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Published in: Chiropractic & Manual Therapies 1/2015

Open Access 01-12-2015 | Research

US chiropractors’ attitudes, skills and use of evidence-based practice: A cross-sectional national survey

Authors: Michael J Schneider, Roni Evans, Mitchell Haas, Matthew Leach, Cheryl Hawk, Cynthia Long, Gregory D Cramer, Oakland Walters, Corrie Vihstadt, Lauren Terhorst

Published in: Chiropractic & Manual Therapies | Issue 1/2015

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Abstract

Background

Evidence based practice (EBP) is being increasingly utilized by health care professionals as a means of improving the quality of health care. The introduction of EBP principles into the chiropractic profession is a relatively recent phenomenon. There is currently a lack of information about the EBP literacy level of US chiropractors and the barriers/facilitators to the use of EBP in the chiropractic profession.

Methods

A nationwide EBP survey of US chiropractors was administered online (Nov 2012-Mar 2013) utilizing a validated self-report instrument (EBASE) in which three sub-scores are reported: attitudes, skills and use. Means, medians, and frequency distributions for each of the sub-scores were generated. Descriptive statistics were used to analyze the demographic characteristics of the sample. Means and proportions were calculated for all of the responses to each of the questions in the survey.

Results

A total of 1,314 US chiropractors completed the EBASE survey; the sample appeared to be representative of the US chiropractic profession. Respondents were predominantly white (94.3%), male (75%), 47 (+/− 11.6) years of age, and in practice for more than 10 years (60%). EBASE sub-score means (possible ranges) were: attitudes, 31.4 (8–40); skills, 44.3 (13–65); and use, 10.3 (0–24). Survey participants generally held favorable attitudes toward EBP, but reported less use of EBP. A minority of participants indicated that EBP coursework (17%) and critical thinking (29%) were a major part of their chiropractic education. The most commonly reported barrier to the use of EBP was “lack of time”. Almost 90% of the sample indicated that they were interested in improving their EBP skills.

