A multimodal approach including manual therapy, self-management advice, and exercise is an effective treatment strategy for both recent-onset and persistent neck pain.

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BackgroundEvidence-based practice (EBP) gaps are widespread across health disciplines. Understanding factors supporting the uptake of evidence can inform the design of strategies to narrow these EBP gaps. Although research utilization (RU) and the factors associated with EBP have been reported in several health disciplines, to date this area has not been reviewed comprehensively in the chiropractic profession. The purpose of this review was to report on the current state of knowledge on EBP, RU, and knowledge translation (KT) in chiropractic.MethodsA scoping review using the Arksey and O’Malley framework was used to systematically select and summarize existing literature. Searches were conducted using a combination of keywords and MeSH terms from the earliest date available in each database to May 2015. Quantitative and thematic analyses of the selected literature were conducted.ResultsNearly 85 % (56/67) of the included studies were conducted in Canada, USA, UK or Australia. Thematic analysis for the three categories (EBP, RU, KT) revealed two themes related to EBP (attitudes and beliefs of chiropractors; implementation of EBP), three related to RU (guideline adherence; frequency and sources of information accessed; and perceived value of websites and search engines), and three related to KT (knowledge practice gaps; barriers and facilitators to knowledge use; and selection, tailoring, and implementation of interventions). EBP gaps were noted in the areas of assessment of activity limitation, determination of psychosocial factors influencing pain, general health indicators, establishing a prognosis, and exercise prescription. While most practitioners believed EBP and research to be important and a few studies suggested that traditional and online educational strategies could improve patient care, use of EBP and guideline adherence varied widely.ConclusionFindings suggest that the majority of chiropractors hold favourable attitudes and beliefs toward EBP. However, much remains to be done for chiropractors to routinely apply evidence into clinical practice. Educational strategies aimed at practicing chiropractors can lead to more EBP and improved patient care. The chiropractic profession requires more robust dissemination and implementation research to improve guideline adherence and patient health outcomes.Electronic supplementary materialThe online version of this article (doi:10.1186/s12906-016-1175-0) contains supplementary material, which is available to authorized users.

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Poor recovery among older adults with hip fractures can occur despite successful surgical repair and rehabilitation, suggesting other factors might play a role in recovery, such as social factors. The aim of this scoping review was to provide an overview of the literature on the role of social factors in older adult's recovery after hip fracture. This review followed the York Framework and its modifications and recent reporting guidelines. Two independent researchers searched main medical databases (CINAHL, EMBASE, Medline, PsycINFO and the Cochrane libraries) from inception to June 2017, for studies investigating social factors and recovery post hip fracture. Studies were excluded if they were qualitative, perspective papers or if participants were < 65 years or they were not living in the community. We screened 2,503 unique abstracts in total and 19 studies fulfilled the inclusion criteria. Social factors investigated in the included studies were social support, socioeconomic factors and living arrangement. We classified outcomes in the studies into three subgroups: physical functional recovery, mortality and other outcomes (pain, hospital length of stay and quality of life). We found evidence that social support and socioeconomic factors (e.g. socioeconomic status) were significantly associated with an increase in functional recovery, a decrease in mortality and other outcomes, but conflicting evidence was found for the effect of one's living arrangement. Only two included studies were randomised controlled trials. To conclude, social factors, such as social support and socioeconomic status, affect physical functional recovery and mortality in older adults with hip fractures. However, this is an under researched area that lacks rigorously designed studies and would benefit from more studies with rigorous designs.

BackgroundThe objective of this systematic review was to summarize and evaluate evidence about the effectiveness of knowledge translation (KT) interventions to improve the uptake and application of clinical practice guidelines and best practices for a wide range of musculoskeletal (MSK) disorders and health care professionals.MethodsA search for relevant randomized controlled trials (RCTs) published in English was conducted in MEDLINE (Ovid interface), EMBASE, CINAHL, and CENTRAL (Cochrane library). Two independent reviewers selected studies, assessed risk of bias, and extracted data. All MSK disorders were included except MSK injuries, fractures, trauma, or inflammatory disorders.ResultsA total of 7904 citations yielded 11 eligible RCTs. The targeted MSK disorders included: low back pain (n = 5), neck pain (n = 2), whiplash (1), spinal disorders (n = 1), and osteoarthritis of the hip and knee (n = 2). Studies primarily involved physiotherapists, chiropractors, and a mix of physiotherapists, chiropractors and osteopaths. Results were reported using effect sizes (Cohen’s d). Interactive educational meetings were the most commonly used KT strategy. For professional outcomes, 3 studies using single-component interventions had a small effect (d ranges from 0.14 to 0.28) and 7 studies used multifaceted interventions (3 were effective (d ranges from 0.824 to 2.27). For patient outcomes, 4 studies were ineffective (d ranges from 0.06 to 0.31). The majority of the included RCTs had moderate-to-high risk of bias. About half of the studies used theory-based interventions, but the elements of the interventions and theoretical frameworks were often poorly described. Furthermore, there were no comparable outcome measures to evaluate the impact of the interventions on a similar scale.ConclusionsThe findings suggested that multifaceted educational KT interventions appear to be effective for improving professional outcomes, although effects were inconsistent. The KT strategies were generally not effective on patient outcomes. In general, studies were of low quality, interventions were poorly described, and only half had theoretical underpinning. Researchers are encouraged to use validated professional and patient outcomes.Electronic supplementary materialThe online version of this article (10.1186/s12913-018-3253-0) contains supplementary material, which is available to authorized users.

