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Evidence-based practice in chiropractic practice:

A survey of chiropractors’ knowledge, skills, use
of research literature and barriers to the use of
research evidence
Walker, B.F.; Stomski, N.J.; Hebert, J.J.; et.al.
https://researchportal.murdoch.edu.au/esploro/outputs/journalArticle/Evidence-based-practice-in-chiropractic-practice-A/991005540576307891/files
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Walker, B. F., Stomski, N. J., Hebert, J. J., & French, S. D. (2014). Evidence-based practice in chiropractic
practice: A survey of chiropractors’ knowledge, skills, use of research literature and barriers to the use of
research evidence. Complementary Therapies in Medicine, 22(2), 286–295.
https://doi.org/10.1016/j.ctim.2014.02.007
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Walker, B.F., Stomski, N.J., Hebert, J.J. and French, S.D. (2014) Evidence-based
practice in chiropractic practice: A survey of chiropractors’ knowledge, skills,
use of research literature and barriers to the use of research evidence.
Complementary Therapies in Medicine, 22 (2). pp. 286-295.

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Accepted Manuscript

Title: Evidence-based practice in chiropractic practice: a

survey of chiropractors’ knowledge, skills, use of research
literature and barriers to the use of research evidence

Author: B.F. Walker N.J. Stomski J.J. Hebert S.D. French

PII: S0965-2299(14)00031-4
DOI: http://dx.doi.org/doi:10.1016/j.ctim.2014.02.007
Reference: YCTIM 1318

To appear in: Complementary Therapies in Medicine

Received date: 20-1-2014

Accepted date: 28-2-2014

Please cite this article as: B.F. WalkerN.J. StomskiJ.J. HebertS.D. French Evidence-
based practice in chiropractic practice: a survey of chiropractors’ knowledge, skills,
use of research literature and barriers to the use of research evidence. (2014),
http://dx.doi.org/10.1016/j.ctim.2014.02.007

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Title: Evidence-based practice in chiropractic practice: a survey of chiropractors’ knowledge,
skills, use of research literature and barriers to the use of research evidence.

Authors
Walker BF1, Stomski NJ1, Hebert JJ2, French SD1,3

1. School of Health Professions, Murdoch University, 90 South St, Murdoch, Western

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Australia 6150.
2. School of Psychology and Exercise Science, Murdoch University, 90 South St, Murdoch,
Western Australia 6150.

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3. School of Rehabilitation Therapy, Queen’s University, Kingston, ONT, Canada.

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Corresponding Author: Stomski NJ, 90 South St Murdoch Western Australia; email:
N.Stomski@murdoch.edu.au; Phone: 6 14 93606038.

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Introduction
Evidence based practice (EBP) involves the “integration of best research evidence with
clinical expertise and patient values and circumstances” [1]. The overall purpose of EBP is to
enable clinicians to incorporate the best available evidence into clinical decision-making and
thereby ensure that patients receive the highest possible standard of healthcare [2].

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In the last few decades there has been a shift in the health professions from treatment just
based on opinion and perceived expertise, to the delivery of care informed by the best
available evidence. The increased emphasis on EBP may be due to escalating costs,

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intensified litigation, calls for more accountability particularly from within the academic and
medical fields, and heightened public knowledge of healthcare associated with the

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proliferation of online medical information sources [2-4]. As a result, there has been
increased uptake of EBP throughout most healthcare professions [5].

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The use of EBP by clinicians may result in a variety of benefits such as enhancing the quality
of healthcare; increased professional credibility; promotion of interdisciplinary
collaboration; and providing uniform care based on the best available research literature [2,
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4, 6-9]. In order for evidence to be effectively implemented in clinical practice, healthcare
professionals need to: identify gaps in knowledge; frame clinically relevant questions;
proficiently search databases; critically appraise research literature; implement research
findings appropriately to the patient problem; and understand how patient values may
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influence the available treatment options and then incorporate patient preferences into
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decision-making [1].

Previous studies have identified barriers to the implementation of evidence-based practice

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by clinicians. The most commonly reported barrier is limited time, which constrains the
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identification and interpretation of research evidence, as well as the ability to apply

research findings in clinical practice [8-17]. Other common barriers include an inability to
determine the legitimacy of research findings; deficient information retrieval skills;
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insufficient research literature on specific patient problems; lack of generalisability of

research findings; and an inability to incorporate patient preferences into the decision-
making process [5, 6, 11, 13, 17-26].

