# Evidence-based practice among physiotherapists in India: a nationwide survey of knowledge, attitude, and implementation behavior

## TL;DR

This study surveyed Indian physiotherapists about their knowledge, attitudes, and barriers to using evidence-based practice in their work.

## Contribution

The study provides a nationwide assessment of evidence-based practice in physiotherapy in India, identifying key barriers and predictors.

## Key findings

- Indian physiotherapists showed a positive attitude toward evidence-based practice but had insufficient knowledge and behavior.
- Educational attainment and workplace were the main factors influencing evidence-based practice domains.
- Lack of time and skills was the top barrier to implementing evidence-based practice in India.

## Abstract

Physiotherapy services are often integrated within the broader healthcare system in India. Unlike in developed countries, physiotherapy is still limited to indirect access and needs a referral from other healthcare providers, which potentially limits physiotherapists. The purpose of this study was to explore the knowledge or skill, attitude, and behavior towards the implementation of evidence-based practice (EBP) in physiotherapy care. In addition, the physiotherapist’s perception of barriers in the implementation of EBP was inquired.

A cross-sectional study was conducted through an online survey involving two thousand nine hundred and ninety-six physiotherapists from 22 states/union territories in India. A 24-item EBP questionnaire (EBPQ) investigating knowledge, attitude, and behavior domains with a 1 to 7 Likert scale response for each item, with a higher score indicating a favorable response. A linear regression model was used to analyze the relationship between factors and evidence-based practice behavior among physiotherapists.

The mean age of the participants was 35.8 ± 6.2 years, with a work experience of 13.25 ± 6.38 years. The overall EBPQ mean score of Indian physiotherapists was 3.6 ± 0.38, and the mean scores of the domains—knowledge, attitude, and implementation of EBP—were 3.59 ± 0.53, 4.29 ± 0.79, and 3.20 ± 0.62, respectively. The EBP domains were mainly determined by the educational attainment and workplace, which explained 46.1% of the variance. Lack of time and skills was identified as the top barrier influencing EBP among physiotherapists in India. The behavior dimension score of EBPQ is determined by 8 knowledge items and 2 attitude items, which explain 61.2% of the variance.

The Indian physiotherapists reported a positive attitude toward evidence-based practice; however, their knowledge and behavior were observed to be insufficient. Lack of time, limited skills, a shortage of resources, and limitations in applying EBP were reported as the main barriers.