BackgroundDespite available evidence for optimal management of spinal pain, poor adherence to guidelines and wide variations in healthcare services persist. One of the objectives of the Canadian Chiropractic Guideline Initiative is to develop and evaluate targeted theory- and evidence-informed interventions to improve the management of non-specific neck pain by chiropractors. In order to systematically develop a knowledge translation (KT) intervention underpinned by the Theoretical Domains Framework (TDF), we explored the factors perceived to influence the use of multimodal care to manage non-specific neck pain, and mapped behaviour change techniques to key theoretical domains.MethodsIndividual telephone interviews exploring beliefs about managing neck pain were conducted with a purposive sample of 13 chiropractors. The interview guide was based upon the TDF. Interviews were digitally recorded, transcribed verbatim and analysed by two independent assessors using thematic content analysis. A 15-member expert panel formally met to design a KT intervention.ResultsNine TDF domains were identified as likely relevant. Key beliefs (and relevant domains of the TDF) included the following: influence of formal training, colleagues and patients on clinicians (Social Influences); availability of educational material (Environmental Context and Resources); and better clinical outcomes reinforcing the use of multimodal care (Reinforcement). Facilitating factors considered important included better communication (Skills); audits of patients’ treatment-related outcomes (Behavioural Regulation); awareness and agreement with guidelines (Knowledge); and tailoring of multimodal care (Memory, Attention and Decision Processes). Clinicians conveyed conflicting beliefs about perceived threats to professional autonomy (Social/Professional Role and Identity) and speed of recovery from either applying or ignoring the practice recommendations (Beliefs about Consequences). The expert panel mapped behaviour change techniques to key theoretical domains and identified relevant KT strategies and modes of delivery to increase the use of multimodal care among chiropractors.ConclusionsA multifaceted KT educational intervention targeting chiropractors’ management of neck pain was developed. The KT intervention consisted of an online education webinar series, clinical vignettes and a video underpinned by the Brief Action Planning model. The intervention was designed to reflect key theoretical domains, behaviour change techniques and intervention components. The effectiveness of the proposed intervention remains to be tested.Electronic supplementary materialThe online version of this article (doi:10.1186/s13012-015-0213-5) contains supplementary material, which is available to authorized users.

BackgroundEvidence-based practice (EBP) is a complex process. To quantify it, one has to also consider individual and contextual factors using multiple measures. Modern measurement approaches are available to optimize the measurement of complex constructs. This study aimed to develop a robust measurement approach for constructs around EBP including practice, individual (e.g. knowledge, attitudes, confidence, behaviours), and contextual factors (e.g. resources).MethodsOne hundred eighty-one items arising from 5 validated EBP measures were subjected to an item analysis. Nominal group technique was used to arrive at a consensus about the content relevance of each item. Baseline questionnaire responses from a longitudinal study of the evolution of EBP in 128 new graduates of Canadian physical and occupational therapy programmes were analysed. Principles of Rasch Measurement Theory were applied to identify challenges with threshold ordering, item and person fit to the Rasch model, unidimensionality, local independence, and differential item functioning (DIF).ResultsThe nominal group technique identified 70/181 items, and modified Delphi approach identified 68 items that fit a formative model (2 related EBP domains: self-use of EBP (9 items) and EBP activities (7 items)) or a reflective model (4 related EBP domains: attitudes towards EBP (17 items), self-efficacy (9 items), knowledge (11 items) and resources (15 items)). Rasch analysis provided a single score for reflective construct. Among attitudes items, 65% (11/17) fit the Rasch model, item difficulties ranged from − 7.51 to logits (least difficult) to + 5.04 logits (most difficult), and person separation index (PSI) = 0.63. Among self-efficacy items, 89% (8/9) fit the Rasch model, item difficulties ranged from − 3.70 to + 4.91, and PSI = 0.80. Among knowledge items, 82% (9/11) fit the Rasch model, item difficulties ranged from − 7.85 to 4.50, and PSI = 0.81. Among resources items, 87% (13/15) fit the Rasch model, item difficulties ranged from − 3.38 to 2.86, and PSI = 0.86. DIF occurred in 2 constructs: attitudes (1 by profession and 2 by language) and knowledge (1 by language and 2 by profession) arising from poor wording in the original version leading to poor translation.ConclusionsRasch Measurement Theory was applied to develop a valid and reliable measure of EBP. Further modifications to the items can be done for subsequent waves of the survey.Electronic supplementary materialThe online version of this article (10.1186/s13012-018-0844-4) contains supplementary material, which is available to authorized users.