Background: Evidence-based practice (EBP) is vital for high-quality patient care, yet its implementation among physiotherapists in sub-Saharan Africa (SSA) faces significant challenges. This scoping review explores the barriers and facilitators of EBP in this region. Objectives: To identify barriers and facilitators of EBP at individual, organisational, and extra organisational levels among physiotherapists in SSA. Methods: A comprehensive literature search was conducted across PubMed, Sabinet, BioMed Central, and Google Scholar. Seven studies from Ghana, Nigeria, Cameroon, Benin, Kenya, Zimbabwe and South Africa met the inclusion criteria. Results: Key barriers at the practitioner level included lack of time, insufficient knowledge of EBP, limited access to information resources, and inadequate research skills. Facilitators comprised positive attitudes toward EBP and a desire for further knowledge. At the organisational level, resource unavailability emerged as a major barrier. Notably, no studies addressed extra organisational factors. Conclusion: This review highlights critical barriers and facilitators of EBP among SSA physiotherapists and emphasises the need for further research on extra organisational influences. Addressing systemic challenges is essential for enhancing physiotherapist engagement in EBP, ultimately improving patient care and outcomes in sub-Saharan Africa.
References
[1]
Maharaj, S., Chung, C., Dhugge, I., Gayevski, M., Muradyan, A., McLeod, K.E., et al. (2018) Integrating Physiotherapists into Primary Health Care Organizations: The Physiotherapists’ Perspective. Physiotherapy Canada, 70, 188-195. https://doi.org/10.3138/ptc.2016-107.pc
[2]
Tiku, R., Tiku, B. and Rathod, A. (2024) The Influence of Physiotherapy on Non-Communicable Diseases. International Journal of Research and Review, 11, 252-254. https://doi.org/10.52403/ijrr.20240227
[3]
Guyatt, G.H., Haynes, R.B., Jaeschke, R.Z., Cook, D.J., Green, L., Naylor, C.D., et al. (2000) Users’ Guides to the Medical Literature. XXV. Evidence-Based Medicine: Principles for Applying the Users’ Guides to Patient Care. JAMA, 284, 1290-1296. https://doi.org/10.1001/jama.284.10.1290
[4]
Veras, M., Kairy, D. and Paquet, N. (2016) What Is Evidence-Based Physiotherapy? Physiotherapy Canada, 68, 95-96. https://doi.org/10.3138/ptc.68.2.gee
[5]
Scurlock-Evans, L., Upton, P. and Upton, D. (2014) Evidence-Based Practice in Physiotherapy: A Systematic Review of Barriers, Enablers and Interventions. Physiotherapy, 100, 208-219. https://doi.org/10.1016/j.physio.2014.03.001
[6]
Rafalimanana, H. (2019) Annex II Classification of SDG Regions and Income Groups. https://population.un.org/ProfilesOfAgeing2019/Docs/Annex%202%20-%20Classification%20of%20countries%20by%20region_updated%20for%20WPP%202019.pdf
[7]
Mapulanga, M., Kgarosi, K., Maluleke, K., Hlongwa, M. and Dlungwane, T. (2024) Evidence of Community Health Workers’ Delivery of Physical Rehabilitation Services in Sub-Saharan Africa: A Scoping Review. BMJ Open, 14, e079738.
