1
|
Naidoo S, Hoenselaar NK, Yelverton C. Chiropractic attitude and utilisation of evidence-based practice in South Africa: a secondary analysis. Chiropr Man Therap 2024; 32:13. [PMID: 38693526 PMCID: PMC11062011 DOI: 10.1186/s12998-024-00534-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 03/05/2024] [Indexed: 05/03/2024] Open
Abstract
BACKGROUND Evidence-Based Practice (EBP) is a model utilised by the majority of healthcare professionals and is a clinical framework that assists with decision-making related to patient care, to improve outcomes and patient satisfaction. The study aimed to analyse the attitudes, skills, and utilization of evidence-based practice (EBP) among South African chiropractors, focusing on perceived skill levels, training, use and identifying facilitators and barriers to EBP application. METHODS A descriptive cross-sectional quantitative secondary analysis was conducted by inviting registered chiropractors in South Africa (n = 920) to participate in an anonymous online questionnaire using the Evidence-Based Practice Attitude and Utilisation Survey (EBASE). RESULTS A total of 132 chiropractors completed the survey, yielding a response rate of 14.4%. Of the respondents, 59.9% were female, 52.3% were between 26 and 35 years old, and 63.3% had graduated from the University of Johannesburg. A third of respondents stated they have poor clinical research skills. Over half of the respondents (56.8%) indicated that EBP constituted a significant part of their education except for completing systematic reviews or meta-analyses. Published clinical evidence was ranked 6th as a source of information for clinical decisions. The obstacles indicated were time constraints and a lack of clinical research in complementary and alternative medicine. Access to the internet, databases and research tools were facilitators that were deemed to be "very useful" in promoting EBP. CONCLUSION The majority of South African chiropractors are generally favourable towards EBP, and this practice therefore appears to be utilised and embraced, with the requisite skills.
Collapse
Affiliation(s)
- Sharné Naidoo
- Department of Chiropractic, University of Johannesburg, Beit Street, 2028, Johannesburg, Gauteng, South Africa.
| | - Nicole Karensa Hoenselaar
- Department of Chiropractic, University of Johannesburg, Beit Street, 2028, Johannesburg, Gauteng, South Africa
| | - Christopher Yelverton
- Department of Chiropractic, University of Johannesburg, Beit Street, 2028, Johannesburg, Gauteng, South Africa
| |
Collapse
|
2
|
Schut SM. Postgraduate training opportunities for chiropractors: A description of United States programs. THE JOURNAL OF CHIROPRACTIC EDUCATION 2024; 38:104-114. [PMID: 38258466 PMCID: PMC11097216 DOI: 10.7899/jce-23-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 07/31/2023] [Accepted: 11/04/2023] [Indexed: 01/24/2024]
Abstract
OBJECTIVE The objective of this study was to describe and compare the current postgraduate training opportunities (PTOs) in the United States (US) for which doctors of chiropractic are eligible, namely, residencies, fellowships, and board certifications. METHODS An internet search of publicly available English-language websites on Google.com was executed using a cache-cleared private browser and key search phrases. Following webpage data extraction, e-mail and telephone follow-up were completed with officials from institutions offering doctor of chiropractic programs possessing accreditation by the Council on Chiropractic Education (CCE) in the US. Additional programs identified were annotated and incorporated into the data set if they met the inclusion criteria. Descriptive statistics were generated following data aggregation. RESULTS Three-hundred internet search results were screened, 70 of which were assessed for eligibility and 47 included for descriptive analysis. Among the 16 CCE-accredited institutions solicited, 13 returned correspondence (81.3% response rate), resulting in the addition of 2 programs to the data set ascertained by the initial web search. There were 49 PTOs for chiropractors. Of programs available, residencies represented 49.0% (24/49) of programs, and fellowships represented 12.2% (6/49) of programs. There were 19 board specialty diplomate programs, constituting 38.8% of PTOs. CONCLUSION This work details preliminary descriptive information on the current state of US-based PTOs for chiropractors.
