These findings are consistent with research in other health care contexts and professions. A recent meta-analysis on the implementation of clinical guidelines in various health care settings indicated that effective strategies often have multiple components (Francke et al 2008). Similar conclusions were drawn in another recent ‘review of systematic reviews’, ie, multifaceted interventions were more likely to improve practice than single interventions, with effect sizes ranging from small to moderate
(Boaz et al 2011). Despite the fact that barriers to EBP are likely to be present at multiple levels, Walker et al (2003) have estimated that ‘80% of existing interventions used in selleck chemicals implementation research focus on the individual practitioner’. Yano (2008) argues that implementation research has ‘failed Dasatinib research buy to fully recognize or adequately address the influence and importance of health care organisational factors’. Mixed results of implementation interventions have also been attributed to a limited theoretical basis for these interventions. To address this shortcoming, theory-based interventions have increasingly been advocated by implementation researchers. Such interventions are typically linked to one or more specific social-cognitive theories (eg, the Theory of Interpersonal Behaviour, the Theory of Planned Behaviour, or the Social Cognitive Theory)
and derive relevant factors from such theories. Interventions based on theories potentially allow for the identification of the ‘active ingredients’ of
interventions and may thus contribute to better understanding of the mechanisms by which interventions cause behaviour change. However, ‘there is a bewildering range of theories from which to choose’, as noted by ICEBeRG (2006). Davies et al (2010) identified 25 different theories used in various interventions to achieve clinical guideline implementation and concluded already that justification of choice of intervention was generally poor. Personal preferences of the researchers rather than evidence often seemed to guide the choice of theory. Ultimately, there are no magic bullets to achieve more widespread implementation of EBP in physiotherapy. However, we believe EBP research must expand beyond its current parameters and address several issues to achieve improved understanding of how a more evidence-based physiotherapy practice can be attained. Qualitative studies are necessary to explore further barriers and facilitators than those identified in surveys and to provide more indepth understanding of EBP problems and solutions. Studies of barriers must be complemented with studies of facilitating conditions for EBP implementation. There is also a need to broaden the current focus on individually-oriented educational measures and clinical guidelines. More experimental research is needed to establish the effects of interventions to increase EBP.