This the ability for physical therapists to perform

This perceived economic threat
explains the nationwide and seemingly organized attempt in the United States by
the chiropractic profession to restrict the physical therapy scope of practice
by removing spinal manipulation as one of the interventions available to therapists
and their patients” (Huijbregts,
2007, p. 70).  He concludes
his editorial by stating that “the chiropractic profession that repeatedly
attempts to limit the physical therapy scope of practice is not motivated by lofty
ideals of patient safety but rather that this attempt is driven solely be economic
motives” (Huijbregts,
2007, p. 77).   Ultimately, the
ability for physical therapists to perform TJM’s has prevailed, as it is well defined
within nearly all state practice acts; the point here is still the same that an
unnecessary struggle has existed to get to this point between two disciplines with
a mutual interest – getting people moving and feeling better.

POTENTIAL
SOLUTIONS

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After reviewing the various political
and financial barriers to EBP it is apparent that something must be done to
address these barriers.  In particular,
the productivity requirements that minimize clinician time and the political
and economic climate that produce unnecessary friction and conflict between
disciplines.  Friction which ultimately
ends up hurting one group more than anyone else; the patients!  Regarding the productivity requirements,
Bernhardsson et al. stated it well, “This important barrier is not likely to be
reduced without organizational or managerial support (eg, provision of
protected work time) and also highlights the need for evidence to be summarized
in brief formats, minimizing time spent searching for and reading literature” (Bernhardsson
et al., 2014, p. 351). 
In many ways this has been addressed at the discipline level, as many
organizations such as the APTA have made a great effort to create valuable
continuing education, online, and print resources summarizing the most current
evidence; such as the current clinical practice guidelines (CPG’s).  Clinicians save time by utilizing these
guidelines as they no longer need to perform a specific literature search and consolidate
the information, which can be conflicting at times; however, guidelines can be
“cookie cutter” and my not be specific enough to address the needs of every
patient, thus still maintaining the need for valuable critical thinking.  Moving forward it is important that from the
management and administration level EBP must be highly valued.  Although it may not be immediately beneficial
to the “bottom line” it is the right thing to do for our patients.  It is important and necessary that
experienced clinicians assume management and administrative roles because,
although it may reduce the amount of patient care time they perform, it will
create a valuable advocate for the best patient care and for protection of
valuable clinician time to pursue EBP. 
Dedicated or protected time for continuing education, journal clubs, and
patient-case presentations (even 5% of time per week) will likely help to
encourage this lifelong growth and can even be pitched as a “benefit” offered by
an employer to help retain valuable talent. 
Additionally, ability to articulate and practice evidence-based care
should be a standard component of every annual clinician/job performance
review.  Also, maintaining private clinician-owned
practices will further help to maintain this valuable alignment of patient
advocacy that can offer EBP services that may not be reimbursed by insurance,
but may allow for cash payment services and increased responsiveness to the
research that larger medical groups may not be able to accommodate as easily.  Finally, medical education across all
disciplines must continue to emphasize and prepare clinicians not only to
utilize and critically appraise the evidence, but also to be an effective
advocate for the clinical application of EBP.

Regarding a solution to the
continuous turf battles between various disciplines, Peter Huijbregts states it
well when he addresses what should be done with the spinal manipulation
discussion, but this same sentiment can be applied to other treatment
interventions and across other disciplines: “spinal manipulation has
historically been and should continue to be part of the professional practice
of practitioners as diverse as physical therapists, chiropractors, medical
physicians, and osteopaths, and that this intervention should not become the
exclusive domain of any of the professions” (Huijbregts,
2007, pp. 77–78). 
He goes on to state further that it is time for all professions to “take
the ethical high ground, so that together we can put an end to this waste of
personal, professional, and societal resources” (Huijbregts,
2007, p. 78).   To put it simply, we should police other
disciplines only in so far as it benefits patients’ safety; but should not go
beyond this to the point where it becomes a detriment to quality patient care.

SUMMARY

In conclusion, we have established
that evidence-based practice (EBP) is essential to the rehabilitation science
profession both at the present, but also to be successful into the future.  Currently, there is widespread support of EBP
amongst clinicians but relatively low utilization of these evidenced-based
practices.  Barriers such as lack of time
are often stated for the reason behind this lack of EBP utilization; however,
in this paper we examine that financial and political or interdisciplinary
barriers are often at the heart of this “lack of time” issue as well.  To see the rehabilitation science profession
(and rest of the medical field) through this, we recommend prioritization of
managers and administrators to value EBP both in the allotment of time for
clinicians in the clinic and in the process of annual job performance
reviews.  Efforts to continue to provide
effective synthesis of EBP in easy to obtain form must be continued by all
disciplines and emphasized in all medical education curricula.  Finally, we recommend that the patient’s best
interests always be kept at the forefront by everyone, including the clinicians
and managers, the insurance companies, and between disciplines (lobbyists
included). 

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