title: Barriers in implementing evidence-informed health decisions in rural rehabilitation settings: a mixed methods pilot study.
abstract: OBJECTIVE
  Literature on the barriers to implementing research findings into physiotherapy practice are often urban centric, using self report based on the hypothetical patient scenario. The objective of this study was to investigate the occurrence of barriers, encountered by evidence informed practice-trained physiotherapists in the management of "real world" patients in rural rehabilitation settings.
  
  
  METHODS
  A mixed-methods research design was used. Physiotherapists working in rural outpatient rehabilitation settings participated in the study. In the first phase, we asked all participants (N = 5) to maintain a log book for a 4-week period to record questions that arose during their routine clinical encounters and asked them also to follow first four of the five steps of evidence-informed practice (ask, access, appraise and apply). In the second phase (after 4 weeks), we conducted a semistructured, direct interviews with the participants exploring their experiences involved in the process of implementing evidence-informed clinical decisions made during the study period.
  
  
  RESULTS
  At the end of 4 weeks, 30 questions were recorded. For 17 questions, the participants found evidence but applied that evidence into their practice only in 9 instances. Being generalist practitioners, lack of outcomes specific to the patients were reported as barriers more so than time constraints in implementing evidence-informed practice.
  
  
  CONCLUSIONS
  Practice setting, lack of patient-centered research and evidence-informed practice competency of physiotherapists can be significant barriers to implementing evidence-informed health decisions in rural rehabilitation setting.
authors.affiliation: Ashok & Rita Patel Institute of Physiotherapy, Charotar University of Science and Technology, CHARUSAT Campus, Changa, Petlad, Anand, Gujarat, 388421, India.
authors.forename: V
authors.initials: V
authors.lastname: Prakash
authors.forename: K
authors.initials: K
authors.lastname: Hariohm
authors.forename: M
authors.initials: M
authors.lastname: Balaganapathy
mesh_terms: D003657:Decision Making; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D007194:India; D008297:Male; D026741:Physical Therapy Modalities / Q000592:standards*; D010865:Pilot Projects; D012423:Rural Health; D055815:Young Adult
keywords: Evidence-based medicine; implementing evidence; knowledge translation; physiotherapists; rural healthcare