaching information
management instead? Academic Medicine. 2005; 80(7): 685-9. doi: 10.1097/00001888-200507000-00014.
Brown CE, Wickline MA, Ecoff L, Glaser D. Nursing practice, knowledge, attitudes and perceived barriers
to evidence‐based practice at an academic medical center. J Adv nurs. 2009; 65(2): 371-81. doi:
1111/j.1365-2648.2008.04878.x. PMID: 19040688.
Iles R, Davidson M. Evidence based practice: a survey of physiotherapists' current practice. Physiotherapy
Research International. 2006; 11(2): 93-103. doi: 10.1002/pri.328. PMID: 16808090.
Jette DU, Bacon K, Batty C, Carlson M, Ferland A, Hemingway RD, et al. Evidence-based practice:
beliefs, attitudes, knowledge, and behaviors of physical therapists. Physical Therapy. 2003; 83(9): 786-805.
PMID: 12940766.
Shuval K, Berkovits E, Netzer D, Hekselman I, Linn S, Brezis M, et al. Evaluating the impact of an
evidence‐based medicine educational intervention on primary care doctors’ attitudes, knowledge and
clinical behaviour: a controlled trial and before and after study. J Eval Clin Pract. 2007; 13(4): 581-98. doi:
1111/j.1365-2753.2007.00859.x. PMID: 17683300.
Kern H, Loefler S, Fialka-Moser V, Paternostro-Sluga T, Crevenna R, Burggraf S, et al. Evidence based
medicine in physical medicine and rehabilitation (English version). European Journal of Translational
Myology. 2014; 23(4). doi: 10.4081/bam.2013.4.217.
DeLisa JA, Jain SS, Kirshblum S, Christodoulou C. Evidence-based medicine in physiatry: The Experience
of One Department's Faculty and Trainees1. American Journal of Physical Medicine & Rehabilitation.
; 78(3): 228-32. doi: 10.1097/00002060-199905000-00008.
Raeissadat SA, Samadi B, Rayegani SM, Bahrami MH, Mahmoudi H. Survey of Medical Residents’
Attitude Toward Physical Medicine and Rehabilitation. American Journal of Physical Medicine &
Rehabilitation. 2014; 93(6): 540-7. doi: 10.1097/PHM.0000000000000057. PMID: 24508929.
Green ML. Graduate medical education training in clinical epidemiology, critical appraisal, and evidence- based medicine: a critical review of curricula. Academic Medicine. 1999; 74(6): 686-94. doi:
1097/00001888-199906000-00017. PMID: 10386099.
Azizi F. Medical Education in the Islamic Republic of Iran: three decades of success. Iranian Journal of
Public Health. 2009; 38(Suppl 1): 19-26.
Raeissadat SA, Bahrami MH, Rayegani SM, Babaee M, Roshan Pajoh R. Attitude, beliefs and knowledge
of iranian physiatrists towards Evidence Based Medicine and its barriers. A cross-sectional study. Eur J
Phys Rehabil Med. 2016; 52(5): 755-7. PMID: 27164540.
Kouhpayehzadeh J, Baradaran H, Arabshahi KS, Knill‐Jones R. Clinical teachers' attitudes toward the
efficacy of evidence‐based medicine workshop and self‐reported ability in evidence‐based practice in
Iran. J Contin Educ Health Prof. 2006; 26(3): 210-4. doi: 10.1002/chp.72. PMID: 16986146.
Adib‐Hajbaghery M. Factors facilitating and inhibiting evidence‐based nursing in Iran. J Adv Nurs.
; 58(6): 566-75. doi: 10.1111/j.1365-2648.2007.04253.x. PMID: 17442028.
Adib‐Hajbaghery M. Evidence‐Based Practice: Iranian Nurses’ Perceptions. Worldviews on Evidence ‐Based Nursing. 2009; 6(2): 93-101. doi: 10.1111/j.1741-6787.2009.00149.x. PMID: 19413583.
Amini M, Moghadami M, Shayegh S, Sagheb MM. The rate of knowledge and practice of medical
residents of Shiraz medical school in regard to evidence-based medicine. Strides in Development of
Medical Education. 2007.
Sadeghi M, Khanjani N, Motamedi F. Knowledge, Attitude and Application of Evidence Based Medicine
(EBM) among Residents of Kerman Medical Sciences University. Iranian Journal of Epidemiology. 2011;
(3): 20-6.
Davoodi R, Badiee Aval S, Salehi M, Rahmani S, Sabouri G, Soltanifar A, et al. Evidence-Based Medicine:
Studying the Attitude of Medical Residents in Mashhad. Journal of Patient Safety & Quality Improvement.
; 3(1): 188-92.
Majid S, Foo S, Luyt B, Zhang X, Theng YL, Chang YK, et al. Adopting evidence-based practice in
clinical decision making: nurses' perceptions, knowledge, and barriers. Journal of the Medical Library
Association. 2011; 99(3): 229. doi: 10.3163/1536-5050.99.3.010. PMID: 21753915, PMCID:
PMC3133901.
Manspeaker SA, Van Lunen BL, Turocy PS, Pribesh S, Hankemeier D. Student Knowledge, Attitudes, and
Use of Evidence-Based Concepts Following an Educational Intervention. Athletic Training Education
Journal. 2011; 6(2): 88-98.
Jeddi FR, Abazari F, Moravveji A, Nadjafi M. Evaluating the ability of hospital information systems to
establish evidence-based medicine in Iran. Journal of medical systems. 2013; 37(2): 1-7.
Saeidnia S, Abdollahi M. Consequences of international sanctions on Iranian scientists and the basis of
science. Hepatitis Mon. 2013;13(9): e14843. doi: 10.5812/hepatmon.14843. PMID: 24282428, PMCID:
PMC3830517.
Negrini S. Why evidence-based medicine is a good approach in physical and rehabilitation medicine.
Thesis. Eur J Phys Rehabil Med. 2014; 50(5): 585-91.
Zaina F, Donzelli S, French MN, Fregni F. Ethics in rehabilitation: challenges and opportunities to promote
research. Eur J Phys Rehabil Med. 2016; 52(3): 267-70. PMID: 27225193.
Akinbo S, Odebiyi D, Okunola T, Aderoba O. Evidence-based practice: knowledge, attitudes and beliefs of
physiotherapists in Nigeria. Internet Journal of Medical Informatics. 2009; 4(2).
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