Collapse
|
3
|
Myhrvold BL, Vikhaug TB, DuRose A, Gausel AM, Eklund A, Axén I. Evidence-based maintenance care among chiropractors in Norway: a cross-sectional survey in the Nordic maintenance care program. Chiropr Man Therap 2023; 31:26. [PMID: 37563673 PMCID: PMC10416359 DOI: 10.1186/s12998-023-00502-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 07/19/2023] [Indexed: 08/12/2023] Open
Abstract
BACKGROUND Chiropractors use a treatment strategy called maintenance care with the intent of secondary and tertiary prevention. The Nordic Maintenance Care Program provides evidence of when and for whom maintenance care should be offered. Dissemination has occurred through articles, workshops, social media, conference in Europe and internationally. However, little is known about chiropractors' awareness and use of this evidence. This study explores chiropractors' attitudes, skills, and use of evidence on maintenance care, as well as study their association with general evidence-based practice and demographic characteristics. Moreover, barriers and facilitators of evidence access are also examined. METHODS Questions pertaining our research aim were included in the anonymous and digital Evidence-Based practice Attitude and utilization SurvEy, which was distributed to all members (n = 770) of the Norwegian chiropractic association in the fall of 2021. RESULTS The response rate was 41% (n = 312). Regarding attitudes towards evidence-based maintenance care, 26% agreed they needed tools to recommend this care to patients. Approximately half (57%) believed they had skills to identify suitable patients, and 45% had used published information in the past month. Strong alignment was observed between Norwegian chiropractors' attitudes, skills, and utilization of evidence-based maintenance care and general evidence-based practice. Maintenance care skills were significantly associated with age (those between 40 and 59 years being less likely to report having high skills), clinical setting (those working with conventional health care providers being less likely to report having high skills) and country of education (those educated in the US and Australia being more likely to report having high skills). Moreover, maintenance care use was significantly associated with country of education (those educated in Australia were less likely to have used published information regarding patient selection for maintenance care). Access to resources was a barrier, whereas knowledge of patient suitability facilitated evidence-based maintenance care. CONCLUSIONS Norwegian chiropractors had neutral attitudes towards maintenance care, but generally reported moderate skills. Most had not used evidence about maintenance care in the previous month. Access to useful resources about the evidence regarding maintenance care was a barrier, and knowledge of who responds to maintenance care was a facilitator.
Collapse
Affiliation(s)
- Birgitte Lawaetz Myhrvold
- Department of Interdisciplinary Health Sciences, Institute of Health and Society, University of Oslo, Blindern, P.O. Box 1089, 0317 Oslo, Norway
- Et Liv I Bevegelse, The Norwegian Chiropractic Research Foundation, Oslo, Norway
| | | | - Alister DuRose
- AECC University College, Parkwood Campus, Parkwood Road, Bournemouth, UK
| | - Anne Marie Gausel
- Et Liv I Bevegelse, The Norwegian Chiropractic Research Foundation, Oslo, Norway
- Stavanger University Hospital, Stavanger, Norway
- Department for Caring and Ethics, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Andreas Eklund
- Unit of Intervention and Implementation Research for Worker Health, Institute of Environmental Medicine, Karolinska Institutet, Nobels Väg 13, 171 77 Stockholm, Sweden
| | - Iben Axén
- Et Liv I Bevegelse, The Norwegian Chiropractic Research Foundation, Oslo, Norway
- Unit of Intervention and Implementation Research for Worker Health, Institute of Environmental Medicine, Karolinska Institutet, Nobels Väg 13, 171 77 Stockholm, Sweden
| |
Collapse
|
4
|
Self-reported attitudes, skills and use of evidence-based practice among Swiss chiropractors: a national survey. Chiropr Man Therap 2022; 30:59. [PMID: 36539910 PMCID: PMC9768918 DOI: 10.1186/s12998-022-00462-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 11/04/2022] [Indexed: 12/24/2022] Open
Abstract
STUDY OBJECTIVES The high burden of disease associated with musculoskeletal disorders severely impacts patients' well-being. As primary care providers, Swiss chiropractors ought to contribute towards identifying and using effective treatment strategies. An established approach is the full integration of evidence-based practice (EBP). This study aimed to investigate the attitudes, skills and use of EBP among Swiss chiropractors, as well as investigating potential facilitators and barriers for its adoption. METHODS AND MATERIAL All 329 members of the Swiss Association of Chiropractic (ChiroSuisse) were invited in March 2021 to participate in this cross-sectional survey. Data were acquired anonymously online, using the Evidence-Based practice Attitude and utilization SurvEy (EBASE). The survey encompassed 55 questions measuring attitudes (n = 8, response range 1-5; total score range of 8-40), skills (n = 13, response range 1-5; total score range of range of 13-65) and use of EBP (n = 6, response range 0-4; total score range of 0-24). RESULTS 228 (69.3%) chiropractors returned complete EBASE questionnaires. This sample was representative of all ChiroSuisse members with respect to gender, age groups and proportion of chiropractic residents. Respondents generally held positive attitudes towards EBP, as indicated by the high mean (31.2) and median (31) attitude sub-score (range 11-40). Self-reported skills had a mean sub-score of 40.2 and median of 40 (range 13-65). Knowledge about EBP-based clinical practice had been primarily obtained in chiropractic under- or postgraduate education (33.8% and 26.3%, respectively). Use of EBP achieved a lower sub-score, with mean and median values of 7.4 and 6, respectively (range 0-24). The most commonly identified barriers preventing EBP uptake were lack of time (67.9%) and lack of clinical evidence in chiropractic/manual therapy-related health fields (45.1%). CONCLUSION Swiss chiropractors held favourable attitudes and reported moderate to moderate-high skill levels in EBP. Nevertheless, similar to chiropractors in other countries, the self-reported use of EBP was relatively low, with lack of time and lack of clinical evidence being the most named barriers.