Scant research has been published about chiropractors’ skills and knowledge associated
with EBP, and their perceived barriers to EBP implementation. To date there has been only
one small qualitative study involving seven chiropractors practising in the United Kingdom
[27], and one small survey of chiropractors holding orthopaedic diplomas in the United
States [28]. The limited scope of research in this area suggests that additional studies are
warranted to develop a better understanding of factors that affect chiropractors’ use of

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research evidence in clinical practice. In a previous article, we detailed Australian
chiropractors’ attitudes and beliefs to EBP [29]. This article presents the second component
of our study and details Australian chiropractors’ knowledge and skills in relation to EBP,
their use of research literature and medical databases, and perceived barriers to EBP.

Methods
Questionnaire Development

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We used an adaptation of the Jette et al. questionnaire, which was originally constructed to
examine EBP among physiotherapists and demonstrated adequate test-retest reliability
[11]. The questionnaire consisted of seven scales which enquired about:

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 attitudes and beliefs about EBP

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 interest and motivation in using EBP

 knowledge and skills related to educational training and confidence in identification

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and critical appraisal of research literature

 attention to literature, which involved reading research literature, using research

literature in making clinical decisions, and the use of medical databases
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 ability to access information

 availability and use of clinical practice guidelines

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 perceived barriers to EBP

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We evaluated and modified the Jette questionnaire to ensure that it was appropriate to
survey chiropractors. The modification of the questionnaire has been reported in detail
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elsewhere [29]. In brief, an expert panel, comprising nine chiropractors, evaluated the
content validity of the original questionnaire [30, 31]. As a result, five items out of 32 were
omitted, leaving 27 scale items, four open-ended questions, and ten demographic items in
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the modified questionnaire (Appendix 1).

Sample
We attempted to contact and survey all registered Australian chiropractors (n=4378).

Survey implementation
A preliminary notice, online survey link, and two fortnightly reminders were disseminated
via email by the Chiropractic and Osteopathic College of Australasia, and the Chiropractors
Association of Australia. The Chiropractic Board of Australia also included the notice and
survey link in its electronic newsletter that is sent to registered chiropractors who have
provided their email address. This recruitment strategy occurred over a three month period

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in early 2013. Participants were instructed to read an information letter contained at the
beginning of the online survey and provide consent before completing the questionnaire.
Responses were downloaded directly into SPSS v.21 and remained anonymous.

Ethics approval was received from the Murdoch University Human Research Ethics
Committee (approval number 2013/007).

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The questionnaire as an instrument of measurement

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Data were analysed using SPSS v.21. Subsequent to the implementation of the survey and
completing data collection, we examined the dimensionality and internal consistency of the

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adapted questionnaire. These analyses have been reported in detail elsewhere [29]. In brief,
we identified five strongly loading factors and one item was not included in the analyses

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which did not load onto any of the five factors. This resulted in the seven original scales
being reduced to six (the perceived barriers scale was not included in the factor analysis due
to its structure), with items from the attitudes/beliefs and interest/motivation scales

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combined into a single scale. The structure of the other four scales included in the factor
analysis were not modified. The Cronbach alpha values for the five scales ranged from 0.73-
0.89, which indicated acceptable internal consistency [32].
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Data Analysis
All data were reported descriptively. To examine for non-response bias, age was classified
into categories used by the Chiropractic Board of Australia so that the age distribution of the
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respondents could be contrasted against the entire Australian chiropractic population. Prior
to examining associations between variables, we collapsed some categories for use as
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dependent variables in logistic regression analyses. For 5-point Likert scale items with
positive wording (ie agreement with the statement suggested positive regard for EBP), the
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“strongly agree” and “agree’” categories were combined, as were the “neutral”, “disagree”
and “strongly disagree” categories”, leaving 1 of 2 categories: “agree” or “disagree”. For 5-
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point Likert scale items with negative wording, the “neutral category” was combined with
the “agree” and “strongly agree” categories. For items with “yes”, “no” and “do not know”
response options, “no” was combined with “do not know”, as it seems likely, for instance,
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that not knowing whether internet access was available was as unhelpful as not having
internet access. For items enquiring about the number of times articles were read or
databases accessed each month, the lowest category, namely one or no articles per month,
was distinguished from higher categories given that it reflects poor attention to the
literature which would be inconsistent with EBP principles.

