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Journal of the Medical Library Association : JMLA logoLink to Journal of the Medical Library Association : JMLA
. 2007 Jan;95(1):64–69.

Evaluating the professional libraries of practicing physical therapists

Suzanne R Brown 1, James R Roush 2, Alyson R Lamkin 3,6, Rena Perrakis 4,6, Michael R Kronenfeld 5
PMCID: PMC1773046  PMID: 17252068

Abstract

Background and Purpose: The primary objective of this study was to explore the use of information resources by a sample of physical therapists.

Methods: A qualitatively designed study using structured individual interviews, examination of professional libraries, and identification of information resources was initiated in three sites (Southern California, Arizona, and Georgia). Participants included forty physical therapists with between five and twenty years of experience.

Results: The Internet and continuing education activities appeared to be the primary information sources for the physical therapists surveyed. The personal professional libraries of participants were limited in scope and contained titles copyrighted more than ten years ago. Access to peer-reviewed journals in the sample was limited primarily to those received as a benefit of professional association membership.

Discussion and Conclusions: Participants did not maintain current print professional information resources. The majority of books in the personal and workplace professional libraries held copyrights dating from the time of the participants' enrollment in an entry-level physical therapy program. Medical librarians may play an important role in shifting physical therapy towards evidence-based practice by collaborating in professional development for this group. Physical therapy educators and professional leaders should support current public collections of physical therapy-related information resources to encourage the movement towards an evidence-based practice model in physical therapy.

Highlights

  • Personal professional information resources for the physical therapists in this convenience sample appeared to be limited and outdated.

  • Computer access was available and widely used among surveyed physical therapists.

  • Information resource utilization did not seem to differ based on demographic characteristics such as gender, experience, or level of education.

  • Physical therapists participating in this research reported frequent engagement in professional development activities to acquire current information.

Implications

  • Medical librarians should be involved in professional development activities for physical therapists to educate users about information resource availability and retrieval strategies.

  • Inclusion of more physical therapy-related journals in digital databases may facilitate evidence-based practice by physical therapists.

INTRODUCTION

The concept of evidence-based practice (EBP) at the point of care is becoming an established professional standard within many different health care professions. For medical librarians to effectively support professions moving towards EBP, a better understanding of the current information resources being used by the clinical population is needed. This paper is a preliminary study of the information resources used by practicing clinicians of one profession, physical therapy, that has adopted a strong commitment to an evidence-based approach to clinical practice [1].

In physical therapy, EBP has been incorporated into graduate and post-professional education programs, creating a shift towards increasing information-gathering skills; analysis and interpretation of the literature; and problem solving [2, 3]. Jette, Bacon, and Batty in 2003 found that the majority of physical therapists had a positive attitude towards both EBP and the necessity of incorporating evidence in their daily practice; they also hypothesized that recent education may have an impact on the effectiveness of incorporating evidence in daily practice [1]. Other authors compared physiotherapists in England and Australia with past or current post-professional higher education experience with their counterparts without such education and asserted that the more recent the higher education experience, the more likely physiotherapists are to utilize journals as a basis for practice [4, 5]. Despite efforts to incorporate EBP into physical therapy practice, studies continue to show that practitioners do not use professional literature to support clinical decision-making [6, 7].

The reading habits of various health professionals have also been investigated in several studies. Researchers in Canada, Europe, and Australia have explored the reading habits of healthcare professionals extensively, finding similar patterns among various healthcare specialties, including physical therapy [4–13]. A majority of healthcare providers scan through journals, reading mostly the abstracts [19], and report time constraints as a major barrier to obtaining information [1, 11–12, 15–16]. In line with these results in the broader healthcare literature, research into the reading habits of physical therapists indicate that books and journals are accessed by this group more frequently than any other forms of obtaining information [9]. Hall [10] looked specifically at the information resources used by private practice physical therapists in Vermont and found that professional associates and personal or office reference collections were accessed most frequently for assistance in clinical decision-making. Library and computer database resources were infrequently used by Hall's 1995 sample.

