How do you get your evidence?

I am employed by an academic institution with a fine health science library. I belong to several sections of the APTA as well as the AAOMPT. Through these affiliations I am able to get my hands on quite a few journals and read full text articles when I like.

I was thinking the other day, about how many allied health professionals do not have access to such a library of content. This would include those working in private practice, non-academic hospitals, rehab centers, local school systems, etc. How do these folks get their dose of evidence? How difficult is it to get access to an important new article?

There is PEDRO, and the Cochrane Database, and the APTA resources such as Open Door, but these are far reduced from what I use. They also suffer from lack of use among therapists. A scattering of journals offer free text, but usually there is a time delay or restriction with this. A service like InfoPOEMs is kind of expensive and not rehab focused even if it is useful in theory.

A colleague recently left the hospital system that I'm in and now works at a corporately owned outpatient clinic. She has no access to journals.

Barriers lead to inactivity. Inactivity leads to the failure of the principles surrounding Evidence-Based Practice. How much of a professional duty is it for health care providers to pay their own $$ for access to evidence? How much of that burden should fall on the employer?

If I assume that a majority of the Physical Therapy work force is in practice settings with limited access to rehab/ortho journals. Does this mean that the majority of the profession does not keep up with new evidence?  Regardless of that being true or not, I think these barriers need to come down somehow.

Any thoughts on access to literature among Physical Therapists?

ERIC

Image: Arnold Bernhard Library, Quinnipiac University, Hamden, Connecticut

Comments

[Nancy F]

I started my carrer at a teaching facility that had an easily accessible library and very helpful librarians. Since leaving that facility 7 years ago I have constantly been frustrated by the barriers I face trying to gain access to current research articles. I have found perhaps the scariest part about it is that my colleagues don't seem the least bit concerned about it. They have never had unfettered access and probably wouldn't know what to do if they did. I am currently working at a hospital and the library is awful. So, I share your curiousity about what is truly happening out there.

[Jennifer Miller]

I am a clinician at a university-affiliated medical center.

What is worse than the barriers others face, is that most of my clinical colleagues won't click from their email to see what our library's search page has to offer.

[Carina Lowry]

I am also a clinician at a university-affiliated medical center. We have access to virtually anything we want through Ovid, CINAHL, or inter-library loan. Each clinician is required to attend a certain number of evidence-based inservices and journal reviews and also to give each of them as a criteria for performance review. We have a large staff and are always swapping articles so there are places out there that are evidence based. It just takes a leader in the facility with initiative and a little consequence behind the requirements.

I also have unfettered access through my alumni association from the t-DPT program I graduated from so I guess this is another reason to pursue the t-DPT?

Carina

[David Penn]

I am PT in private practice earning Medicare rates. I think there are numerous barriers to accessing quality information in a timely manner. One barrier is $$ but I don't think that is the primary problem. I believe it to be lack of interest on the part of our fellow PT's to want to seek out further knowledge. If one compares APTA membership with total numbers of PT's, you would understand there is a huge gap. If these PT's won't pay the APTA dues, they certainly are less interested in paying a service such as OVID for access. Certainly the EIM readership is likely not the demographic that I am referring.

I have not gotten a raise in my fees since 1991 but my expenses have sure gone up and everyone wants raises. I would like to be able to serve my community with valuable PT services that are evidenced based as well as maintain profitability to put back into the facility. The last thing on my list is paying for the ability for my staff to access to journals. The upside is we still provide $1,500 / yr. CEU money to use at the PT's discretion. Many use this for APTA dues and other use it towards manual therapy certification programs or OCS application fee's.

As a PT and supervisor I feel it should be a professional personal responsibility that each therapist keep current with the latest advances. At least in Texas CEU's are required to maintain our license.

Currently I keep abreast of the current literature through a variety of methods: 1. CEU courses 2. Journal Subscription: JOSPT,PT Journal, JMMT, Spine, 3. t-DPT program 2001-2004 ( was cut off after graduation--that sucked). 4. Regis Manual therapy Fellowship 5. Evidence Express 6. APTA and AAOMPT memberships.

The above is partially (80%) sponsored by my employer -

My suggestion is instead of getting a raise in salary ask for a raise in CEU $'s one year. This may actually work out better for both parties.

David

[Eric Robertson]

David, Thanks for the well thought out comment. I enjoyed the breakdown of where you get your evidence from. The question I will now pose to you is: How effective or useful is the ill-defined CEU? My feeling about CEUs is that they are a very inefficient measure of learning and only loosely tied to the concept of Evidence-Based Practice. For example, if I spend 2 hours reading a collection of articles and searching for information related to one of my patient's conditions, I get no credit even thought what I have learned is super useful and likely to be retained by my brain for the long term. However, if I took advantage of the single day of Free CEUs put on by a local wheelchair supplier, I would have gotten a substantial amount of CEU credits. I have not seen someone in a wheelchair in my work setting in over 2 years! I think this is a whole separate post topic, so I will stop here.

[Sean]

Too many of us look at this as a job and not a career. So many PT's just go along, getting their continuing education credits and not reading anything else.
It would help if the APTA membership dues came with access to these research databases for free. It would also help if the research journal that comes to us in the mail every month had some relevant studies related to ortho patients... more than twice a year. I don't recall the last time I opened one of those.
I do my research through about 4 of the databases listed above. You know what, APTA's journal has never come up as a resource. I am critical of our professional associating in many ways b/c I think they could do better. But I'm still a member. Even with these shortcomings.