Logistic regression analyses were undertaken to investigate the following univariate

associations: (1) responses to items measuring skill and knowledge with items measuring;
age; years since registration; and attention to literature. Odds ratios and 95% confidence
intervals were calculated to examine the likelihood of exhibiting a certain behaviour (e.g.,

Page 4 of 19
using research evidence) given an individual characteristic (e.g., confidence in ability to
critically review literature).

Results
Some questionnaires were incomplete, which accounts for the differing number of reported
responses.

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Demographic Characteristics

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Questionnaires were returned by 584 respondents. Table 1 displays the demographic
details. Respondents were typically male (73.4%), with one-third aged 31-40 years (31.3%).

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Most respondents practised in a metropolitan region (63.5%), working 30 to 40 (37.7%)
hours per week.

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Attention to literature
Table 2 displays the responses to items enquiring about attention to research literature.
One in six respondents (16.5%) read one or no articles per month, and almost half (45.1%)

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read two to five articles a month. Around one-third of respondents (30.3%) used healthcare
journal databases to search for practice relevant literature two to five times per month, and
about half (45.3%) used them once or not at all. One in five (21.2%) used literature to inform
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clinical decision-making once, or not at all, each month.

Skill and knowledge

Table 3 displays the responses to items enquiring about skills and knowledge. About half of
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the respondents stated they had learned the foundations of EBP (56.6%) and critical
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appraisal of research literature (57.9%) during their undergraduate training. Fifty seven per
cent (56.6%)stated they had also received formal training in search strategies to identify
research literature. More than four in five respondents were familiar with the medical
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research databases (82.6%). Around seven out of ten respondents were confident in their
ability to critically review literature (69.5%) and find relevant research to answer clinical
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questions (72.6%).

The demographic factors age and year since graduation were associated with most aspects
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of skills and knowledge (Tables 4 & 5). Older respondents were less likely to: have learnt the
foundations of EBP during undergraduate training; have received formal training in search
strategies; be familiar with medical databases; and have received formal training in critical
appraisal. The odds ratios for these associations ranged from 0.92-0.95. Respondents who
had been registered for more years were less likely to: have learnt the foundations of EBP
during undergraduate training (OR 0.89; 95% CI 0.87-0.91); have received formal training in
search strategies (OR 0.93; 95% CI 0.92-0.95); be familiar with medical databases (OR 0.95;
95% CI 0.93-0.97); and have received formal training in critical appraisal (OR 0.90; 95% CI
0.88-0.92). The odds ratios for these associations ranged from 0.89-0.95.

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Several skills and knowledge items were associated with reading research literature and
using research literature in clinical decision-making (Tables 6 & 7). Respondents who
expressed confidence in their ability to critically review professional literature were almost
three times more likely to read research literature (OR 2.70; 95% CI 1.55-4.70), and twice as
likely to use research literature in the process of clinical decision-making (OR 1.98; 95% CI
1.19-3.31). Respondents who felt confident about finding relevant research to answer
clinical questions were almost twice as likely to read research literature (OR 1.79; 95% CI

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1.03-3.12), and close to twice as likely to use research literature in the process of clinical
decision making (OR 1.84; 95% CI 1.11-3.05).

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Access to research literature and medical databases
The overwhelming majority of respondents had access to current research through
professional journals either in a paper or electronic form (91.4%), and had the ability to

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access relevant healthcare journal databases either at their practice (85.1%) or at
home/locations other than their practice (92.0%).

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Sources of information
Table 8 displays the responses to the items enquiring about sources of research evidence.
The most common sources of research evidence for the respondents were professional
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seminars (82.5% listed it as one of the three most common); professional newsletters
(80.9% listed it as one of the three most common); and primary research journals (70.5%
listed it as one of the three most common).
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Barriers to evidence-based practice

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Table 9 displays the responses to items enquiring about perceived barriers to EBP. The
respondents viewed the three main barriers as insufficient time (59.4% indicated that it was
either the first, second or third most important barrier); lack of generalisability of literature
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findings to patient population (58% indicated that it was either the first, second or third
most important barrier); and an inability to apply research findings to individual patients
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with unique characteristics (57.7% indicated that it was either the first, second or third most
important barrier). The lowest ranked barriers were a lack of collegial support (10.6%
indicated that it was either the first, second or third most important barrier), and poor
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ability to critically appraise research literature (16.3% indicated that it was either the first,
second or third most important barrier).

