Andragogical and Medical-Social Sciences, Research Fellow Belgian Centre for Evidence-Based Medicine, 3000 Leuven, Belgium.
Physiother Theory Pract. 2009 Oct;25(7):476-88. doi: 10.3109/09593980802661949.
Over the past few years concerns have been rising about the use of Evidence-Based Practice (EBP). We explored obstacles among Belgian physiotherapists to the implementation of EBP in clinical work. We used a qualitative research strategy based on five focus groups, organised between October 2004 and May 2005. Purposeful sampling was used to recruit 43 participants from diverse geographical regions in Flanders, working in different settings and with a variety of interest and expertise in EBP. Data collection and analysis were concurrent and guided by "grounded theory approach." A problem tree was developed. Important obstacles to the implementation of EBP include physiotherapists' lack of autonomy and authority to decide on patients' treatments or to negotiate with government. In addition, the lack of evidence, inaccessibility and inapplicability of scientific evidence, the economic parameters influencing government and physicians, the expectations from patients and a lack of motivation hamper the implementation of EBP. The problem tree developed reveals direct links between the lack of autonomy from physiotherapists and the dominant position from physicians in the Belgian health care system, which further impacts the boundaries between both professions and the weight of physiotherapists in governmental advisory boards. Direct access to physiotherapy has not yet been considered in Belgium. However, it could have major advantages for physiotherapists who are in favour of a more autonomous, professional status.
在过去的几年中，人们对循证实践（EBP）的应用越来越关注。我们探讨了比利时物理治疗师在将 EBP 应用于临床工作中所面临的障碍。我们使用了一种基于五个焦点小组的定性研究策略，这些小组于 2004 年 10 月至 2005 年 5 月之间组织。目的抽样用于从佛兰德的不同地理区域招募 43 名参与者，他们在不同的环境中工作，对 EBP 有不同的兴趣和专业知识。数据收集和分析是同时进行的，并以“扎根理论方法”为指导。实施 EBP 的重要障碍包括物理治疗师在决定患者治疗或与政府协商方面缺乏自主权和权威。此外，缺乏证据、科学证据的不可及性和不可适用性、影响政府和医生的经济参数、患者的期望以及缺乏动力也阻碍了 EBP 的实施。所开发的问题树揭示了物理治疗师缺乏自主权与比利时医疗保健系统中医生的主导地位之间的直接联系，这进一步影响了这两个专业之间的界限以及在政府咨询委员会中物理治疗师的权重。在比利时，还没有考虑直接获得物理治疗。然而，对于那些赞成更自主、更专业地位的物理治疗师来说，这可能有很大的优势。
