Evidence-based physiotherapy and the use of PEDro

In the article ‘Ability of physiotherapists to undertake evidence-based practice steps: a scoping review’ Condon et al. assess the literature on the ability of physiotherapists to practice evidence-based physiotherapy (EBP) [1]. This is a very important question with ramifications for both physiotherapy practice and education. We agree with Condon et al. that there is a paucity of information on this topic. We noted two of Condon et al.’s findings with interest: first, that physiotherapists ‘do not engage routinely in the steps of EBP’ and, second, that physiotherapists ‘are confident in formulating specific research questions about patient problems’. We agree that these are valid interpretations of the data identified in Condon et al.’s review. However, we would also point to some contrasting evidence that was not included in their review.

Regarding the first finding that physiotherapists ‘do not engage routinely in the steps of EBP’, we have published many papers [[2], [3], [4]] looking at the use of the Physiotherapy Evidence Database (PEDro). PEDro is a free evidence resource indexing over 33,000 reports of randomised controlled trials, systematic reviews and evidence-based clinical practice guidelines about the effects of physiotherapy interventions and in 2015 was used to answer over 2 million clinical questions posed by users from 222 countries [5]. Whilst we acknowledge that we cannot know the exact proportion of users that are physiotherapists, which is presumably why these papers were not considered by Condon et al., the targeted promotion of PEDro to physiotherapy and that most users who contact us about PEDro are physiotherapists suggests that a high percentage PEDro users are physiotherapists. Therefore, the high usage of the PEDro evidence resource suggests that many physiotherapists do engage in EBP to address their clinical questions.

Regarding the second finding, that physiotherapists ‘are confident in formulating specific research questions about patient problems’, Condon et al. note the absence of studies that use the PICO (Patient-Intervention-Comparator-Outcome) format in order to assess the abilities of physiotherapists to formulate clinical questions [1]. Our recent paper [6] may provide some additional insights into how physiotherapists ask clinical questions. The paper examined how users of PEDro ask and acquire answers to their clinical questions. Our analysis of the searches conducted on PEDro revealed that fully formulated PICO questions were not routinely used in PEDro searching, with over half of the searches evaluated using either no or one PICO element [6]. Of PICO, the Patient was the most commonly specified element. This suggests that whilst physiotherapists may be capable of formulating a research question, their ability to break that question down into its PICO elements and formulate a search to answer that question is lacking.

In summary, we commend Condon et al. for conducting valuable research on this important issue and we certainly support their calls for further research in this area. To the extent that users of PEDro can be assumed to be mostly physiotherapists, the additional data we outline above are likely to be representative of physiotherapy practice and thus may add further information to their valuable findings.Funding: MS is supported by a scholarship provided by the Chiropractic & Osteopathic College of Australasia (COCA) Research Limited.Conflict of interest: AM, ME and CM are members of the steering committee for the Centre for Evidence-Based Physiotherapy (CEBP), which manages PEDro.

Evidence-based physiotherapy and the use of PEDro.