Discussion
Most respondents expressed confidence in their ability to identify clinically relevant
research literature and to critically appraise this literature. This finding was consistent with
results of studies involving physiotherapists, orthodontists, occupational therapists, and
speech language therapists [16, 18, 23, 33-37]. While previous studies have shown that health
professionals express confidence in identifying and reviewing research literature, they
typically report a much lower level of knowledge about common research terms (for
instance, odds ratios) and specific strategy skills ( for instance, correct usage of Boolean

Page 6 of 19
search terms) [18, 34, 36, 37]. This leads to the question of whether the confidence health
professionals express about EBP skills is well founded. Our study did not enquire about the
knowledge of particular research terms or search skills, and further studies are required to
gain a more precise understanding of chiropractors EBP skills and knowledge.

The importance of gaining confidence in EBP skills was highlighted by our findings that
indicate that those respondents who expressed confidence were much more likely to read

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research literature and incorporate it into clinical decision-making. These findings have

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important implications because the increased use of research evidence in clinical practice
can lead to higher quality care and improved patient outcomes [38]. Although most

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respondents were confident about their EBP skills, about one third expressed doubts. This
suggests that chiropractic continuing professional development programs should focus on
improving fundamental EBP skills such as the ability to undertake proficient search

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strategies and critically appraise research literature.

Our respondents viewed time constraints as the principal barrier to EBP, which is congruent

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with previous reports of barriers in several healthcare settings, including physiotherapy,
complementary therapies, general practice, occupational therapy, speech language therapy,
and dietetics [5, 8-13, 15, 16, 36, 39]. This suggests that educational interventions should
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highlight the availability of evidence summaries and clinical practice guidelines, both of
which provide information in a format readily accessible for time poor clinicians.

The respondent’s most common sources of evidence, namely professional seminars,

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professional newsletters, and primary research journals, were generally consistent with the
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findings of previous studies of physiotherapists, occupational therapists, and speech

language therapists [15, 16, 33, 35, 40]. However, previous studies also report colleagues
are among the main two favoured information sources and, unlike our study, newsletters
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are not typically reported as a common information source [15, 16, 35, 40]. On the one
hand, this difference in information sources was an encouraging finding as the opinion of
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colleagues traditionally ranks last in the hierarchy of evidence. On the other hand, it was
potentially concerning to find that newsletters were the second most common information
source as the quality, and interpretation, of research evidence in some newsletters may be
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questionable. However, it is acknowledged that some newsletters include scientific

abstracts on the latest evidence. Australian chiropractors are required to undertake 24
hours of mandatory continuing professional development programs (CPD) each year. The
associations who accredit these programs could enable chiropractors to make the best
possible use of their time by ensuring that the content reflects the best available evidence.

There are several strengths and limitations that inform the interpretation of our results.
The approach we used to assess the structure of the Jette et al. questionnaire accorded with
recommendations for the development of survey instruments [11, 32]. It consisted of an
evaluation of content validity, dimensionality, and internal consistency. Additional studies
that examine the test-retest reliability of the questionnaire to further consolidate its

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psychometric properties may be useful. The adaptions we made to the questionnaire, which
had originally been developed to survey physiotherapists, have resulted in a questionnaire
that is more suitable for studies of chiropractors. Hence, we recommend that our modified
questionnaire should be considered for use in subsequent studies of chiropractic evidence-
based practice.

We identified the total number of registered chiropractors in Australia, but the precise

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response rate was indeterminate as third parties disseminated the questionnaire through

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email and it is unclear how many chiropractors received the invitation to participate.
However, the number of returned questionnaires (n=584) was low as it is possible that all

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registered chiropractors (n=4378) may have received the questionnaire. Notwithstanding
this limitation, the external validity of our results is supported by the demographic
characteristics of the respondents being comparable to all chiropractors in Australia.

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However, our findings should be interpreted cautiously as the Chiropractic Board of
Australia’s demographic material contained details only for age and location, and the
respondents may have been more positively predisposed to EBP than non-respondents

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(volunteer bias).

Conclusion
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The majority of respondents expressed confidence in their EBP skills. Whether such
confidence is well founded remains unclear and further studies may be beneficial to
examine the ability of Australian chiropractors to apply their skills in answering evidence-
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based case scenarios. Such information could inform the content of continuing professional
development programs in evidence-based practice skills. It is important to deliver
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educational interventions that enhance Australian chiropractors’ confidence in their ability

to identify and critically appraise research literature as these factors were associated with
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increased use of research literature in clinical decision-making, which in turn tends to

promote higher quality healthcare.
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References.

