Barriers and facilitators in the selection of diagnostic tests in primary care physiotherapy: A delphi study

Physiotherapists value evidence-based practice (EBP) but applying it when selecting diagnostic tests remains challenging. Existing evidence mainly addresses general EBP implementation, while factors specifically influencing evidence-based diagnostic decision-making are less clear.

To achieve consensus on key barriers and facilitators affecting the selection of diagnostic tests within EBP among physiotherapists and manual therapists in primary care in the Netherlands and Belgium, and to identify broadly relevant targets for education, guideline development, and implementation.

A qualitative study using a modified Delphi method was conducted. A preliminary literature search informed a focus group discussion, which was used to refine relevant barriers and facilitators. In round 1, participants answered open-ended questions structured around the three domains of EBP and their integration. In rounds 2 and 3, they rated derived statements to determine consensus. Consensus was defined as ≥70% agreement on a 5-point Likert scale. Eighty-five participants commenced the study, and 42 completed all rounds.

Out of 33 identified barriers, consensus was reached on 12, including limited generalisability of research, time constraints, and financial limitations. Commonly cited obstacles such as difficulties accessing or interpreting literature and language issues were considered less relevant. Consensus was reached on 22 facilitators, including improved access to scientific resources, clear reporting of diagnostic accuracy, and enhanced translation of research findings into practice.

Consensus on barriers to EBP was limited, but broad agreement existed on practical facilitators, notably improving access to scientific information, education, and tools supporting evidence-based diagnostic decision-making.