Collapse
|
5
|
Leach MJ, Veziari Y. Enablers and Barriers to Evidence Implementation in Complementary Medicine: A Systematic Review. Integr Med Res 2022; 11:100899. [DOI: 10.1016/j.imr.2022.100899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 10/27/2022] [Accepted: 10/30/2022] [Indexed: 11/05/2022] Open
|
6
|
de Zoete A, de Boer MR, van Tulder MW, Rubinstein SM, Ostelo R. Diagnostic Imaging in Chiropractic Practice: A Survey of Opinions and Self-Reported Guideline Adherence of Dutch and Belgian Chiropractors. J Manipulative Physiol Ther 2022; 45:57-72. [PMID: 35753875 DOI: 10.1016/j.jmpt.2022.03.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 02/23/2022] [Accepted: 03/08/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The purpose of this study was (1) to describe diagnostic imaging in Dutch and Belgian chiropractic practice in general, (2) to estimate adherence to the diagnostic imaging guidelines for patients with low back pain (LBP) via vignettes, and (3) to evaluate factors associated with diagnostic imaging and adherence to the guidelines. METHODS We used a web-based survey to collect sociodemographic data, practice characteristics, amount of imaging, opinions, and indications for requesting imaging from registered Dutch and Belgian chiropractors in 2013. Additionally, adherence to imaging guidelines for LBP was assessed by 6 vignettes in patients with LBP. Multivariable regression analyses were conducted to explore associations between characteristics of chiropractors and the use of imaging. Generalized mixed models were used to explore guidelines adherence and their relationship with chiropractor's characteristics. RESULTS The overall response rate was 60% (n = 203 out of 340). In total, 83% of chiropractors viewed diagnostic imaging in general as an important part of their practice. It is important to note that Dutch and Belgian chiropractors are not allowed to refer directly for imaging. Chiropractors reported that they would like to have imaging in 42% of their patients. Imaging had already been performed in 37% of patients before the first visit and was ordered by another health care provider (ie, general practitioner or medical specialist). The most common indication for ordering imaging was exclusion of contraindications (73%). The most common reason against imaging was the perceived limited value (45%). Many chiropractors (71%) were familiar with imaging guidelines. Adherence to the imaging guidelines for LBP based upon the vignettes was 66%. Dutch chiropractors and chiropractors with less than 10 years in practice demonstrated better adherence to guidelines and imaging use as compared with Belgian and those with more than 10 years of experience. CONCLUSIONS Most Dutch and Belgian chiropractors reported that imaging in general was important in chiropractic practice. Self-reported indications for ordering diagnostic imaging were in line with the imaging guidelines in the majority of cases. We found some variances between Belgian and Dutch chiropractors and years of experience related to guideline adherence.