[8]
Peters, M.D., Godfrey, C., McInerney, P., Munn, Z., Tricco, A.C. and Khalil, H. (2024) Scoping Reviews. In: Aromataris, E., Lockwood, C., Porritt, K., Pilla, B. and Jordan, Z., Eds., JBI Manual for Evidence Synthesis. https://doi.org/10.46658/jbimes-24-09
[9]
Arksey, H. and O’Malley, L. (2005) Scoping Studies: Towards a Methodological Framework. International Journal of Social Research Methodology, 8, 19-32. https://doi.org/10.1080/1364557032000119616
[10]
National Health and Medical Research Council (2009) NHMRC Levels of Evidence for Developers of Guidelines. https://www.mja.com.au/sites/default/files/NHMRC.levels.of.evidence.2008-09.pdf#page=20.08
[11]
Quartey, J. and Kwakye, S. (2018) Barriers to Evidence-Based Physiotherapy Practice for Stroke Survivors in Ghana. South African Journal of Physiotherapy, 74, a423. https://doi.org/10.4102/sajp.v74i1.423
[12]
Ibikunle, P.O., Onwuakagba, I.U., Maduka, E.U., Okoye, E.C. and Umunna, J.O. (2020) Perceived Barriers to Evidence-Based Practice in Stroke Management among Physiotherapists in a Developing Country. Journal of Evaluation in Clinical Practice, 27, 291-306. https://doi.org/10.1111/jep.13414
[13]
Muntessu, D.L.N., Ghassi, H.T., Buh, F.C., Nietho, A.W., Siewe, J.R. and Mpatoutou, M.M. (2024) Assessment of Evidence-Based Practice (EBP) among Physiotherapists in Cameroon: A Cross-Sectional Survey. BMC Medical Education, 24, Article No. 332. https://doi.org/10.1186/s12909-024-05273-w
[14]
Sawadogo, A., Sogbossi, E.S., Everard, G.J., Kpadonou, T. and Batcho, C.S. (2024) Use of Standardised Outcome Measures among Physiotherapists in French-Speaking Sub-Saharan Africa. South African Journal of Physiotherapy, 80, a1981. https://doi.org/10.4102/sajp.v80i1.1981
[15]
Tadyanemhandu, C., Chiyangwa, P.C., Chengetanai, S., Chibhabha, F. and van Aswegen, H. (2016) Utilisation of Research Evidence in Clinical Practice to Improve Health Care Delivery-Practices, Attitudes and Challenges Faced by Physiotherapists in Zimbabwe: A Descriptive Cross Sectional Study. Safety in Health, 2, Article No. 11. https://doi.org/10.1186/s40886-016-0022-9
[16]
Mwololo, T.K., Olivier, B., Karuguti, W.M. and Matheri, J.M. (2021) Attitudes, Perceptions and Barriers around Evidence-Based Practice in Sports Physiotherapy in Kenya. South African Journal of Physiotherapy, 77, a1561. https://doi.org/10.4102/sajp.v77i1.1561
[17]
Stander, J., Grimmer, K. and Brink, Y. (2019) Factors Influencing Clinical Practice Guideline Uptake by South African Physiotherapists: A Qualitative Investigation of Barriers and Facilitators. Journal of Evaluation in Clinical Practice, 26, 728-737. https://doi.org/10.1111/jep.13182
[18]
Bevacqua, N. and Intelangelo, L. (2023) Evidence-Based Practice in Physiotherapy in Argentina: Barriers, Perceptions and Behaviors. Physiotherapy Research International, 28, e2034. https://doi.org/10.1002/pri.2034
[19]
Jesrani, P., Sarfraz, M., Kumar, K., Imtiaz, F., Kanwal, R., Husnain, F., et al. (2019) Barriers to Implementation of Evidence-Based Practice in Physiotherapy. International Journal of Endorsing Health Science Research, 7, 22-32. https://doi.org/10.29052/ijehsr.v7.i1.2019.22-32
[20]
Alshehri, M.A., Alalawi, A., Alhasan, H. and Stokes, E. (2017) Physiotherapists’ Behaviour, Attitudes, Awareness, Knowledge and Barriers in Relation to Evidence-Based Practice Implementation in Saudi Arabia. International Journal of Evidence-Based Healthcare, 15, 127-141. https://doi.org/10.1097/xeb.0000000000000106
[21]
Castellini, G., Corbetta, D., Cecchetto, S. and Gianola, S. (2020) Twenty-five Years after the Introduction of Evidence-Based Medicine: Knowledge, Use, Attitudes and Barriers among Physiotherapists in Italy—A Cross-Sectional Study. BMJ Open, 10, e037133. https://doi.org/10.1136/bmjopen-2020-037133