Conclusion

American chiropractors appear similar to chiropractors in other countries, and other health professionals regarding their favorable attitudes towards EBP, while expressing barriers related to EBP skills such as research relevance and lack of time. This suggests that the design of future EBP educational interventions should capitalize on the growing body of EBP implementation research developing in other health disciplines. This will likely include broadening the approach beyond a sole focus on EBP education, and taking a multilevel approach that also targets professional, organizational and health policy domains.
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Literature
2.
go back to reference Claridge JA, Fabian TC. History and development of evidence-based medicine. World J Surg. 2005;29:547–53.CrossRefPubMed Claridge JA, Fabian TC. History and development of evidence-based medicine. World J Surg. 2005;29:547–53.CrossRefPubMed
3.
go back to reference Balakas K, Potter P, Pratt E, Rea G, Williams J. Evidence equals excellence: the application of an evidence-based practice model in an academic medical center. Nurs Clin North Am. 2009;44:1–10.CrossRefPubMed Balakas K, Potter P, Pratt E, Rea G, Williams J. Evidence equals excellence: the application of an evidence-based practice model in an academic medical center. Nurs Clin North Am. 2009;44:1–10.CrossRefPubMed
4.
go back to reference Glasziou P, Ogrinc G, Goodman S. Can evidence-based medicine and clinical quality improvement learn from each other? BMJ Qual Saf. 2011;20:13–7.CrossRef Glasziou P, Ogrinc G, Goodman S. Can evidence-based medicine and clinical quality improvement learn from each other? BMJ Qual Saf. 2011;20:13–7.CrossRef
5.
go back to reference Ubbink DT, Guyatt GH, Vermeulen H. Framework of policy recommendations for implementation of evidence-based practice: a systematic scoping review. BMJ Open. 2013; doi:10.1136/bmjopen-2012-001881. Ubbink DT, Guyatt GH, Vermeulen H. Framework of policy recommendations for implementation of evidence-based practice: a systematic scoping review. BMJ Open. 2013; doi:10.1136/bmjopen-2012-001881.
6.
go back to reference Cabana MD, Rand C, Powe N, Wu A, Wilson M, Abboud P, et al. Why don’t physicians follow clinical practice guidelines? A framework for improvement. JAMA. 1999;282(15):1458–65.CrossRefPubMed Cabana MD, Rand C, Powe N, Wu A, Wilson M, Abboud P, et al. Why don’t physicians follow clinical practice guidelines? A framework for improvement. JAMA. 1999;282(15):1458–65.CrossRefPubMed
8.
go back to reference Evans R, Maiers M, Delagran L, Kreitzer MJ, Sierpina V. Evidence informed practice as the catalyst for culture change in CAM. Explore. 2012;8(1):68–72.CrossRefPubMedCentralPubMed Evans R, Maiers M, Delagran L, Kreitzer MJ, Sierpina V. Evidence informed practice as the catalyst for culture change in CAM. Explore. 2012;8(1):68–72.CrossRefPubMedCentralPubMed
9.
go back to reference Haas M, Leo M, Peterson D, Lefebvre R, Vavrek D. Evaluation of the effects of an evidence-based practice curriculum on knowledge, attitudes, and self-assessed skills and behaviors in chiropractic students. J Manipulative Physiol Ther. 2012;35(9):701–9.CrossRefPubMedCentralPubMed Haas M, Leo M, Peterson D, Lefebvre R, Vavrek D. Evaluation of the effects of an evidence-based practice curriculum on knowledge, attitudes, and self-assessed skills and behaviors in chiropractic students. J Manipulative Physiol Ther. 2012;35(9):701–9.CrossRefPubMedCentralPubMed
10.
go back to reference Sullivan BM, Furner SE, Cramer GD. Development of a Student Mentored Research Program between a Complementary and Alternative Medicine University and a Traditional, Research Intensive University. Acad Med. 2014;89(9):1220–6.CrossRefPubMed Sullivan BM, Furner SE, Cramer GD. Development of a Student Mentored Research Program between a Complementary and Alternative Medicine University and a Traditional, Research Intensive University. Acad Med. 2014;89(9):1220–6.CrossRefPubMed
11.
