Attitudes toward evidence-based clinical practice among doctors of chiropractic with diplomate-level training in orthopedics

Abstract

BackgroundEvidence-based clinical practice (EBCP) is a practice model gaining prominence within healthcare, including the chiropractic profession. The status of EBCP has been evaluated in a variety of healthcare disciplines, but little is known regarding the attitudes doctors of chiropractic (DCs) hold toward this model of healthcare. This project examines the attitudes toward EBCP within a specialty discipline of DCs.MethodsWe identified a survey questionnaire previously used to evaluate EBCP among non-chiropractic complementary and alternative practitioners. We adapted this questionnaire for use among DCs and pretested it in 5 chiropractic college faculty. The final version was administered to DCs with diplomate-level training in orthopedics. The survey was emailed to 299 potential participants; descriptive results were calculated.Results144 surveys were returned, resulting in a 48% response rate. The majority of respondents perceived EBCP as an important aspect of chiropractic practice. Respondents also believed themselves to have an above average skill level in EBCP, reported that training originated from their diplomate education, and based the majority of their practice on clinical research.ConclusionDoctors of chiropractic with an orthopedic diplomate appear to have favorable attitudes toward EBCP. Further study will help understand EBCP perceptions among general field DCs. A logical next step includes validation of this questionnaire.

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

“…A sizeable proportion (a quarter to one third) also cited: ‘lack of industry support’; ‘lack of incentive’; ‘insufficient skills for interpreting research’; ‘locating and critically appraising research’; ‘lack of colleague support for EBP’; and ‘lack of relevance to chiropractic practice’. Many of the barriers identified in this study are similar to those found for chiropractors in Australia [ 19 ], Canada [ 20 ] and Great Britain [ 21 ] as well as a sub-specialty of chiropractic orthopedists in the US [ 22 ]. Interestingly, many of the same barriers are encountered in the medical and nursing professions [ 5 , 6 ], leading us to conclude that the challenges facing the chiropractic profession in implementing EBP are not unique.…”

“…This is one of the largest studies to examine chiropractors’ perspectives relative to EBP, and to our knowledge, the first national survey to be conducted in the United States. One other EBP study was performed in the US, however the sample was limited to mid-western chiropractors with advanced training in orthopedics [ 22 ]. Despite the large absolute sample size of our survey (n = 1,314), it represents only a small relative cross-sectional sample of the American chiropractic profession (n = 60,000) [ 27 - 29 ].…”

“…The instrument has demonstrated good internal consistency, content validity, and acceptable test-retest reliability [ 26 ]. Minor modifications of a few EBASE items were required to ensure the language was appropriate for use with chiropractors [ 22 ]. These changes were made in consultation with the survey developer (ML) to ensure the structure and intent of the modified questions were not altered in any manner that would jeopardize the validity of the original survey.…”

“…A study in a sub-specialty of 144 chiropractic orthopedists in the US also found favorable attitudes towards EBP, and a desire for EBP post-graduate continuing education [ 22 ]. The most frequently reported barriers to EBP in this study were lack of relevant clinical evidence and lack of time.…”

Evidence-based practice, research utilization, and knowledge translation in chiropractic: a scoping review

“…Five studies found that chiropractors generally held positive attitudes towards EBP, and were interested in improving their EBP skills [ 36 – 40 ]. Nonetheless, application of EBP in clinical practice appears to be suboptimal, with only a small majority of American chiropractors (53 %) reporting that about half of their practice was based on research evidence [ 40 ].…”