Moving physiotherapy from evidence based practice towards evidence informed practice

The context in which health professionals’ function is rapidly changing and demands proactive change. Health care is not adequately reforming towards a structure, which orientates to the health questions of an ageing population and the exploding prevalence of non-communicable diseases. The demand of the society to show more efficiency in the work done is failing, as innovations don’t get incorporated into practice and expenses for both research and practice keep rising. All these developments are set in the context of the knowledge society with its ability to collect and share more knowledge, more globally. This dissertation focuses in this context on the failure of the community of physiotherapy to manage the knowledge innovation and knowledge circulation in its theory and practice. The aim is to rethink the framework in which we manage knowledge in the profession, the evidence based practice movement, and define factors that can positively influence the impasse. An alternative framework, called Evidence Informed Practice, is formulated, to improve the knowledge management. Based on this new framework three studies were performed. The first one is a critical analysis of review methodology, representing one of the main EBP-tools used at the moment. In this analysis alternative and complementary directions for both the theory and practice of review methodology are formulated. The second and third study explores epistemic beliefs as one of the factors relevant for developing the evidence informed practice of the physiotherapist. This is done in a European perspective. The second study is the development of a survey by cross-cultural adapting two questionnaires measuring the epistemic beliefs of physiotherapist and one questionnaire to measure the attitude towards EBP. This is done in 10 different countries in Europe. The third study performs this survey in these countries. The results show that physiotherapists in Europe are similar in a moderate positive attitude towards EBP and that they have moderate epistemic beliefs. The conclusion of this dissertation is that the framework of evidence based practice and, consequently, its tools needs to be reformulated in order to solve the apparent knowledge management problem. The study offers an alternative framework and emphasize the ‘understanding of practice’ and, more specifically within this broad concept, epistemic beliefs as a determinant for innovation within physiotherapy