go back to reference Cramer GD, Guiltinan J, Maiers M, Laird S, Goertz C, Furner SE, et al. Benefits, Challenges And Culture Change Related To Collaborations Between Complementary And Alternative Medicine And Traditional Research-Intensive Institutions. Med Sci Educator. 2014. doi:10.1007/s40670-014-0077-3. Cramer GD, Guiltinan J, Maiers M, Laird S, Goertz C, Furner SE, et al. Benefits, Challenges And Culture Change Related To Collaborations Between Complementary And Alternative Medicine And Traditional Research-Intensive Institutions. Med Sci Educator. 2014. doi:10.1007/s40670-014-0077-3.
12.
go back to reference Shaw L, Descarreaux M, Bryans R, Duranleau M, Marcoux H, Potter B, et al. A systematic review of chiropractic management of adults with Whiplash-Associated Disorders: recommendations for advancing evidence-based practice and research. Work. 2010;35(3):369–94.PubMed Shaw L, Descarreaux M, Bryans R, Duranleau M, Marcoux H, Potter B, et al. A systematic review of chiropractic management of adults with Whiplash-Associated Disorders: recommendations for advancing evidence-based practice and research. Work. 2010;35(3):369–94.PubMed
13.
go back to reference Bussieres A, Stuber K. The Clinical Practice Guideline Initiative: A joint collaboration designed to improve the quality of care delivered by doctors of chiropractic. J Can Chiropr Assoc. 2013;57(4):279–84.PubMedCentralPubMed Bussieres A, Stuber K. The Clinical Practice Guideline Initiative: A joint collaboration designed to improve the quality of care delivered by doctors of chiropractic. J Can Chiropr Assoc. 2013;57(4):279–84.PubMedCentralPubMed
14.
go back to reference Hawk C, Schneider M, Evans Jr MW, Redwood D. Consensus Process to Develop a Best-Practice Document on the Role of Chiropractic Care in Health Promotion, Disease Prevention, and Wellness. J Manipulative Physiol Ther. 2012;35(7):556–67.CrossRefPubMed Hawk C, Schneider M, Evans Jr MW, Redwood D. Consensus Process to Develop a Best-Practice Document on the Role of Chiropractic Care in Health Promotion, Disease Prevention, and Wellness. J Manipulative Physiol Ther. 2012;35(7):556–67.CrossRefPubMed
15.
go back to reference Hawk C, Schneider M, Dougherty P, Gleberzon B, Killinger L. Best practices recommendations for chiropractic care for older adults: results of a consensus process. J Manipulative Physiol Ther. 2010;33(6):464–73.CrossRefPubMed Hawk C, Schneider M, Dougherty P, Gleberzon B, Killinger L. Best practices recommendations for chiropractic care for older adults: results of a consensus process. J Manipulative Physiol Ther. 2010;33(6):464–73.CrossRefPubMed
16.
go back to reference Hawk C, Schneider M, Ferrance R, Hewitt E, Van Loon M, Tanis L. Best practices recommendations for chiropractic care for infants, children, and adolescents: results of a consensus process. J Manipulative Physiol Ther. 2009;32(8):639–47.CrossRefPubMed Hawk C, Schneider M, Ferrance R, Hewitt E, Van Loon M, Tanis L. Best practices recommendations for chiropractic care for infants, children, and adolescents: results of a consensus process. J Manipulative Physiol Ther. 2009;32(8):639–47.CrossRefPubMed
17.
go back to reference Institute of Medicine Committee on Quality of Health Care in America. Crossing the quality chasm: a new health system for the 21st century. Washington, DC: National Academies Press; 2001. Institute of Medicine Committee on Quality of Health Care in America. Crossing the quality chasm: a new health system for the 21st century. Washington, DC: National Academies Press; 2001.
18.
go back to reference Schillinger D. An Introduction to Effectiveness, Dissemination and Implementation Research. P. Fleisher and E. Goldstein, eds. From the Series: UCSF Clinical and Translational Science Institute (CTSI) Resource Manuals and Guides to Community-Engaged Research, P. Fleisher, editor. Published by Clinical Translational Science Institute Community Engagement Program, University of California San Francisco; 2010. Schillinger D. An Introduction to Effectiveness, Dissemination and Implementation Research. P. Fleisher and E. Goldstein, eds. From the Series: UCSF Clinical and Translational Science Institute (CTSI) Resource Manuals and Guides to Community-Engaged Research, P. Fleisher, editor. Published by Clinical Translational Science Institute Community Engagement Program, University of California San Francisco; 2010.
19.
