How do scientific evidence and clinical experience influence physiotherapists' confidence in a treatment's efficacy ? A survey of French-speaking physiotherapists

Background and ObjectivesCurrent physiotherapy practice is not always in line with the best available scientific evidence. Some barriers to evidence-based practice have been identified with self-declared questionnaires, but it remains unknown how much physiotherapists agree that high-quality scientific evidence is more reliable than clinical experience to evaluate a treatments efficacy. The goal of this study is to investigate the relative influence of research findings, positive and negative, and clinical experience on physiotherapists confidence in a treatments efficacy. Materials and MethodIn a web-based survey, French-speaking physiotherapists in France and Belgium and physiotherapy students gave their degree of confidence in the efficacy of four fictitious treatments whose characteristics varied regarding scientific evidence and clinical experience, on a 0-100 scale. ResultsWe found that 20.9 % of students (95%CI [16.4, 26.2]) and 17.3 % of physiotherapists (95%CI [13.1, 22.4]) had equal or higher confidence in clinical experience than scientific evidence. Moreover, for about a fourth of the participants, negative placebo-controlled trial findings had no impact on their confidence in a treatments efficacy, while for about half of the participants, such findings increased their confidence in a treatments efficacy. Level of training in evidence-based practice seems to have a null to at most moderate effect on the relative confidence in scientific evidence and clinical experience. ConclusionHigh confidence in clinical experience may have been an underestimated barrier to evidence-based practice in previous studies. The interpretation of negative findings of placebo-controlled trials show that most physiotherapists misunderstand placebos or ignore negative study findings. This could also be an important barrier to evidence-based practice.