Knowledge translation in physiotherapy practice: improving education, lowering barriers, and promoting behaviour change

The physiotherapy (PT) profession in the United States (US) has undergone a substantial transition in the last three decades, from master’s level education to the Doctor of Physical Therapy (DPT) degree. This transition occurred in concert with, and in response to, the emergence and then dominance of evidence-based practice (EBP) and knowledge translation (KT) as foundational elements of high-quality healthcare delivery. However, early efforts in EBP and KT for PTs faced significant challenges. Although enthusiastic about EBP and KT, PTs struggled to adapt their practice to meet evidence-based standards.

This thesis presents results from one of the first theoretically based, EBP-focused educational interventions for PTs. Initially participants showed improvements in EBP self-efficacy and self-reported behaviour and reported motivation to engage in KT. However, they also reported that navigating statistical terms in professional literature was a barrier. A long-term analysis showed only limited behaviour change to align with established evidence, suggesting that the educational intervention was incomplete.

Limited access to research evidence and physiotherapists’ (PTs’) low self-efficacy and skills for understanding statistical terms were identified. Access to research evidence was ameliorated by providing second generation smart tablet computers to PT students. A bibliometric analysis of US-based PT literature provided an innovative approach to inform statistical curricula to support KT in PT.

Finally, new perspectives are presented on behaviour change to align with clinical practice guideline (CPG) recommendations specific to PT practice. The knowledge to action model served as a foundation to promote alignment with a new CPG in five organisationally distinct PT practices. The addition of audit and feedback in an inclusive, educational, and collaborative team setting was associated, quantitatively and qualitatively, with long-term behaviour change. A novel secondary qualitative analysis identified drivers of behaviour change for PTs and their patients adopt behaviours that align with CPG recommendations.

This thesis advances understanding of effective interventions and solutions to barriers impacting KT in PT. A new Tilson Architecture for Effective KT in PT is presented that can serve as a model for PT practices working to optimise patient care and establish PT as an evidence-based profession and a vital contributor to the healthcare team.