go back to reference Walker BF, Stomski N, Hebert J, French S. A survey of Australian chiropractors’ attitudes and beliefs about evidence-based practice and their use of research literature and clinical practice guidelines. Chiropr Man Therap. 2013;21(1):44.CrossRefPubMedCentralPubMed Walker BF, Stomski N, Hebert J, French S. A survey of Australian chiropractors’ attitudes and beliefs about evidence-based practice and their use of research literature and clinical practice guidelines. Chiropr Man Therap. 2013;21(1):44.CrossRefPubMedCentralPubMed
20.
go back to reference Suter E, Vanderheyden L, Trojan L, Verhoef M, Armitage G. How important is research-based practice to chiropractors and massage therapists? J Manipulative Physiol Ther. 2007;30(2):109–15.CrossRefPubMed Suter E, Vanderheyden L, Trojan L, Verhoef M, Armitage G. How important is research-based practice to chiropractors and massage therapists? J Manipulative Physiol Ther. 2007;30(2):109–15.CrossRefPubMed
21.
go back to reference Hall G. Attitudes of chiropractors to evidence-based practice and how this compares to other healthcare professionals: a qualitative study. Clin Chiropractic. 2011;14:106–11.CrossRef Hall G. Attitudes of chiropractors to evidence-based practice and how this compares to other healthcare professionals: a qualitative study. Clin Chiropractic. 2011;14:106–11.CrossRef
22.
go back to reference Roecker CB, Long C, Vining R, Lawrence D. Attitudes toward evidence-based clinical practice among doctors of chiropractic with diplomate-level training in orthopedics. Chiropr Man Therap. 2013;21(1):43.CrossRefPubMedCentralPubMed Roecker CB, Long C, Vining R, Lawrence D. Attitudes toward evidence-based clinical practice among doctors of chiropractic with diplomate-level training in orthopedics. Chiropr Man Therap. 2013;21(1):43.CrossRefPubMedCentralPubMed
25.
go back to reference Leach MJ, Gillham D. Evaluation of the Evidence-Based practice Attitude and utilization SurvEy for complementary and alternative medicine practitioners. J Eval Clin Pract. 2008;14(5):792–8.CrossRefPubMed Leach MJ, Gillham D. Evaluation of the Evidence-Based practice Attitude and utilization SurvEy for complementary and alternative medicine practitioners. J Eval Clin Pract. 2008;14(5):792–8.CrossRefPubMed
26.
go back to reference Leach MJ, Gillham D. Are complementary medicine practitioners implementing evidence based practice? Complement Ther Med. 2011;19(3):128–36.CrossRefPubMed Leach MJ, Gillham D. Are complementary medicine practitioners implementing evidence based practice? Complement Ther Med. 2011;19(3):128–36.CrossRefPubMed
27.
go back to reference Christensen MG, Kerkhoff D, Kollash M. Job Analysis of Chiropractic. Greeley, CO: National Board of Chiropractic Examiners; 2000. Christensen MG, Kerkhoff D, Kollash M. Job Analysis of Chiropractic. Greeley, CO: National Board of Chiropractic Examiners; 2000.
28.
go back to reference Christensen MG, Kollash M, Ward R, Webb K, Day M. zum Brunnen J. Job Analysis of Chiropractic. Greeley, CO: National Board of Chiropractic Examiners; 2005. Christensen MG, Kollash M, Ward R, Webb K, Day M. zum Brunnen J. Job Analysis of Chiropractic. Greeley, CO: National Board of Chiropractic Examiners; 2005.
29.
go back to reference Christensen MG, Kollash M, Hyland J. Job Analysis of Chiropractic. Greeley, CO: National Board of Chiropractic Examiners; 2010. Christensen MG, Kollash M, Hyland J. Job Analysis of Chiropractic. Greeley, CO: National Board of Chiropractic Examiners; 2010.
30.
go back to reference Gaglio B, Phillips SM, Heurtin-Roberts S, Sanchez MA, Glasgow RE. How pragmatic is it? Lessons learned using PRECIS and RE-AIM for determining pragmatic characteristics of research. Implement Sci. 2014;9:96.CrossRefPubMedCentralPubMed Gaglio B, Phillips SM, Heurtin-Roberts S, Sanchez MA, Glasgow RE. How pragmatic is it? Lessons learned using PRECIS and RE-AIM for determining pragmatic characteristics of research. Implement Sci. 2014;9:96.CrossRefPubMedCentralPubMed
31.
go back to reference Slawson DC, Shaughnessy A. Teaching evidence-based medicine: Should we be teaching information management instead? Acad Med. 2005;80:685–9.CrossRefPubMed Slawson DC, Shaughnessy A. Teaching evidence-based medicine: Should we be teaching information management instead? Acad Med. 2005;80:685–9.CrossRefPubMed
32.