[22]
Alqahtani, J.M., Carsula, R.P., Alharbi, H.A., Alyousef, S.M., Baker, O.G. and Tumala, R.B. (2022) Barriers to Implementing Evidence-Based Practice among Primary Healthcare Nurses in Saudi Arabia: A Cross-Sectional Study. Nursing Reports, 12, 313-323. https://doi.org/10.3390/nursrep12020031
[23]
Alatawi, M., Aljuhani, E., Alsufiany, F., Aleid, K., Rawah, R., Aljanabi, S., et al. (2020) Barriers of Implementing Evidence-Based Practice in Nursing Profession: A Literature Review. American Journal of Nursing Science, 9, 35-42. https://doi.org/10.11648/j.ajns.20200901.16
[24]
Neuppmann Feres, M.F., Roscoe, M.G., Job, S.A., Mamani, J.B., Canto, G.D.L. and Flores-Mir, C. (2020) Barriers Involved in the Application of Evidence-Based Dentistry Principles: A Systematic Review. The Journal of the American Dental Association, 151, 16-25.E16. https://doi.org/10.1016/j.adaj.2019.08.011
[25]
Upton, D. and Upton, P. (2006) Knowledge and Use of Evidence-Based Practice of GPS and Hospital Doctors. Journal of Evaluation in Clinical Practice, 12, 376-384. https://doi.org/10.1111/j.1365-2753.2006.00602.x
[26]
Kyei, K., Antwi, W. and Suapim, J. (2015) Evidence-Based Practice in Radiography: Attitudes, Beliefs, Knowledge and Practices of Radiographers in Ghana. OMICS Journal of Radiology, 4, Article ID: 1000176. https://doi.org/10.4172/2167-7964.1000176
[27]
Sullivan, K.J., Wayne, C., Patey, A.M. and Nasr, A. (2017) Barriers and Facilitators to the Implementation of Evidence-Based Practice by Pediatric Surgeons. Journal of Pediatric Surgery, 52, 1666-1673. https://doi.org/10.1016/j.jpedsurg.2017.02.001
[28]
Stander, J., Grimmer, K. and Brink, Y. (2020) Time as a Barrier to Evidence Uptake—A Qualitative Exploration of the Concept of Time for Clinical Practice Guideline Uptake by Physiotherapists. Journal of Evaluation in Clinical Practice, 27, 280-290. https://doi.org/10.1111/jep.13397
[29]
Paci, M., Faedda, G., Ugolini, A. and Pellicciari, L. (2021) Barriers to Evidence-Based Practice Implementation in Physiotherapy: A Systematic Review and Meta-Analysis. International Journal for Quality in Health Care, 33, mzab093. https://doi.org/10.1093/intqhc/mzab093
[30]
Addis, B.A., Gelaw, Y.M., Eyowas, F.A., Bogale, T.W., Aynalem, Z.B. and Guadie, H.A. (2023) “Time Wasted by Health Professionals Is Time Not Invested in Patients”: Time Management Practice and Associated Factors among Health Professionals at Public Hospitals in Bahir Dar, Ethiopia: A Multicenter Mixed Method Study. Frontiers in Public Health, 11, Article 1159275. https://doi.org/10.3389/fpubh.2023.1159275
[31]
Yahui, H.C. and Swaminathan, N. (2017) Knowledge, Attitudes, and Barriers Towards Evidence-Based Practice among Physiotherapists in Malaysia. Hong Kong Physiotherapy Journal, 37, 10-18. https://doi.org/10.1016/j.hkpj.2016.12.002
[32]
Vithana, K., Jayasekera, R., Choudhry, T. and Baruch, Y. (2021) Human Capital Resource as Cost or Investment: A Market-Based Analysis. The International Journal of Human Resource Management, 34, 1213-1245. https://doi.org/10.1080/09585192.2021.1986106
[33]
Bello, A. (2011) Utilizing Research Findings in Physiotherapy: A Call for Gap Bridging. Journal of the Nigeria Society of Physiotherapy, 18 & 19, 54-58.
[34]
Gleadhill, C., Bolsewicz, K., Davidson, S., Kamper, S., Tutty, A., Robson, E., Viana Da Silva, P., Donald, B., Doodley, K., Manvell, J., Manvell, N., Delbridge, A. and Wil-liams, C. (2022) Physiotherapists’ Opinions, Barriers, and Enablers to Providing Evidence-Based Care: A Mixed-Methods Study. BMC Health Services Research, 22, Article No. 1382.
