Background
Methods
Study design and setting
Ethics
Context
Participants & recruitment
Questionnaire and outcomes
Survey administration and data collection
Data analysis
Results
Sample Size
Participant characteristics (Demographics and Education/Training)
Variable
|
Characteristic
|
n (%)
|
---|---|---|
Gender
| Male | 989 (75.3) |
Female | 325 (24.7) | |
Age
| Mean = 46.7 yrs (SD = 11.6); Range = 24-85 yrs | |
Race
| White | 1239 (94.3) |
Black | 13 (1.0 ) | |
Asian | 33 (2.5 ) | |
Mixed Race/Other | 29 (2.2 ) | |
Years since chiropractic graduation
| 0-5 | 273 (20.8) |
6-10 | 146 (11.1) | |
11-15 | 187 (14.2) | |
16-20 | 159 (12.1) | |
21-25 | 170 (12.9) | |
26-29 | 144 (11.0) | |
30 or more Mean = 17 yrs; Range = 0-30 or more yrs | 235 (17.9) | |
Highest education level
| High School | 17 (1.3 ) |
Associate’s Degree | 214 (16.3) | |
Bachelor’s Degree | 821 (62.5) | |
Master’s Degree | 226 (17.2) | |
Doctorate | 36 (2.7 ) | |
Region of practice
| Midwest | 380 (28.9) |
Northeast | 287 (21.8) | |
West | 264 (20.1) | |
Southeast | 245 (18.6) | |
Southwest | 131 (10.0) | |
Non-continental US | 7 (0.5 ) | |
Geographic setting
| Suburban | 629 (47.9) |
City | 449 (34.2) | |
Rural | 236 (18.0) | |
Patients seen daily
| 0-10 | 367 (27.9) |
11-20 | 455 (34.6) | |
21-30 | 259 (19.7) | |
31-40 | 126 (9.6 ) | |
41-50 | 60 (4.6 ) | |
51 or more Median = 20/day; (IQR = 10-30) Range = 0-100/day | 47 (3.6 ) | |
Focus of clinical practice
|
Musculoskeletal focus
|
869 (66.1)
|
Spine and extremities | 742 (56.5) | |
Spine | 72 (5.5) | |
Sports | 55 (4.2) | |
Non-musculoskeletal focus
|
445 (33.9)
| |
Family care | 192 (14.6) | |
Subluxation-based | 114 (8.7) | |
Wellness/Prevention | 105 (8.0) | |
Non-musculoskeletal | 20 (1.5) | |
Pediatrics | 14 (1.1) | |
Clinical role
| Sole Proprietor | 946 (72.0) |
Partner or group practice | 171 (13.0) | |
Associate or employee | 144 (11.0) | |
Hospital-based practice | 53 (4.0) | |
Organizational membership
| Unaffiliated | 722 (55.0) |
American Chiropractic Assoc. (ACA) | 526 (40.0) | |
International Chiropractors Assoc. (ICA) | 66 (5.0) |
PART C Item
|
None
|
Seminar (<1 day)
|
Short course (<1 week)
|
Minor part of chiropractic education
|
Major part of chiropractic education
|
Minor part of diplomate education
|
Major part of diplomate education
|
Academic diploma
|
Informal personal study
|
---|---|---|---|---|---|---|---|---|---|
Applying research evidence to clinical practice | 8.1% | 23.4% | 5.7% | 23.4% | 13.1% | 3.7% | 3.9% | 1.8% | 17.0% |
Critical thinking/critical analysis | 10.8% | 8.4% | 5.3% | 21.7% | 29.0% | 2.7% | 3.8% | 3.4% | 14.9% |
Evidence-based clinical practice/evidence-based chiropractic | 4.8% | 25.5% | 5.5% | 22.8% | 17.0% | 5.6% | 4.9% | 1.8% | 12.1% |
Conducting systematic reviews or meta-analysis | 47.6% | 6.3% | 6.5% | 21.8% | 3.7% | 1.9% | 0.6% | 1.2% | 10.4% |
Conducting clinical research | 42.2% | 6.3% | 6.1% | 26.5% | 4.0% | 2.4% | 0.9% | 1.8% | 9.8% |
Descriptive results for parts A, B and D (Attitudes, Skills and Use)
Part A Items
|
Strongly Disagree(1)
|
Disagree(2)
|
Neutral(3)
|
Agree(4)
|
Strongly Agree(5)
|
Mean (Range=1-5)
|
---|---|---|---|---|---|---|
*I am interested in learning or improving the skills necessary to incorporate EBP into my practice | 0.9% | 2.1% | 7.5% | 42.8% | 46.7% | 4.3 |