[David Penn]

Eric,

Your point regarding CEU courses is well taken. All CEU courses are not created equal but likely are broken down in two three levels: The Good _ EIM course,Stan Paris' group etc. The Bad_IWA ( strength training courses)-possibly the BARNES MFR series )(although there may be a few pearls in there) and the Ugly_ John Imaes primitive reflex therapy. So the bottom line for me is taking sound evidence based courses as well as reading the literature. If you are fairly well read as a PT, you will know whom to take a CEU course from. IF you don't know then ask a fellow PT which course to steer clear of.

Sean- I do think the APTA is moving forward with their publications. There have been some good ortho article recently. I agree in the past there would be one or two useful articles but you should check out some of the latest publications of PT Journal.

David

[Andrew Guccione]

Perhaps some people are not getting as much out of their APTA membership as they should - FOR FREE! OPEN DOOR provides full-text on-line access to over 1,000 journals through the ProQuest and CINAHL databases. Access to the Cochrane Library was added a few weeks ago. Hooked on Evidence has over 3,500 literature extractions and two different search engines. One is a traditional search engine using keywords; the other uses clinical scenarios that attach the relevant literature to a particular case created by member experts. And Hooked calculates effect size, where appropriate (even if it wasn't provided in the original article) and displays it graphically so you can compare findings across studies. The Research page on the APTA website updates "Current Research" at least monthly (and who isn't at least a month behind in their journal reading?) And speaking of CEUs, you can get CEUs for submitting to Hooked on Evidence. If quality in continuing education is a concern, consider APTA's ACP courses taught by the some of the best in the profession. Furthermore, clincians need more than scientific knowledge to be successful in today's environment. APTA audio conferences and podcasts have important information on policies and regulations that directly affect clinical practice. Many of these things are free to members, and what isn't free comes with a substantial member discount. Money is definitely tight these days, so I regret thinking that anyone who is an APTA member may not know the value of that membership. And if you are not a member, why are you spending your money here, there and everywhere?

[David G]

David-
You said that fellow PT's have no interest in further knowledge, as evidenced by APTA membership/ total # of PT's (if they won't pay dues, they won't pay for OVID, etc). I think that may be a little unfair, and I would be interested to see a study/ survey that would verify that. I am a PT student, married to a PT, and have a couple of PT friends, so I don't have the personal experience that everyone on this board has. But using just my wife as an example (n=1, so not definitive; 1 friend is a member and the other is not but I don't know why), she strongly disagrees with the APTA's direction and does not see it representing her (she works in acute care; and is interested in furthering her knowledge though not as much as those here), and I can see her point (as well as those on this board about being involved, so no need to respond about that!). Also, as mentioned above, with the PTJ being inferior until lately, why pay all the money for a crappy journal? My advisor will only submit there if she is rejected by more respected journals. When I graduate I intend to keep the APTA membership, hope to have access to Pubmed as an alumni, and will look for ways to continue knowledge besides CEU's. But if I decide for my own reasons not to continue w/ APTA, that by no means infers that I don't care about furthering my knowledge.
David G.
(this is a great blog and I check it regularly - I don't agree with everything or everyone all the time, but it gets me thinking. Thanks to those who contribute!)

[David G]

I have a friend who works in the biological sciences. We were chatting over a beer last night and he asked about this very thing (evidence in PT - what is it, where do we get it, etc). Apparently in the realm of the sciences there is a move for journals to publish solely online with free access (journals like Science and Nature stay in print because people pick them up and read them, but otherwise they use PubMed, etc to type in a key word, find the articles they want, and download them rather than go down to the library and make/ request a copy). The journals make their money by charging a hefty fee for publication, and since you need to get published, you will pay (or generally the organization you work for does). This lends itself to some difficulties, namely peer review (what does it mean/ entail?), conflict of interest (to make more money just select more articles), etc.

Personally, I doubt that the medical journals would head in that direction, but does anyone know if there is one or more respectable journals that have gone that way? If so, have any issues been raised about conflict of interest, etc? Would you or do you use them?
Thanks,
David G. (SPT)

[VPC]

my personal feelings is that I hold the individual responsible. If its really that important to them, limited access won't make a difference (drugs for instance) Access will not get some lazy PTs to start reading research and making changes to thier practice.

The reality is that people don't change unless there is a really good reason for them to change and unless there is usually some event in thier life to realize their current paradigm is not working. Other than than, the status quo works just fine because it is easy. Change does not occur unless the status quo means they cannot survive.

This readers of this site I find to be in the small minority of the PTs I've have met. They care even though they disagree. The trick is to get the majority of the PTs to care enough to want to read research, let alone to figure out whether they have good access or not.

Here's to our survival!

[Sean]

Andrew,
I've been a member of APTA for quite some time. It would have been nice if they sent out an email or something stating all these benfits included in the membership. BTW how do we get there? I find APTA's website bogged down with redundant logins galore. Hopefully it's not thru there.

[PLR - Private Label Article Packs]

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