Future Directions of Evidence-Based Practice in Athletic Training: Perceived Strategies to Enhance the Use of Evidence-Based Practice

Context:

The shift to a culture of evidence-based practice (EBP) in athletic training is a necessary step in both the optimization of patient care and the advancement of athletic trainers (ATs) as health care professionals. Whereas individuals have gained knowledge in this area, most ATs still are not practicing in an evidence-based manner. Exploring perceived strategies to enhance the use of EBP will help to determine the best approaches to assist ATs in applying EBP concepts to practice to improve patient care.

Objective:

To explore beneficial strategies and techniques ATs perceived would promote successful implementation of EBP within athletic training education and clinical practice.

Design:

Qualitative study.

Setting:

Individual telephone interviews.

Patients or Other Participants:

Twenty-five ATs (12 educators, 13 clinicians; athletic training experience = 16.00 ± 9.41 years) were interviewed.

Data Collection and Analysis:

One phone interview was conducted with each participant. After the interview was transcribed, the data were analyzed and coded into common themes and categories. Triangulation of the data occurred via the use of multiple researchers and member checking to confirm the accuracy of the data.

Results:

Participants identified several components they perceived as essential for enhancing the use of EBP within the athletic training profession. These components included the need for more EBP resources, more processed information, focused workshops, peer discussion and mentorship, and continual repetition and exposure. Participants also indicated that ATs need to accept their professional responsibilities to foster EBP in their daily practices.

Conclusions:

The proper shift to a culture of EBP in athletic training will take both time and a persistent commitment by ATs to create strategies that will enhance the implementation of EBP across the profession. Researchers should focus on continuing to identify effective educational interventions for ATs and to determine successful strategies to implement EBP into didactic curricula and clinical practice. Additional focus should be given to which strategies most effectively produce changes in clinical practice.Key Words: professional responsibility, mentorship, evidence-based medicine, qualitative research

Key Points

• Participants perceived that certain strategies might enhance the inclusion of evidence-based practice concepts throughout athletic training.
• Researchers should continue to identify effective educational interventions for athletic trainers and determine successful strategies to implement evidence-based practice into didactic curricula and clinical practice.
• Focus also needs to be placed on strategies that most effectively achieve knowledge translation to effect change in clinical practice.

The athletic training profession has begun to place greater emphasis on evidence-based practice (EBP) to align with the 2003 recommendations from the Institute of Medicine.¹ These recommendations focus on the inclusion of 5 core competencies: (1) delivering patient-centered care, (2) working as part of interprofessional teams, (3) practicing evidence-based medicine, (4) focusing on quality improvement, and (5) using information technology. While focusing on the EBP competency, researchers have reported that athletic training students, educators, and clinicians believe that EBP is an important shift for the profession,^2–6 but barriers, including time, accessibility to resources, and knowledge of EBP concepts, are preventing athletic trainers (ATs) from applying this paradigm to clinical practice.^6–9 The release of the fifth edition of the Athletic Training Education Competencies,¹⁰ which includes an EBP focus, has provided a preliminary mechanism for helping future generations of ATs overcome some of these barriers at the professional education level. The hope is that the inclusion of EBP concepts within curricula will promote a new generation of clinicians who will translate the concepts of EBP into their daily clinical practices. The incorporation of EBP will require ATs to understand and teach the principles of EBP didactically and to be familiar with and willing to implement these concepts into clinical practice.As athletic training education moves toward EBP, practicing clinicians also must embrace and adopt this paradigm shift. The approach to creating a culture of EBP needs to be multifaceted^7,11 and must be targeted at all ATs, including those who have been reared in a culture of tradition. Overall, one of the main goals of athletic training is to improve the outcomes of the care provided to patients.¹² However, until all members of the profession are willing to accept this paradigm shift, athletic training may never fully embrace an EBP culture.Leaders in the profession recognize the need for change and are attempting to move in this direction.¹³ In addition to updating the educational competencies, more continuing education in the area of EBP has become available to ATs.¹⁴ The board of directors of the National Athletic Trainers'' Association (NATA) provided funding for the development and dissemination of educational EBP modules that were made available to the entire NATA membership free of cost.¹⁵ A randomized controlled trial on the ability of these modules to increase knowledge of EBP concepts revealed that they were an effective mechanism to teach these concepts to ATs.¹⁵ Only an immediate knowledge increase was assessed, and no authors of the current literature have explored long-term knowledge retention and translation among ATs or implementation practices resulting from the Web-based modules.Whereas education of current ATs is a vital step in shifting the culture of the profession, merely increasing knowledge cannot be assumed to correlate with an actual change in clinical practice. Researchers have conducted multiple systematic reviews in which they assessed the effectiveness of educational interventions on clinical practice changes. Forsetlund et al¹⁶ concluded that educational meetings elicit small improvements in professional practice and health care outcomes. Freemantle et al¹⁷ reported that printed educational materials, audit and feedback, and meetings or workshops had little to no effect on clinical practice. Most investigators^16–20 have determined that multifaceted educational interventions (eg, didactic lecture combined with interactive discussion) and active rather than passive interventions are most effective in changing professional behavior. Oxman et al²¹ and Foy et al²² found that interventions can only be effective in changing behaviors under ideal conditions, so multiple factors, including the condition and patient and clinician attributes, should be considered when developing an educational intervention. Overall, authors^19,23 of the majority of studies conducted to assess clinical practice changes after an intervention have indicated that most interventions are effective under some circumstances but that no single intervention is effective for all circumstances.The true shift to EBP in athletic training requires not only enhanced knowledge of EBP concepts but also a translation of this knowledge into practices that will improve patient care outcomes. Therefore, it is important not only to assess if a knowledge gain has occurred but also to determine if and how this knowledge has translated to clinical practice. Recently, researchers²⁴ have revealed that whereas ATs perceive they have retained knowledge gained from the Web-based modules, they have not shifted that knowledge to their daily practices in patient care. For this reason, it is necessary to seek strategies that will be most effective in bridging the gap between knowledge and practice. Qualitatively exploring the perceptions and experiences of ATs will lead to a rich perspective of which mechanisms they perceive will be most effective in shifting ideas and behaviors toward clinical practice and didactic education. A qualitative exploration allows participants to provide ideas that are not limited by the researchers'' opinions and biases and ideas that they believe will ultimately influence their behaviors. Therefore, the purpose of this qualitative study was to explore the experiences and theories ATs have toward identifying beneficial strategies and techniques to promote successful implementation of EBP within athletic training education and clinical practice.