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

Background: 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. Methods: 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. Results: 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. Conclusions: 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.