[35]
Ramírez-Vélez, R., Bagur-Calafat, M.C., Correa-Bautista, J.E. and Girabent-Farrés, M. (2015) Barriers against Incorporating Evidence-Based Practice in Physical Therapy in Colombia: Current State and Factors Associated. BMC Medical Education, 15, Article No. 220. https://doi.org/10.1186/s12909-015-0502-3
[36]
Maigeh, E. (2003) The Perceived Attitudes, Knowledge and Barriers towards Evidence-Based Practice (EBP) amongst Physiotherapists in the United Republic of Tanzania. Master’s Thesis, University of the Western Cape. https://core.ac.uk/reader/58912790
[37]
Baatiema, L., de-Graft Aikins, A., Sav, A., Mnatzaganian, G., Chan, C.K.Y. and Somerset, S. (2017) Barriers to Evidence-Based Acute Stroke Care in Ghana: A Qualitative Study on the Perspectives of Stroke Care Professionals. BMJ Open, 7, e015385. https://doi.org/10.1136/bmjopen-2016-015385
[38]
Rodríguez-Nogueira, Ó., Leirós-Rodríguez, R., Pinto-Carral, A., Álvarez-Álvarez, M.J., Morera-Balaguer, J. and Moreno-Poyato, A.R. (2021) Examining the Association between Evidence-Based Practice and Burnout among Spanish Physical Therapists: A Cross-Sectional Study. Journal of Personalized Medicine, 11, Article 805. https://doi.org/10.3390/jpm11080805
[39]
Stander, J., Grimmer, K. and Brink, Y. (2018) Training Programmes to Improve Evidence Uptake and Utilisation by Physiotherapists: A Systematic Scoping Review. BMC Medical Education, 18, Article No. 14. https://doi.org/10.1186/s12909-018-1121-6
[40]
Gorgon, E.J.R., Barrozo, H.G.T., Mariano, L.G. and Rivera, E.F. (2012) Research Evidence Uptake in a Developing Country: A Survey of Attitudes, Education and Self-Efficacy, Engagement, and Barriers among Physical Therapists in the Philippines. Journal of Evaluation in Clinical Practice, 19, 782-790. https://doi.org/10.1111/j.1365-2753.2012.01849.x
[41]
AlKetbi, H., Hegazy, F., Alnaqbi, A. and Shousha, T. (2021) Evidence-based Practice by Physiotherapists in UAE: Investigating Behavior, Attitudes, Awareness, Knowledge and Barriers. PLOS ONE, 16, e0253215. https://doi.org/10.1371/journal.pone.0253215
[42]
Obembe, A.O., Dada, O., Balogun, A.O., Ojo, O.W. and Johnson, O.E. (2018) Standardized Outcome Measures for Cerebral Palsy among Physiotherapists in Southwestern Nigeria: Awareness, Use, Barriers, and Facilitators. Physiotherapy Theory and Practice, 35, 1314-1321. https://doi.org/10.1080/09593985.2018.1474983
[43]
Salbach, N.M., Guilcher, S.J.T., Jaglal, S.B. and Davis, D.A. (2009) Factors Influencing Information Seeking by Physical Therapists Providing Stroke Management. Physical Therapy, 89, 1039-1050. https://doi.org/10.2522/ptj.20090081
[44]
McQuide, P., Millonzi, K. and Farrell, C. (2007) Strengthening Health Professional Associations. https://www.intrahealth.org/sites/default/files/attachment-files/techbrief_8.pdf
[45]
Kanmounye, U.S., Jumbam, D.T., Endomba, F.T., Tochie, J.N., Mbonda, A.N., Ghomsi, N.C., et al. (2020) Advancing Medical Research in Sub-Saharan Africa: Barriers, Facilitators, and Proposed Solutions. PAMJ Clinical Medicine, 3, Article 83. https://doi.org/10.11604/pamj-cm.2020.3.83.23716