1. Straus SE, Glasziou P, Richardson SW, Haynes BR: Evidence-Based Medicine: How to
Practice and Teach it. Churchill Livingstone, London 2011, 4th Edition.
2. Montori VM, Guyatt GH: What is evidence-based medicine? Endocrinol Metab Clin North
Am 2002, 31(3):521-526.
3. Klardie KA, Johnson J, McNaughton MA, Meyers W: Integrating the principles of evidence-
based practice into clinical practice. J Am Acad Nurse Pract 2004, 16(3):100-105.

t
4. Leach MJ: Evidence-based practice: a framework for clinical practice and research design.

ip
Int J Nurs Pract 2006, 12(5):248-251.
5. Leach MJ, Gillham D: Are complementary medicine practitioners implementing evidence
based practice? Complement Ther Med 2011, 19(3):128-136.

cr
6. McKenna H, Ashton S, Keeney S: Barriers to evidence based practice in primary care: a
review of the literature. Int J Nurs Stud 2004, 41(4):369-378.
7. Romyn DM, Allen MN, Boschma G, Duncan SM, Edgecombe N, Jensen LA, Ross-Kerr JC,

us
Marck P, Salsali M, Tourangeau AE et al: The notion of evidence in evidence-based practice
by the Nursing Philosophy Working Group. J Prof Nurs 2003, 19(4):184-188.
8. Stomski N, Grimmer-Somers K, Petkov J: A survey of the uptake and implementation of
research evidence by South Australian acupuncturists in clinical practice: attitudes and

an
associated predictive factors. Complement Ther Med 2008, 16(4):199-205.
9. Stomski NJ, Mackintosh S, Stanley M: Acupuncturists' perspectives on outcome measures
to evaluate acupuncture care for chronic low back pain. Complement Ther Med 2010,
18(1):28-41.
M
10. Grimmer-Somers K, Lekkas P, Nyland L, Young A, Kumar S: Perspectives on research
evidence and clinical practice: a survey of Australian physiotherapists. Physiother Res Int
2007, 12(3):147-161.
11. Jette DU, Bacon K, Batty C, Carlson M, Ferland A, Hemingway RD, Hill JC, Ogilvie L, Volk D:
d

Evidence-based practice: beliefs, attitudes, knowledge, and behaviors of physical

therapists. Phys Ther 2003, 83(9):786-805.
te

12. Maaskant JM, Knops AM, Ubbink DT, Vermeulen H: Evidence-based practice: a survey
among pediatric nurses and pediatricians. J Pediatr Nurs 2013, 28(2):150-157.
13. Hutchinson AM, Johnston L: Bridging the divide: a survey of nurses' opinions regarding
p

barriers to, and facilitators of, research utilization in the practice setting. J Clin Nurs 2004,
13(3):304-315.
ce

14. Brazil K, Cloutier MM, Tennen H, Bailit H, Higgins PS: A qualitative study of the relationship
between clinician attributes, organization, and patient characteristics on implementation
of a disease management program. Dis Manag 2008, 11(2):129-137.
15. Dysart AM, Tomlin GS: Factors related to evidence-based practice among U.S. occupational
Ac

therapy clinicians. Am J Occup Ther 2002, 56(3):275-284.

16. Finch E, Cornwell P, Ward EC, McPhail SM: Factors influencing research engagement:
research interest, confidence and experience in an Australian speech-language pathology
workforce. BMC Health Serv Res 2013, 13:144.
17. Kamwendo K: What do Swedish physiotherapists feel about research? A survey of
perceptions, attitudes, intentions and engagement. Physiother Res Int 2002, 7(1):23-34.
18. Madhavji A, Araujo EA, Kim KB, Buschang PH: Attitudes, awareness, and barriers toward
evidence-based practice in orthodontics. Am J Orthod Dentofacial Orthop 2011, 140(3):309-
316 e302.
19. Abrahamson KA, Fox RL, Doebbeling BN: Facilitators and barriers to clinical practice
guideline use among nurses. Am J Nurs 2012, 112(7):26-35; quiz 46,36.
20. Lyons SS: Evidence-based protocol: fall prevention for older adults. J Gerontol Nurs 2005,
31(11):9-14.