Numerous studies in the past two decades have examined the importance of EBP and its implications regarding the quality of care delivered to patients, indicating that increased use of evidence in daily clinical practice is needed to provide best practices that are cost-effective, decrease complications, and reduce lengths of stay [1, 17]. However, lack of time due to increased job demands and lack of access to scientific material have been reported as barriers to obtaining evidence [10, 15] and incorporating it into practice [1, 7]. With the advent of the World Wide Web and electronic databases, scientific information is becoming increasingly more accessible to physical therapists [3, 18, 20]. Hall's 1995 study found little use of electronic databases [10], and Stevenson et al. found that professional literature ranked fifth of six choices of the preferred source of information for physical therapists working in the neurological sciences [7]. However, with increasing electronic accessibility over the last decade, it is appropriate to determine how often physical therapists now access scientific information and what resources are being used, as an important step towards supporting evidence-based practice.

Recent research in the United States exploring resources that physical therapists access for scientific information and how often they do so is limited [1, 8]. This study was designed to offer a view of information resources by investigating the print resources, electronic access, and readership behavior of practicing physical therapists through therapist interviews and an inventory of personal professional libraries.

METHODS

The study used a mixed quantitative/qualitative design to obtain demographic information and data regarding information resources, technology access, and participation in professional development activities in a sample of physical therapists. The Institutional Review Board of A. T. Still University of the Health Sciences, Mesa (AZ) Campus approved the study as an exempt study presenting no risk to human subjects.

Subjects

A sample of forty subjects was recruited by snowball sampling using word of mouth and telephone solicitation by authors AL and RP. Trochim [19] describes snowball sampling as a nonprobability convenience sampling technique in which one subject meeting the inclusion criteria is identified and requested to recommend others for inclusion in the study.

Inclusion criteria were set by the authors to achieve a representative sample of physical therapists in general clinical practice. Inclusion required a five-year minimum and twenty-year maximum duration of clinical experience as a physical therapist and a professional degree from an entry-level physical therapy curriculum in the United States (US). Participants with less than five years and more than twenty years of experience were excluded in order to provide a study population of mid-career professionals. Entry-level education programs for physical therapists have awarded bachelors, masters, or clinical doctorates over the past twenty-five years; however, since licensure to practice has no distinction for academic level, no differentiation was made based on level of academic degree for this study. US-educated physical therapists were selected to limit the resources available to primarily English-language materials. Academic program faculty members were excluded because of the nature of their work and their institutional settings, with greater access to information resources. No criteria were indicated for gender, age, or other professional practice characteristics.

To solicit participants, the investigators made telephone calls or personal visits to hospitals and outpatient clinics in the metropolitan areas of Phoenix, Arizona; San Diego, California; and Atlanta, Georgia. These geographic areas were chosen for convenience by authors AL and RP, who were in residence in these areas during their third years of professional education. No remuneration was given to any subjects for participating in the study. Potential subjects were invited to participate after initial screening indicated that they met inclusion criteria. Upon each subject's agreement to participate, a scheduled appointment was made for the face-to-face interview and data collection. At the time of the interview, informed consent was obtained from each subject. All subjects were assigned an identifying number for record-keeping and to maintain confidentiality.

Data collection

Data was collected in an individual face-to-face interview with each participant. Scripted interview questions (Appendix) were read aloud by the investigator and the responses recorded; the structured interview guide was used to ensure reliability and consistency of data collection. Interviews lasted from fifteen to forty-five minutes and normally occurred in the home of the participant. Questions included items exploring population characteristics reported in the literature on physical therapists [10, 21] as well as questions about information resources cited as usable to support evidence-based practice [1, 9].

The final scripted interview included fifteen items and a book/journal inventory. Items were designed to gather the desired information as well as to confirm that inclusion and exclusion criteria had been met in the subject selection. Two items (age and gender) were used to collect demographic information. Eight items solicited information on the subject's professional practice; these items included length and type of clinical experience, specialization, professional association membership, professional educational degree, and educational institution granting the degree. Five items queried subjects on the availability and use of information resources; this portion of the interview included availability of peer-reviewed journals, availability and frequency of access of Web-based materials, and the location (home or office) where Web-based materials could be accessed. The final section required an inventory of all professional books and journals (e.g., title, author, edition, and year of publication) present in subjects' personal or office collections. This inventory was gathered through direct observation by one of the authors. The location of resources, in either the home or the office, was also noted.