Collapse
Affiliation(s)
- Annemarie de Zoete
- Department of Health Sciences, Faculty of Science and Amsterdam Movement Science Research Institute, Vrije Universiteit, Amsterdam, The Netherlands.
| | - Michiel R de Boer
- Department of Health Sciences, Faculty of Science and Amsterdam Movement Science Research Institute, Vrije Universiteit, Amsterdam, The Netherlands; Department of General Practice and Elderly Care Medicine, University Medical Center Groningen, Groningen, The Netherlands
| | - Maurits W van Tulder
- Department of Health Sciences, Faculty of Science and Amsterdam Movement Science Research Institute, Vrije Universiteit, Amsterdam, The Netherlands; Department Physiotherapy & Occupational Therapy, Aarhus University Hospital, Aarhus, Denmark
| | - Sidney M Rubinstein
- Department of Health Sciences, Faculty of Science and Amsterdam Movement Science Research Institute, Vrije Universiteit, Amsterdam, The Netherlands
| | - Raymond Ostelo
- Department of Health Sciences, Faculty of Science and Amsterdam Movement Science Research Institute, Vrije Universiteit, Amsterdam, The Netherlands; Department of Epidemiology and Biostatistics, Vrije Universiteit Medical Center, Amsterdam, The Netherlands
| |
Collapse
|
7
|
Veziari Y, Kumar S, Leach MJ. An exploration of barriers and enablers to the conduct and application of research among complementary and alternative medicine stakeholders in Australia and New Zealand: A qualitative descriptive study. PLoS One 2022; 17:e0264221. [PMID: 35180276 PMCID: PMC8856519 DOI: 10.1371/journal.pone.0264221] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Accepted: 02/06/2022] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Most studies examining complementary and alternative medicine (CAM) stakeholder engagement with evidence-based practice have relied on quantitative research methods, which often fail to capture the nuances of this phenomena. Using qualitative methods, this study aimed to explore the experiences of CAM stakeholders regarding the barriers and enablers to the conduct and application of research. METHODS This research was guided by a qualitative descriptive framework. CAM practitioners and researchers of multiple CAM disciplines from across Australia and New Zealand were invited to share their personal perspectives of the study phenomena. Semi-structured interviews were conducted via Zoom, which were audio-recorded and transcribed verbatim. Rigour strategies were applied to ensure the credibility of results. The transcript was analysed using thematic analysis. RESULTS CAM stakeholders identified an array of barriers and enablers to the conduct and application of research within their disciplines. The barriers and enablers that emerged were found to be inter-connected with two similar constructs: capacity and culture. Captured within the construct of capacity were five themes-lack of resources, inadequate governance/leadership, lack of competency, bias directed from outside and within CAM, and lack of time for research. Within the construct of culture were two themes-intrinsic perceptions in CAM, and lack of communication within and outside CAM. CONCLUSIONS Promoting evidence-based practice and engaging with research in CAM continues to face challenges. This study, for the first time, has highlighted the multitude of interlinked barriers that confront CAM stakeholders when engaging with research. These findings highlight the need for a concerted and targeted approach to tackle these challenges.
Collapse
Affiliation(s)
- Yasamin Veziari
- UniSA Allied Health & Human Performance, University of South Australia, North Terrace, Adelaide, South Australia, Australia
| | - Saravana Kumar
- UniSA Allied Health & Human Performance, University of South Australia, North Terrace, Adelaide, South Australia, Australia
| | - Matthew J. Leach
- Southern Cross University, National Centre for Naturopathic Medicine, East Lismore, New South Wales, Australia
| |
Collapse
|
8
|
|
9
|
Kim S, Capo-Lugo C, Reed WR, Vora A, Ehsanian R, Krishnan S, Hu X, Galantino ML, Mortera MH, Beattie A, Sasson N, Theodore BR, Erb M, Heyn P. Using a Survey to Characterize Rehabilitation Professionals' Perceptions and Use of Complementary, Integrative, and Alternative Medicine. J Altern Complement Med 2020; 26:663-665. [PMID: 32302490 DOI: 10.1089/acm.2019.0383] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Sonya Kim
- Department of Rehabilitation Medicine, New York University School of Medicine, New York, NY, USA
| | - Carmen Capo-Lugo
- Department of Physical Therapy, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - William R Reed
- Department of Physical Therapy, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Ariana Vora
- Department of PM&R, Spaulding Rehabilitation Network, Harvard Medical School, Boston, MA, USA
| | - Reza Ehsanian
- Division of PM&R, Department of Neurosurgery, School of Medicine, University of New Mexico, Albuquerque, NM, USA
| | - Shilpa Krishnan
- Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Xiaolei Hu
- Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden
| | - Mary Lou Galantino
- School of Health Sciences, Doctoral Physical Therapy Program, Stockton University, Galloway, NJ, USA.,Physiotherapy Department, University of Witwatersrand, Johannesburg, South Africa.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Marianne H Mortera
- Department of Occupational Therapy, NYU Steinhardt, New York University, New York, NY, USA
| | - Aaron Beattie
- Department of Rehabilitation Medicine, New York University School of Medicine, New York, NY, USA
| | - Nicole Sasson