Page 9 of 19
21. Asadoorian J, Hearson B, Satyanarayana S, Ursel J: Evidence-based practice in healthcare:
an exploratory cross-discipline comparison of enhancers and barriers. J Healthc Qual 2010,
32(3):15-22.
22. Koh SS, Manias E, Hutchinson AM, Donath S, Johnston L: Nurses' perceived barriers to the
implementation of a Fall Prevention Clinical Practice Guideline in Singapore hospitals. BMC
Health Serv Res 2008, 8:105.
23. Nilsagård YL, Georg: Evidence-based physiotherapy: A survey of knowledge, behaviour,
attitudes and prerequisites Advances in Physiotherapy 2010, 12(4):179-186.

t
24. Parahoo K, McCaughan EM: Research utilization among medical and surgical nurses: a

ip
comparison of their self reports and perceptions of barriers and facilitators. J Nurs Manag
2001, 9(1):21-30.
25. Scott IA, Buckmaster ND, Harvey KH: Clinical practice guidelines: perspectives of clinicians

cr
in Queensland public hospitals. Intern Med J 2003, 33(7):273-279.
26. Toulkidis V, Donnelly NJ, Ward JE: Engaging Australian physicians in evidence-based
medicine: a representative national survey. Intern Med J 2005, 35(1):9-17.

us
27. Hall G: Attitudes of chiropractors to evidence-based practice and how this compares to
other healthcare professionals: A qualitative study. Clinical Chiropractic 2011, 14(3):106-
111.
28. Roecker CB, Long CR, Vining RD, Lawrence DJ: Attitudes toward evidence-based clinical

an
practice among doctors of chiropractic with diplomate-level training in orthopedics.
Chiropr Man Therap 2013, 21(1):43.
29. Walker BF, Stomski NJ, Hebert JJ, French SD: A survey of Australian chiropractors' attitudes
and beliefs about evidence-based practice and their use of research literature and clinical
M
practice guidelines. Chiropractic and Manual Therapies 2013, 21.
30. Lynn MR: Determination and quantification of content validity. Nurs Res 1986, 35(6):382-
385.
31. Polit DF, Beck CT: The content validity index: are you sure you know what's being
d

reported? Critique and recommendations. Res Nurs Health 2006, 29(5):489-497.

32. Streiner D, Norman GR: Health Measurement Scales. A practical guide to their
te

development and use. Oxford University Press, Oxford 1995.

33. Graham F, Robertson L, Anderson J: New Zealand occupational therapists' views on
evidence-based practice: a replicated survey of attitudes, confidence and behaviours. Aust
p

Occup Ther J 2013, 60(2):120-128.

34. Heiwe S, Kajermo KN, Tyni-Lenne R, Guidetti S, Samuelsson M, Andersson IL, Wengstrom Y:
ce

Evidence-based practice: attitudes, knowledge and behaviour among allied health care
professionals. Int J Qual Health Care 2011, 23(2):198-209.
35. Valdes K, von der Heyde R: Attitudes and opinions of evidence-based practice among hand
therapists: a survey study. J Hand Ther 2012, 25(3):288-295; quiz 296.
Ac

36. McColl A, Smith H, White P, Field J: General practitioner's perceptions of the route to
evidence based medicine: a questionnaire survey. BMJ 1998, 316(7128):361-365.
37. Young JM, Ward JE: Evidence-based medicine in general practice: beliefs and barriers
among Australian GPs. J Eval Clin Pract 2001, 7(2):201-210.
38. Grol R, Grimshaw J: From best evidence to best practice: effective implementation of
change in patients' care. Lancet 2003, 362(9391):1225-1230.
39. Iles R, Davidson M: Evidence based practice: a survey of physiotherapists' current practice.
Physiother Res Int 2006, 11(2):93-103.
40. Fell DW, Burnham JF, Dockery JM: Determining where physical therapists get information
to support clinical practice decisions. Health Info Libr J 2013, 30(1):35-48.