Data analysis procedures

Descriptive statistics using frequency and central tendency measures were used to analyze the quantitative data. Data analysis was performed using Microsoft Excel (Seattle, WA) and the Statview 5.0 (Cary, NC) statistical package. Qualitative analysis of data by triangulation with published data was used to analyze narrative responses. Triangulation of data, or analysis of information collected from several perspectives, strengthens the internal validity of qualitative data analysis [19]. In this study, results of the interviews and inventories were compared with similar published studies. The expertise of the senior authors enabled data analysis from both physical therapy and medical librarian perspectives. This triangulation analysis sought similar and dissimilar findings in order to affirm the reliability and validity of the study; similarities of responses in a small sample study may be considered valid if the sample is demographically and professionally similar to that of other published sources [19].

RESULTS

Demographics

Forty participants were recruited for the study, including 28 males (70%) and 12 females (30%), from the selected geographic areas. The average participant had received a bachelor's degree in physical therapy, had been practicing for 11.5 years, and was working in an outpatient facility. Table 1 illustrates the personal and clinical practice demographics of the sample.

Table 1 The personal and clinical practice demographics of the sample

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Information resources

Membership in the major professional association, the American Physical Therapy Association (APTA) was claimed by 55% (n = 22) of the participants. Fifty-five percent (n = 22) attended continuing education activities three or more times per year, while 20% (n = 8) participated in one or no continuing education activities. No apparent difference was seen in frequency of participation in continuing education based on professional association membership.

All subjects reported access to a computer. The majority (80%, n = 32) had computer access at both home and office. Eighteen percent (n = 7) reported having computer access only at home, and only one participant reported office-only access. The majority (57%, n = 23) reported use of a computer to access clinical information at both home and office, while 28% (n = 11) accessed only from home and 15% (n = 6) accessed such information only from the office.

Participants reported accessing the Internet for clinical purposes at frequencies ranging from daily to less than monthly. The greatest proportion of subjects (32%, n = 13) accessed the Internet two to five times per week, while 25% (n = 10) utilized the Internet once a month or less. Only two subjects (5%) reported using the Internet daily.

The most common peer-reviewed journals accessible to participants were Physical Therapy, Journal of Orthopaedic and Sports Physical Therapy (JOSPT), and Journal of Neurological Physical Therapy. Each journal is a benefit of membership in the APTA or one of its affiliates. Three (7%) participants subscribed to peer-reviewed journals unrelated to professional association memberships. Only 39% (n = 7) of the association nonmembers reported subscriptions to any professional publications. Twenty-three percent (n = 9) of the participants claimed no personal subscriptions to any peer-reviewed publication, although all participants claimed access to at least one peer-reviewed journal through personal subscriptions or in the workplace.

The average number of print books in the individual professional libraries was 12.8 (range 5–29 books). The 560 volumes inventoried represented 255 separate titles in various editions. When categorized by area of interest corresponding to curriculum areas in a typical physical therapy professional program (Table 2), orthopedics and basic science with anatomy represent 49% (n = 274) of the individual books. The average date of copyright of all books in the professional libraries was 14.6 years (SD = 7.5) previous to the date of the interview. Table 3 lists the most common titles found in the combined inventories.

Table 2 Subject categories of library holdings (560 items)

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Table 3 Most common book titles (all editions)

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DISCUSSION

The primary objective of this pilot study was to describe the use of information resources by physical therapists through interview and inventory of personal professional libraries. The sample population was similar to the profile of physical therapists as published by the APTA in terms of education and practice setting but dissimilar in gender and experience [21]. The study sample was predominately male, less experienced (11.6 yrs) and working in outpatient settings, whereas the average APTA member is female, has worked for 16.6 years, and also works in an outpatient setting [21]. The work experience found in the study sample was similar to Hall's [10] private practice therapists who reported 11.9 years of experience; however, Hall did not report the gender of the subjects. The professional education level of the sample was similar to that of the APTA profile.

Electronic access

Participants reported frequent access to the Internet at both home and office locations. This finding is similar to Jette et al.'s 2003 report of computer access and use by physical therapists [1], notably with greater frequency than that reported by Hall almost a decade earlier [10]. When frequency of Internet access is considered with the limited and often outdated print resources available to the participants, use of digital databases and information resources is a viable alternative to print resources to support evidence-based practice.

