Evidence-based practice among Italian osteopaths: a national cross-sectional survey

Abstract

Background While evidence-based practice (EBP) is widely accepted across healthcare professions, research investigating its implementation in manual therapy professions such as osteopathy is limited. The primary aim of this study was to investigate Italian osteopaths’ attitudes, skills, and use of EBP. A secondary purpose was to understand the obstacles and enablers to EBP adoption in the Italian osteopathic context. Methods A cross-sectional national survey was conducted (April to June 2020) among a sample of Italian osteopaths. Eligible participants were invited to complete the Italian-translated Evidence-Based practice Attitude and Utilization Survey (EBASE) anonymously online using various recruitment strategies, including email and social media campaigns. In addition to the three EBASE sub-scores (attitudes, skills and use), the demographic characteristics of the sample were considered. Results A total of 473 osteopaths responded to the survey. The sample appeared to represent the Italian osteopathic profession. The majority of participants had a favorable attitude toward EBP. Eighty-eight percent of respondents agreed that EBP was necessary for osteopathy practice and that scientific literature and research findings were beneficial to their clinical scenario (95%). Perceived skill levels in EBP were rated as moderate, with the lowest scores for items relating to clinical research and systematic review conduct. Apart from reading/reviewing scientific literature and using online search engines to locate relevant research papers, participant engagement in all other EBP-related activities was generally low. Clinical practice was perceived to be based on a very small proportion of clinical research evidence. The primary obstacles to EBP implementation were a dearth of clinical evidence in osteopathy, and poor skills in applying research findings. The primary enablers of EBP adoption were access to full-text articles, internet connectivity at work, and access to online databases. Conclusions Italian osteopaths were largely supportive of evidence-based practice but lacked basic skills in EBP and rarely engaged in EBP activities. The updating of osteopathic training curriculum and professional formal regulation in Italy could provide a suitable framework to improve EBP skills and use.

Attitudes, skills and implementation of evidence-based practice: a national cross-sectional survey of licensed naprapaths in Sweden

“…In contrast, the lowest skill levels related to evidence generation (conducting systematic reviews and clinical research). Similar skill levels have been reported among other manual therapy professions, in Sweden [ 13 , 34 ], Europe [ 14 , 15 , 17 ], Australia [ 16 ], and USA [ 4 ]. While manual therapists in clinical practice may not be required to possess high-level skills in generating or conducting clinical research, there is an expectation that they have sufficient skills in identifying, retrieving, assessing and applying research findings to clinical practice considering the importance of providing best practice care to patients at the point of care [ 39 , 40 ].…”

Enablers and barriers to evidence implementation in complementary medicine: A systematic review

“…Thirteen reports were excluded (for reasons outlined in Fig. 1 ), resulting in a total of 39 studies (including 32 published studies 18 , 19 , 20 , 21 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 and 7 unpublished studies) 57 , 58 , 59 , 60 , 61 , 62 , 63 being included in this review.

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“…(2015) 18 1 1 1 1 1 1 1 NA NA NA 1 1 1 0 1 0.92 Cerritelli et al. (2021) 19 1 1 1 1 1 1 1 NA NA NA 1 1 1 0 1 0.92 Gowan-Moody et al. (2013) 34 1 1 1 1 1 0 0 NA NA NA 1 1 1 0 1 0.75 Hadley et al.…”

“…Despite the push for CM practitioners to engage in evidence implementation, and the arguments in support of evidence-based practice, the uptake of EBP amongst most CM professions remains low. 18 , 19 , 20 , 21 Drawing upon the field of implementation science, it is likely that a range of factors may be contributing to the low level of EBP uptake in CM. These factors can be broadly categorised as attitudinal (e.g., beliefs), structural (e.g., time, access to resources), cognitive (e.g., skill level, self-efficacy) or cultural (e.g., philosophical alignment, availability of clinical evidence) in nature.…”

Beliefs and Use of Palpatory Findings in Osteopathic Clinical Practice: A Qualitative Descriptive Study among Italian Osteopaths

“…Tradition, with an emphasis on the role of the osteopath and their “listening, seeing hands” [ 38 ] is still one of the main features that characterise the way many professionals feel about themselves [ 39 ]. In confirmation of this, although Italian osteopaths are in favour of EBP, they lack basic skills in EBP and rarely engage in EBP activities [ 40 ], thus, maintaining above all a hands-on operator-dependent clinical approach [ 41 ], which is supported by some evidence [ 20 , 21 , 22 ], but at the same time has shown scientific fragilities in terms of reliability and validity considering the complexity of the phenomenon involved [ 7 , 42 , 43 , 44 , 45 , 46 , 47 ]. Osteopathic reliability can be related to perception and interpretation of the palpation which is influenced by previous experiences, type of information to collect, habitual and context-related influences, and cultural and social imprinting [ 42 ].…”