- Department of Rehabilitation Medicine, New York University School of Medicine, New York, NY, USA.,Department of Physical Medicine & Rehabilitation, VA-New York Harbor Healthcare System, New York, NY, USA
| | - Brian R Theodore
- Kaiser Permanente, Kaiser Foundation Rehabilitation Center, Vallejo, CA, USA
| | - Matt Erb
- The Center for Mind-Body Medicine, Washington DC, USA
| | - Patricia Heyn
- Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora, CO, USA
| |
Collapse
|
10
|
Veziari Y, Kumar S, Leach M. The development of a survey instrument to measure the barriers to the conduct and application of research in complementary and alternative medicine: a Delphi study. BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2018; 18:335. [PMID: 30547785 PMCID: PMC6295050 DOI: 10.1186/s12906-018-2352-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Accepted: 10/16/2018] [Indexed: 11/10/2022]
Abstract
BACKGROUND As Complementary and Alternative medicine (CAM) grows in popularity, there is overt recognition for research evidence to inform clinical practice. While various strategies have been trialed to overcome the barriers to such progress, it is important to first understand the extent to which these barriers impact the conduct and application of CAM research. This study aimed to garner consensus and agreement among CAM researchers and practitioners in refining and validating a preliminary survey instrument for measuring these barriers. METHODS A three-round Delphi study was undertaken with 22 international experts of CAM research and practice. Round one gathered consensus on 30 statements listing barriers to the application and conduct of CAM research. Only rounds two and three sought consensus on revised statements. Any statement demonstrating ≥ 70% agreement on a four-point Likert scale was determined to have reached consensus. RESULTS Consensus and agreement was achieved for all 30 statements listing the barriers to the application and conduct of research in CAM. Additional commentary by the Delphi participants directed whether a statement had to be split into two parts or reworded. This process resulted in the generation of the "BarrierS To the Application and Conduct of rEsearch" (oBSTACLES) instrument. CONCLUSION This study, the first of its kind on this topic, identified consensus and agreement on a series of evidence-informed statements to measure the barriers to the conduct and application of research in CAM. The uniqueness of the oBSTACLES instrument is its ability to measure barriers across the evidence-based continuum.
Collapse
Affiliation(s)
- Yasamin Veziari
- School of Health Sciences, University of South Australia, North Terrace, Adelaide, SA 5000 Australia
| | - Saravana Kumar
- School of Health Sciences, University of South Australia, North Terrace, Adelaide, SA 5000 Australia
| | - Matthew Leach
- Department of Rural Health, University of South Australia, North Terrace, Adelaide, SA 5000 Australia
| |
Collapse
|
11
|
Buabbas AJ, Alsaleh FM, Al-Shawaf HM, Abdullah A, Almajran A. The readiness of hospital pharmacists in Kuwait to practise evidence-based medicine: a cross-sectional study. BMC Med Inform Decis Mak 2018; 18:4. [PMID: 29325555 PMCID: PMC5765677 DOI: 10.1186/s12911-018-0585-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 01/04/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The evolving role of pharmacists in providing pharmaceutical care, as part of the healthcare team, challenges them to acquire up-to-date knowledge of medicines to make the best clinical decisions. The volume of medical literature is on the increase, and it is important to utilise these resources to optimise patients' therapeutic outcomes. This study aimed at assessing the readiness of government hospital pharmacists in practising evidence-based medicine (EBM) in Kuwait in regards to their attitude, knowledge and skills, as well as the perceived barriers and facilitators. METHODS This descriptive cross-sectional study used pre-tested self-reported questionnaires to collect information from pharmacists working at government hospitals in Kuwait. In addition, one-to-one, face-to-face semi-structured interviews were conducted with the chief pharmacists of all health regions in Kuwait to discuss and identify the barriers and facilitators of implementing EBM in the hospitals. Quantitative and qualitative analytical measures were undertaken for the data acquired from the questionnaires and interviews, respectively. RESULTS A total of 176 pharmacists (of 445) working in secondary and tertiary government hospitals in Kuwait agreed to take part in the study, giving a response rate of 40%. Over half of the study sample (n = 94, 53.4%) had good confidence in performing online database searches. Approximately 50% of the pharmacists were familiar with searching the Internet for medical resources, asking answerable clinical questions and retrieving research evidence. However, 67% of the pharmacists (n = 118) were neither able to apply research evidence to patient care nor capable of identifying knowledge gaps in practice. Barriers to EBM practice were identified, which included limited access to EBM resources (75%), a lack of time and patient overload (71.6%). The interview results confirmed the willingness of the hospital pharmacists to adopt EBM in their practice if necessary resources such as computers and internet connection were provided. CONCLUSION The hospital pharmacists in Kuwait showed good attitude and willingness towards EBM, however, they need to acquire adequate knowledge and skills for applying it in "real life" practise. Using the current results, clinical implications were recommended to demonstrate how to overcome the barriers, wherein hospital pharmacists could be ready to practice EBM.