*Evidence based practice (EBP) is necessary in the practice of chiropractic | 2.1% | 3.5% | 9.1% | 39.6% | 45.7% | 4.2 |
*Professional literature (i.e. journals & textbooks) and research findings are useful in my day-to-day practice | 0.9% | 3.4% | 9.6% | 53.4% | 32.7% | 4.1 |
*EBP improves the quality of my patient’s care | 2.1% | 4.4% | 14.4% | 43.2% | 35.9% | 4.1 |
*EBP assists me in making decisions about patient care | 1.2% | 3.7% | 10.6% | 48.6% | 35.9% | 4.1 |
Prioritizing EBP within chiropractic practice is fundamental to the advancement of the profession | 2.4% | 7.8% | 13.3% | 39.8% | 36.7% | 4.0 |
*EBP takes into account my clinical experience when making clinical decisions | 2.3% | 14.8% | 17.7% | 41.5% | 23.7% | 3.7 |
*The adoption of EBP places an unreasonable demand on my practice [Note: Item is reverse coded]
| 14.4%[5] | 43.2[4] | 29.1%[3] | 10.6% [2] | 2.7%[1] | 3.6 |
*EBP takes into account a patient’s preference for treatment | 5.3% | 24.1% | 28.5% | 27.1% | 15.0% | 3.2 |
There is a lack of evidence from clinical trials to support most of the treatments I use in my practice | 13.5% | 42.2% | 17.7% | 22.6% | 4.0% | 2.6 |
PART B Items
|
Poor (1)
|
(2)
|
(3)
|
(4)
|
Advanced(5)
|
Mean (Range=1-5)
|
---|---|---|---|---|---|---|
Identifying answerable clinical questions | 0.3% | 3.0% | 18.6% | 52.5% | 25.6% | 4.0 |
Identifying knowledge gaps in practice | 0.4% | 3.5% | 29.5% | 50.0% | 16.7% | 3.8 |
Locating professional literature | 1.7% | 8.6% | 25.5% | 38.7% | 25.5% | 3.8 |
Online database searching | 3.7% | 12.1% | 25.3% | 35.2% | 23.7% | 3.6 |
Retrieving evidence | 3.0% | 11.4% | 28.5% | 38.5% | 18.6% | 3.6 |
Critical appraisal of evidence | 1.9% | 10.6% | 31.2% | 42.4% | 13.9% | 3.6 |
Synthesis of research evidence | 3.7% | 15.8% | 34.6% | 36.6% | 9.3% | 3.3 |
Applying research evidence to patient cases | 1.7% | 8.0% | 27.2% | 48.9% | 14.2% | 3.7 |
Using findings from clinical research | 1.5% | 7.1% | 29.1% | 47.4% | 14.9% | 3.7 |
Sharing evidence with colleagues | 4.8% | 18.0% | 30.6% | 33.3% | 13.3% | 3.3 |
Using findings from systematic reviews | 6.3% | 19.2% | 30.7% | 34.0% | 9.8% | 3.2 |
Conducting systematic reviews | 17.0% | 29.9% | 29.9% | 18.4% | 4.8% | 2.6 |
Conducting clinical research | 36.8% | 29.5% | 20.9% | 10.3% | 2.5% | 2.1 |
PART D Item
|
None (0)
|
Very small (1-25%) (1)
|
Small (26-50%) (2)
|
Moderate (51-75%) (3)
|
Large (76-99%) (4)
|
All (100%) (5)
|
Mean (Range=1-5)
|
---|---|---|---|---|---|---|---|
What percentage of your practice do you estimate is based on clinical research evidence (i.e. evidence from clinical trials)? | 2.7% | 21.2% | 21.0% | 32.3% | 21.0% | 1.8% | 2.5 |
PART D Items
|
0 times (0)
|
1-5 times (1)
|
6-10 times (2)
|
11-15 times (3)
|
16+ times (4)
|
Mean (Range=0-4)
| |
*I have read/reviewed professional literature (i.e. professional journals & textbooks) related to my practice | 3.4% | 41.9% | 22.6% | 8.7% | 23.4% | 2.1 | |
*I have used an online search engine to search for practice related literature or research | 7.9% | 39.0% | 23.5% | 9.9% | 19.7% | 1.9 | |
*I have read/reviewed clinical research findings related to my practice | 7.8% | 48.3% | 17.4% | 7.5% | 19.0% | 1.8 | |
*I have used professional literature or research findings to assist my clinical decision making | 11.0% | 52.1% | 14.8% | 6.3% | 15.8% | 1.6 | |
