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Implementation Scale (Table 4). Discussion The results show that many different variables were associated with implementation of EBP, which suggests the complexity of EBP implementation. Three factors were found to be most clearly associated with higher EBP implementation: longer experience in rheumatology practice, experience of research activities, and better perceived personal ability to use research evidence in practice. Table 3: Odds -ratios (OR) for a high score on the EBP-implementation scale, adjusted for sex and age. N (%) OR CI p-value Profession Registered nurses Occupational therapists Physiotherapists Social workers Physicians Because there were no respondents in the category of high EBP implementation score with low intent to use research evidence in the future, the model did not converge. Neher et al. J Rheum Dis Treat 2016, 2:039 ISSN: 2469-5726 • Page 6 of 8 • Experience of rheumatology was more important than experience in profession for explaining EBP implementation. A longer exposure to the clinical problems of a specific category of patients may foster a deeper motivation to learn more and encourage interest in research. No consistent evidence has been found concerning work experience as a factor for research use [11]. Dalheim, et al. [22] suggest that experienced nurses may be a resource for implementing EBP, while other studies detected tendencies for a decline in research use over time in practice [23]. Experience of research activities was associated with high EBP implementation, despite only one in six respondents having been active in research activities during the past year. Our study outcome was not associated with educational level, even though the odds for higher EBP-implementing scores were significantly higher for participants with CPE, and especially for those with a research education. Academic level has been shown to influence levels of EBP implementation in other studies [24-26]. That perceived personal ability to use evidence in practice was an important factor for EBP implementation accords well with Social Cognitive Theory, which proposes the relevance of self-efficacy for performing a new behavior [27]. Studies concerning EBP in terms of hand hygiene practice and lumbar spine X-ray referrals have shown that beliefs about capabilities are important for developing a new behavior [28,29]. In general, individual motivational and attitudinal factors have been shown to be of importance to EBP implementation [11,30,31]. The mean score for the EBP Implementation Scale was low, which is in line with the results found in several other studies, predominantly within nursing [32-35]. It should be noted that the outcome in our study is a composite score representing several professional groups together. There are no comparable studies, making it difficult to interpret the outcome of our study. Two approaches to EBP have been described in the literature: EBP as a critical appraisal process leading to clinical decisions informed by evidence and EBP in terms of adopting and using various empirically supported interventions, including those specified in clinical guidelines or other recommendations [6,36]. The EBP Implementation Scale features mixed items and reflects both approaches to EBP. However, neither approach was favored over the other in our study. A majority of the respondents reported that they had not performed several of the activities traditionally related to the critical appraisal EBP process, such as accessing the Cochrane Database of Systematic Reviews or the National Guidelines Clearinghouse. Our results are similar to those of Stokke, et al. [32]. Other activities, such as collecting data on a patient problem, critically appraising evidence from a (clinical) research study, and “formulating a PICO question about my clinical practice” were performed regularly by 1 in 10 of the respondents, while about half of the respondents did not perform these at all. Activities related to the second EBP approach, i.e., adopting and using EBPs (interventions, programs, etc.), as exemplified by items like “using an EBP guideline or systematic review to change practice” and “sharing an EBP guideline with a colleague,” were not so much more common.
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