Collapse
Affiliation(s)
- Ali Jasem Buabbas
- Faculty of Medicine, Kuwait University, PO Box 24923, Safat 13110, Al-Jabriya, Kuwait
| | | | | | - Ali Abdullah
- Hamza Mohamad Al-Shawaf, MSc Health Informatics and Information Management, Faculty of Allied Health Sciences, Kuwait University, Al-Jabriya, Kuwait
| | - Abdullah Almajran
- Faculty of Medicine, Kuwait University, PO Box 24923, Safat 13110, Al-Jabriya, Kuwait
| |
Collapse
|
12
|
Veziari Y, Leach MJ, Kumar S. Barriers to the conduct and application of research in complementary and alternative medicine: a systematic review. BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2017; 17:166. [PMID: 28335766 PMCID: PMC5364631 DOI: 10.1186/s12906-017-1660-0] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 03/04/2017] [Indexed: 01/12/2023]
Abstract
BACKGROUND The popularity of Complementary and alternative medicine (CAM) has grown considerably over the past few decades. This has been accompanied by increasing public pressure for CAM to be evidence-based. Notwithstanding, the conduct and application of research in CAM faces a number of obstacles. No systematic review has mapped these barriers to date. Therefore, this systematic literature review aimed to explore, identify and map the barriers to the conduct and application of research in CAM. METHODS Systematic searching of MEDLINE, Embase, AMED, CINAHL, The Cochrane library, Google scholar and Google was conducted between February and June 2016 for pertinent publications. Pearling (secondary searching) of retrieved publications was also undertaken. Literature published only in English were included; however, no year limit was placed for searching. Two critical appraisal tools were used to critically appraise descriptive studies and opinion publications. RESULTS A total of 21 eligible publications were included in this review; this comprised of eight primary research articles and thirteen opinion publications. A critical appraisal process found two categories of good quality publications while recognising their limitations in terms of descriptive and opinion publications. The synthesised data from the selected publications about the barriers to the conduct and application of research within CAM were captured within two broad components, namely capacity and culture. Capacity encompassed elements such as access, competency, bias, incentives and time. Encompassed within culture were elements relating to the values and complex system of CAM. CONCLUSIONS Multiple barriers exist for the conduct and application of research in CAM. Given the growing popularity of these therapies, it is essential that the evidence base underpinning CAM also continues to expand. Without overt recognition of these barriers, enabling strategies cannot be applied. By addressing these barriers, CAM professions will be able to develop a critical mass and a well-coordinated research effort to assist the integration of evidence - based practice in CAM.
Collapse
Affiliation(s)
- Yasamin Veziari
- School of Health Sciences, University of South Australia, North Terrace, Adelaide, SA 5000 Australia
| | - Matthew J. Leach
- Department of Rural Health, University of South Australia, North Terrace, Adelaide, SA 5000 Australia
| | - Saravana Kumar
- School of Health Sciences, University of South Australia, North Terrace, Adelaide, SA 5000 Australia
| |
Collapse
|
13
|
Bussières AE, Al Zoubi F, Stuber K, French SD, Boruff J, Corrigan J, Thomas A. Evidence-based practice, research utilization, and knowledge translation in chiropractic: a scoping review. Altern Ther Health Med 2016; 16:216. [PMID: 27412625 PMCID: PMC4944433 DOI: 10.1186/s12906-016-1175-0] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Accepted: 06/16/2016] [Indexed: 12/18/2022]
Abstract
Background Evidence-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. Methods A 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. Results Nearly 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. Conclusion Findings 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 material The online version of this article (doi:10.1186/s12906-016-1175-0) contains supplementary material, which is available to authorized users.
