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. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xv CHAPTER 1—INTRODUCTION AND THEORETICAL FRAMEWORK. . . . . . . 1 Background. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Evidence-Based Practice in Physical Therapy. . . . . . . . . . . . . . . . . . . . . . . . . 2 Guidelines for Evidence-Based Practice in Physical Therapy: Conceptual Frameworks and Clinical Decision-Making. . . . . . . . . . . . . . . . . 3 Knowledge Translation and Theoretical Frameworks. . . . . . . . . . . . . . . . . . . . . . 5 CHAPTER 2—PROBLEM STATEMENT AND RESEARCH QUESTIONS. . . . . 12 Problem Statement. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 Purpose of Study. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 Significance. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 Research Questions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 CHAPTER 3—LITERATURE REVIEW. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 Evidence-Based Medicine and Evidence-Based Practice. . . . . . . . . . . . . . . . . . . 15 Evidence-Based Practice in Physical Therapy. . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 Guidelines for Evidence-Based Practice in Physical Therapy: Decision-Making and Conceptual Frameworks.. . . . . . . . . . . . . . . . . . . . . . . . . . 21 viii Definition and Application of Standardized Outcome Measures. . . . . . . . . . . . . 26 Hypotheses. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51 CHAPTER 4—METHODOLOGY. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52 Research Design.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52 Study Population. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52 Data Collection Tools. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52 Variables. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54 Dependent Variables. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54 Independent Variables. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54 Statistical Analysis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54 CHAPTER 5—DATA ANALYSIS AND PRESENTATION OF RESULTS. . . . . . 56 Participants.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56 Practice Style Questionnaire. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56 Evidence-Based Practice Questionnaire Domains and Their Relevance to Evidence-Based Practice and Guidelines/Outcome Measures.. . . . . . . . . . . . . 59 Evidence-Based Practice Questionnaire—Individual Questions for Sections B and C (Questions 9-32). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59 Section B: Questions about attitudes toward, use of, and perceived benefits and limitations of evidence-based practice. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 Section C: Questions about attitudes toward and use of clinical practice guidelines/outcome measures. . . . . . . . . . . . . . . . . . . . . 63 Combination of Both the Practice Style and Evidence-Based Practice Questionnaires. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68 Post Hoc Analysis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69 Tukey HSD. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69 ix Chi Square Analyses: Evidence-based Practice Questionnaire by Practice Style Trait.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69 Chi Square Analyses: Demographics.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72 CHAPTER 6—DISCUSSION, IMPLICATIONS OF RESEARCH, AND CONCLUSIONS. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74 Discussion. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74 Practice Style Traits. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74 Evidence-Based Practice Questionnaire. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76 Combination of Practice Style Traits and Evidence-Based Practice Questionnaire. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80 Strengths and Limitations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82 Implications of Research. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84 Conclusion. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86 REFERENCES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89 APPENDICES A. Practice Style Questionnaire. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101 B. Evidence-Based Practice Questionnaire. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103 x LIST OF TABLES PAGE Table 1. The Five-Step Evidence-Based Practice Process. . . . . . . . . . . . . . . . . . . . . 17 Table 2. Summary of Practice Style Traits. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46 Table 3. Summary of Variables. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55 Table 4. Demographic Information for 79 Participants. . . . . . . . . . . . . . . . . . . . . . . 57 Table 5. Practice Style Questionnaire—Scale Scores to Determine Practice Style Trait.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58 Table 6. Practice Style Questionnaire—Total Scores to Determine Practice Style Trait.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59 Table 7. Question 9 (Attitude Domain)—I Consider It Necessary to Apply EBP in the Daily Practice of Physical Therapy.. . . . . . . . . . . . . . . . . . . . . 60 Table 8. Question 10 (Attitude Domain)—I Think it Creates Unreasonable Demands to Apply EBP in My Daily Work.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 Table 9. Question 11 (Attitude Domain)—I Want to Learn and Improve the Knowledge and Skills Necessary to Apply EBP in My Work. . . . . . . . . . . . . 61 Table 10. Question 12 (Attitude Domain)—Strong Evidence Is Lacking for Most Treatments That I Use for My Patients. . . . . . . . . . . . . . . . . . . . . . . . . . 61 Table 11. Question 13 (Attitude Domain)—EBP Can Help Me Make Decisions in the Choice of Treatment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61 Table 12. Question 14 (Behavior Domain)—Number of Scientific Articles Related to My Clinical Work That I Read During a Typical Month. . . . . . . . . . . 62 Table 13. Question 15 (Behavior Domain)—Number of Times I Use PubMed or Other Databases to Search Literature That Is Relevant to My Clinical Work During a Typical Month. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62 Table 14. Question 16 (Knowledge Domain)—I Know How to Access Relevant Databases. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62 Table 15. Question 17 (Barriers and Prerequisites)—At My Place of Work the Use of Current Research Is Encouraged.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63 xi Table 16. Question 18 (Attitude Domain)—I Feel Confident in My Ability to Find Relevant Research to Answer My Clinical Questions.. . . . . . . . . . . . . . . 63 Table 17. Question 19 (Attitude Domain)—I Feel Confident in My Ability to Treat My Patients According to Current Evidence. . . . . . . . . . . . . . . . . . . . . . 63 Table 18. Question 20 (Attitude Domain)—I Consider It Important That Easily Available Evidence-based Guidelines/Outcome Measures Related to My Work Exist. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64 Table 19. Question 21 (Attitude Domain)—I Consider It Important to Use Evidence-based Guidelines/Outcome Measures in My Work. . . . . . . . . . . . . . . . 64 Table 20. Question 22 (Knowledge Domain)—I’m Aware That Evidencebased Guidelines/Outcome Measures for Diagnoses Relevant to My Work Exist. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64 Table 21. Question 23 (Knowledge Domain)—I Know How and Where to Find Evidence-based Guidelines/Outcome Measures Related to My Work on the Internet. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65 Table 22. Question 24 (Barriers and Prerequisites)—I Have Fast and Easy Access to Relevant Evidence-based Guidelines/Outcome Measures at My Place of Work. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65 Table 23. Question 25 (Behavior Domain)—I Use Evidence-based Guidelines/Outcome Measures in My Work. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65 Table 24. Question 26 (Knowledge Domain)—I Can Integrate the Patients’ Preferences With Evidence-based Guidelines/Outcome Measures. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

A Study Examining Practice Style Traits of Physical Therapists: Do They Explain Practice Behaviors and Knowledge Translation?