go back to reference Murthy L, Shepperd S, Clarke MJ, Garner SE, Lavis JN, Perrier L, Roberts NW, Straus SE. Interventions to improve the use of systematic reviews in decision-making by health system managers, policy makers and clinicians. Cochrane Database Syst Rev. 2012;Issue 9. Art. No.: CD009401. doi:10.1002/14651858.CD009401.pub2. Murthy L, Shepperd S, Clarke MJ, Garner SE, Lavis JN, Perrier L, Roberts NW, Straus SE. Interventions to improve the use of systematic reviews in decision-making by health system managers, policy makers and clinicians. Cochrane Database Syst Rev. 2012;Issue 9. Art. No.: CD009401. doi:10.1002/14651858.CD009401.pub2.
33.
go back to reference Zwickey H, Schiffke H, Fleishman S, Haas M, Cruser D, LeFebvre R, et al. Teaching Evidence-Based Medicine at Complementary and Alternative Medicine Institutions: Strategies, Competencies, and Evaluation. J Altern Complement Med. 2014;20(12):925–31.CrossRefPubMed Zwickey H, Schiffke H, Fleishman S, Haas M, Cruser D, LeFebvre R, et al. Teaching Evidence-Based Medicine at Complementary and Alternative Medicine Institutions: Strategies, Competencies, and Evaluation. J Altern Complement Med. 2014;20(12):925–31.CrossRefPubMed
34.
go back to reference Long CR, Ackerman D, Hammerschlag R, Delagran L, Peterson D, Berlin M, et al. Faculty development initiatives to advance research literacy and evidence-based practice at CAM academic institutions. J Altern Complement Med. 2014;20(7):563–70.CrossRefPubMed Long CR, Ackerman D, Hammerschlag R, Delagran L, Peterson D, Berlin M, et al. Faculty development initiatives to advance research literacy and evidence-based practice at CAM academic institutions. J Altern Complement Med. 2014;20(7):563–70.CrossRefPubMed
35.
go back to reference Clar C, Tsertsvadze A, Court R, Hundt GL, Clarke A, Sutcliffe P. Clinical effectiveness of manual therapy for the management of musculoskeletal and non-musculoskeletal conditions; systematic review and update of UK evidence report. Chiropr Man Therap. 2014;28(22):1. Clar C, Tsertsvadze A, Court R, Hundt GL, Clarke A, Sutcliffe P. Clinical effectiveness of manual therapy for the management of musculoskeletal and non-musculoskeletal conditions; systematic review and update of UK evidence report. Chiropr Man Therap. 2014;28(22):1.
36.
go back to reference Bartholomew LK, Parcel GS, Kok G, Gottlieb NH. Planning Health Promotion Program: An Intervention Mapping Approach. San Francisco, California: Jossey-Bass; 2006. Bartholomew LK, Parcel GS, Kok G, Gottlieb NH. Planning Health Promotion Program: An Intervention Mapping Approach. San Francisco, California: Jossey-Bass; 2006.
37.
go back to reference French SD, Green SE, O’Connor DA, McKenzie JE, Francis JJ, Michie S, et al. Developing theory-informed behaviour change interventions to implement evidence into practice: a systematic approach using the Theoretical Domains Framework. Implement Sci. 2012;7:38.CrossRefPubMedCentralPubMed French SD, Green SE, O’Connor DA, McKenzie JE, Francis JJ, Michie S, et al. Developing theory-informed behaviour change interventions to implement evidence into practice: a systematic approach using the Theoretical Domains Framework. Implement Sci. 2012;7:38.CrossRefPubMedCentralPubMed
39.
go back to reference Kawchuk G, Newton G, Srbely J, Passmore S, Bussières A, Busse J, et al. Knowledge transfer within the Canadian Chiropractic Community. Part 2: Narrowing the evidence-practice gap. J Can Chiropr Assoc. 2014;58(3):206–14.PubMedCentralPubMed Kawchuk G, Newton G, Srbely J, Passmore S, Bussières A, Busse J, et al. Knowledge transfer within the Canadian Chiropractic Community. Part 2: Narrowing the evidence-practice gap. J Can Chiropr Assoc. 2014;58(3):206–14.PubMedCentralPubMed
Metadata
Title
US chiropractors’ attitudes, skills and use of evidence-based practice: A cross-sectional national survey
Authors
Michael J Schneider
Roni Evans
Mitchell Haas
Matthew Leach
Cheryl Hawk
Cynthia Long
Gregory D Cramer
Oakland Walters
Corrie Vihstadt
Lauren Terhorst
Publication date
01-12-2015
Publisher
BioMed Central
Published in
Chiropractic & Manual Therapies / Issue 1/2015
Electronic ISSN: 2045-709X
DOI
https://doi.org/10.1186/s12998-015-0060-0

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