Collapse
|
14
|
Bussières AE, Terhorst L, Leach M, Stuber K, Evans R, Schneider MJ. Self-reported attitudes, skills and use of evidence-based practice among Canadian doctors of chiropractic: a national survey. THE JOURNAL OF THE CANADIAN CHIROPRACTIC ASSOCIATION 2015; 59:332-48. [PMID: 26816412 PMCID: PMC4711333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVES To identify Canadian chiropractors' attitudes, skills and use of evidence based practice (EBP), as well as their level of awareness of previously published chiropractic clinical practice guidelines (CPGs). METHODS 7,200 members of the Canadian Chiropractic Association were invited by e-mail to complete an online version of the Evidence Based practice Attitude & utilisation SurvEy (EBASE); a valid and reliable measure of participant attitudes, skills and use of EBP. RESULTS Questionnaires were completed by 554 respondents. Most respondents (>75%) held positive attitudes toward EBP. Over half indicated a high level of self-reported skills in EBP, and over 90% expressed an interest in improving these skills. A majority of respondents (65%) reported over half of their practice was based on evidence from clinical research, and only half (52%) agreed that chiropractic CPGs significantly impacted on their practice. CONCLUSIONS While most Canadian chiropractors held positive attitudes towards EBP, believed EBP was useful, and were interested in improving their skills in EBP, many did not use research evidence or CPGs to guide clinical decision making. Our findings should be interpreted cautiously due to the low response rate.
Collapse
Affiliation(s)
- André E. Bussières
- Assistant Professor, School of Physical and Occupational Therapy, McGill University
- Professor, Département Chiropratique, Université du Québec à Trois-Rivières
| | - Lauren Terhorst
- Associate Professor, Department of Occupational Therapy and Health and Community Systems, University of Pittsburgh
| | - Matthew Leach
- Senior Research Fellow, School of Nursing & Midwifery, University of South Australia
| | - Kent Stuber
- Division of Graduate Education and Research, Canadian Memorial Chiropractic College
| | - Roni Evans
- Associate Professor, Center for Spirituality & Healing, Academic Health Center, University of Minnesota
| | - Michael J. Schneider
- Associate Professor, Department of Physical Therapy and Clinical and Translational Science Institute, University of Pittsburgh
| |
Collapse
|
15
|
Schneider MJ, Evans R, Haas M, Leach M, Hawk C, Long C, Cramer GD, Walters O, Vihstadt C, Terhorst L. US chiropractors' attitudes, skills and use of evidence-based practice: A cross-sectional national survey. Chiropr Man Therap 2015; 23:16. [PMID: 25949800 PMCID: PMC4422535 DOI: 10.1186/s12998-015-0060-0] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Accepted: 04/07/2015] [Indexed: 01/24/2023] Open
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. Electronic supplementary material The online version of this article (doi:10.1186/s12998-015-0060-0) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Michael J Schneider
- Department of Physical Therapy, School of Health and Rehabilitation Sciences, Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, PA USA
| | - Roni Evans
- Center for Spirituality and Healing, Integrative Health and Wellbeing Research Program, University of Minnesota, Minneapolis, MN USA
| | | | - Matthew Leach
- School of Nursing and Midwifery, University of South Australia, Adelaide, SA Australia
| | - Cheryl Hawk
- Logan College of Chiropractic, Chesterfield, MO USA
| | - Cynthia Long
- Palmer Center for Chiropractic Research, Palmer College of Chiropractic, Davenport, IA USA
| | | | | | - Corrie Vihstadt
- Center for Spirituality and Healing, Integrative Health and Wellbeing Research Program, University of Minnesota, Minneapolis, MN USA
| | - Lauren Terhorst
- Department of Occupational Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA USA
| |
Collapse
|
16
|
Walker B, Stomski N, Hebert J, French S. Evidence-based practice in chiropractic practice: A survey of chiropractors’ knowledge, skills, use of research literature and barriers to the use of research evidence. Complement Ther Med 2014; 22:286-95. [DOI: 10.1016/j.ctim.2014.02.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Accepted: 02/28/2014] [Indexed: 11/15/2022] Open
|