*I have used an online database to search for practice related literature or research | 28.6% | 36.5% | 12.4% | 6.4% | 16.1% | 1.4 | |
*I have used professional literature or research findings to change my clinical Practice | 23.2% | 48.9% | 11.3% | 4.3% | 12.3% | 1.3 | |
I have consulted a colleague or industry expert to assist my clinical decision making | 22.5% | 51.8% | 13.5% | 4.7% | 7.5% | 1.2 | |
I have referred to magazines, layperson/self-help books, or non-government/non-education institution websites to assist my clinical decision making | 35.6% | 43.8% | 11.1% | 4.2% | 5.3% | 1.0 |
Descriptive results for parts E and F (Barriers and Facilitators to EBP Uptake)
PART E Items
|
Not a barrier (1)
|
Minor barrier (2)
|
Moderate barrier (3)
|
Major barrier (4)
|
Mean (Range = 1-4)
|
---|---|---|---|---|---|
Lack of time | 19.2% | 33.0% | 34.1% | 13.7% | 2.4 |
Lack of clinical evidence in complementary and alternative medicine | 18.9% | 37.2% | 32.2% | 11.7% | 2.4 |
Lack of industry support for EBP | 31.4% | 31.6% | 26.3% | 10.7% | 2.2 |
Lack of incentive to participate in EBP | 34.6% | 29.2% | 26.2% | 10.0% | 2.1 |
Insufficient skills for interpreting research | 34.3% | 38.7% | 19.9% | 7.1% | 2.0 |
Insufficient skills for locating research | 39.7% | 37.3% | 16.8% | 6.2% | 1.9 |
Insufficient skills to critically appraise/evaluate the literature | 35.8% | 39.8% | 18.8% | 5.6% | 1.9 |
Lack of colleague support for EBP | 44.1% | 32.7% | 17.0% | 6.2% | 1.9 |
Insufficient skills to apply research findings to clinical practice | 39.9% | 41.5% | 15.8% | 2.8% | 1.8 |
Lack of relevance to chiropractic practice | 47.1% | 29.1% | 17.8% | 6.0% | 1.8 |
Patient preference for treatment | 41.5% | 38.0% | 16.8% | 3.7% | 1.8 |
Lack of interest in EBP | 52.5% | 30.5% | 12.6% | 4.4% | 1.7 |
Lack of resources (i.e. access to a computer, the internet or online databases) | 60.0% | 26.8% | 10.4% | 2.8% | 1.6 |
PART F Items
|
Not useful (1)
|
Slightly useful (2)
|
Moderately useful (3)
|
Very useful (4)
|
Mean (Range = 1-4)
|
---|---|---|---|---|---|
Access to the Internet in your workplace | 3.4% | 5.2% | 13.5% | 77.9% | 3.7 |
Access to free online databases in the workplace, such as Cochrane and PubMed | 2.0% | 8.9% | 18.9% | 70.2% | 3.6 |
Ability to download full-text / full-length journal articles | 2.1% | 11.5% | 20.9% | 65.5% | 3.5 |
Access to online education materials related to evidence based practice | 1.4% | 9.3% | 23.7% | 65.6% | 3.5 |
Access to critical reviews of research evidence relevant to your field (these are critical reviews of multiple research papers addressing a single topic) | 1.8% | 11.3% | 31.4% | 55.5% | 3.4 |
Free access to online databases that usually require license fees, such as DynaMed and CINAHL | 6.9% | 15.1% | 19.7% | 58.3% | 3.3 |
Access to critically appraised topics relevant to your field (these are critical appraisals of single research papers) | 2.2% | 15.6% | 35.2% | 47.0% | 3.3 |
Access to tools used to assist the critical appraisal/evaluation of research evidence | 3.4% | 17.6% | 36.7% | 42.3% | 3.2 |
Access to research rating tools that facilitate critical appraisal of single research papers | 4.3% | 21.9% | 35.5% | 38.3% | 3.1 |
Access to online tools that assist you to conduct your own critical appraisals of multiple research papers related to a single topic | 6.8% | 22.9% | 30.4% | 39.9% | 3.0 |