Continuing education

The majority of participants regularly participated in professional continuing education (CE) activities. This result supports engagement in CE activities as the most prevalent information resource used by the sample, and at a higher level than that reported by Hall a decade earlier [10]. The current results most likely have been affected by mandatory continuing education requirements for re-licensure in both Arizona and Georgia, two of the three geographic locations of study participants. Vermont, the location of Hall's [10] study, did not mandate continuing education at the time of the study. Use of traditional continuing education venues to educate physical therapists on the availability of other information resources may be the most efficient and effective method to support wider reliance on peer-reviewed and published evidence.

Peer-reviewed journal access

Although professional association membership did not appear to influence computer access or continuing education participation, it did appear to influence personal subscription access to peer-reviewed publications. Peer-reviewed journals accessible to the study participants were those most frequently received as a benefit of membership in the professional association. These findings parallel those of Arsenault and Cleather [13] who found 29.7% of Canadian physiotherapists read only Physiotherapy Canada, and 50.4% read between one and three other professional journals. While 23% of the participants in the present study indicated they did not personally subscribe to peer-reviewed publications, they did report having access to Physical Therapy through colleagues, journal clubs, discussion groups, and medical libraries. Only three participants (7%) in the study subscribed independently to peer-reviewed journals not associated with professional memberships or indicated access to such journals in the practice setting. Wakiji [22], in mapping the literature of physical therapy, found a diverse and multidisciplinary collection of publications outside the core journals of physical therapy and recommended that library collections for physical therapists include related publications. While the current study's findings show that physical therapists have limited access to peer-reviewed journals at the home or workplace, it is not known if larger collections of physical therapy-related resources in medical libraries would be utilized if accessible. Further studies are needed to determine if physical therapists would access and use current library collections outside their personal or workplace resources.

Books found in personal professional libraries are assumed, based on date of copyright, to be primarily those acquired during the subjects' professional education. Only 23% of the titles inventoried carried copyright dates of 1995 or later, while 30% had copyright dates prior to 1985. The most commonly owned books parallel common textbooks used in physical therapy curriculums. Bohannon [9] found in 1990 that the most common textbooks used in physical therapy curriculums were Cyriax's Textbook of Orthopaedic Medicine, Hoppenfeld's Physical Examination of the Spine and Extremities, and Bobath's Abnormal Postural Reflex Activity Caused by Brain Lesions. The current study shows that the Hoppenfeld text is the most commonly owned by physical therapists, while the other two titles are infrequently owned. Hall reported that 82% of private practice physical therapists relied on their personal or office collections of books and journals to make clinical decisions more than 10 times per year [10]. If this observation is valid, then the sample in this study is potentially relying on outdated references to support clinical decision-making.

CONCLUSIONS

This pilot study demonstrated increasing utilization of computer access among physical therapists compared with previous studies in this population. This access, participation in continuing education activities, and peer-reviewed professional journals in physical therapy appeared to be the primary information resources used by this sample of physical therapists in an outpatient setting. Personal professional libraries were limited in scope and outdated, containing titles copyrighted more than ten years prior to the study. Peer-reviewed journal access was limited primarily to those journals received as a benefit of professional association membership or available in the workplace.

Generalization of the specific findings of this study is limited by the small sample size; however, the geographic diversity and similarity to national demographics do strengthen the findings and their applicability. No effort was made in this study to further investigate the Web-based resources being utilized by the sample population, the availability and use of medical library reference services or collections, or the perceived need for access to such services or collections. The authors recommend a larger study sample and inclusion of more detailed questions in a future study.

This study has several implications for medical libraries and librarians serving physical therapy educational programs as well as physical therapists in clinical practice. While physical therapy as a profession has strongly adopted an evidence-based approach to practice, many practicing PTs may not seek access to the current information resources necessary to support EBP. Practicing physical therapists in this sample currently have the Internet access necessary to support a greater use of Web-based evidence in their practice. Medical librarians supporting entry-level academic physical therapy programs and clinical physical therapists need to be involved in educating physical therapists about available information systems and in assisting the programs to teach students and practicing therapists how to effectively access and use these resources. Medical librarians should, in addition, seek ways to present information at continuing education programs as an effective method of reaching the physical therapist population.

Supplementary Material

Appendix
jmla-095-01-0064-s1-a1.pdf (37.4KB, pdf)

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Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Supplementary Materials

Appendix
jmla-095-01-0064-s1-a1.pdf (37.4KB, pdf)

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