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Table 1 Demographic characteristics of participating chiropractors

Mean Standard Deviation National %

Years since registration 15.7 11.0
Gender No. (n= 515) %
Females 136 26.4
Age No. (n= 515) %
21-30 91 17.9 20.6
31-40 161 31.3 31.7
41-50 120 23.3 23.4

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51-60 103 20.0 14.6
61 and above 39 7.6 9.7

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State/Territory No. (n= 519) %
Australian Capital Territory 13 2.5 1.3
New South Wales 141 27.1 33.4
Northern Territory 4 1.0 0.5

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Queensland 81 15.6 15.3
South Australia 53 10.5 7.8
Tasmania 5 1.0 1.0
Victoria 133 25.6 26.9

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Western Australia 89 17.1 11.3
Practice location
Rural 63 12.3
Regional 124 24.2
Suburban 325 63.5

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Membership
Chiropractors’ Association of Australia 365
Chiropractic and Osteopathic College of Australasia 196
Australian Spinal Research Foundation 144
Average work hours per week
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Less than twenty 99 19.3
Twenty to thirty 146 28.5
Thirty to forty 193 37.7
More than forty 74 14.5
Average number of patients seen per typical day
Five or less 41 8.0
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Six to ten 62 12.1

Eleven to fifteen 65 12.6
Sixteen to twenty 86 16,7
te

Twenty one to thirty 111 21.6

Thirty one to forty 70 13.6
More than forty 79 15.4
* Questionnaires were returned by 584 respondents. Some questionnaires
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Table 2 Responses to items enquiring about attention to literature

Times per month

None or 2-5 6-10 11-15 16 or

once more

Read/review research/literature related to 16.5% 45.1% 20.1% 8.1% 10.2%

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my clinical practice (n=581)

ip
I use professional literature and research 21.2% 44.7% 15.4% 5.5% 13.1%
findings in the process of clinical decision-

cr
making (n=579)

I use The Cochrane Library, MEDLINE, 45.3% 30.6% 11.9% 4.7% 7.6%

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PUBMED or other databases to search for
practice-relevant literature/research (n=579)

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Table 3 Skills and Knowledge

Disagree Neutral Agree

I learned the foundations for EBP as part of my undergraduate 29.5% 17.6% 52.9%
chiropractic education (n=550)

I have received formal training in search strategies for finding 28.9% 14.5% 56.6%
research relevant to my practice (n=550)

t
I am familiar with the medical research databases (eg, MEDLINE, 8.7% 8.7% 82.6%

ip
PUBMED, CINAHL, The Cochrane Library) (n=549)

I received formal training in critical appraisal of research literature 29.4% 12.6% 57.9%

cr
as part of my undergraduate chiropractic education (n=547)

I am confident in my ability to critically review professional 12.9% 17.8% 69.3%

us
literature (n=546)

I am confident in my ability to find relevant research to answer my 10.6% 16.8% 72.7%

clinical questions (n=549)

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Table 4 Associations between age and items enquiring about skills and knowledge

OR 95% CI
I learned the foundations for EBP as part of my undergraduate chiropractic
education (n=550) 0.92 0.90- 0.93

I have received formal training in search strategies for finding research

relevant to my practice (n=550) 0.95 0.93-0.96

t
I am familiar with the medical research databases (eg, MEDLINE, PUBMED,

ip
CINAHL, The Cochrane Library) (n=549) 0.95 0.93-0.97

I received formal training in critical appraisal of research literature as part of

cr
my undergraduate chiropractic education (n=547) 0.92 0.90-0.93

I am confident in my ability to critically review professional literature (n=546)

0.99 0.97-1.01

us
I am confident in my ability to find relevant research to answer my clinical
0.99 0.98-1.01
questions (n=549)

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Table 5 Associations between years since registration and items enquiring about skills and
knowledge

OR 95% CI
I learned the foundations for EBP as part of my undergraduate chiropractic
education (n=550) 0.89 0.87-0.91

I have received formal training in search strategies for finding research relevant
to my practice (n=550)

t
0.93 0.92-0.95

ip
I am familiar with the medical research databases (eg, MEDLINE, PUBMED,
CINAHL, The Cochrane Library) (n=549) 0.95 0.93-0.97

cr
I received formal training in critical appraisal of research literature as part of my
undergraduate chiropractic education (n=547) 0.90 0.88-0.92

us
I am confident in my ability to critically review professional literature (n=546)
0.98 0.97-1.00

I am confident in my ability to find relevant research to answer my clinical

0.99 0.98-1.02
questions (n=549)

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Table 6 Associations between reading literature and items enquiring about EBP skills and
knowledge

OR 95% CI
I learned the foundations for EBP as part of my undergraduate chiropractic
education (n=550) 1.01 0.55-1.85

I have received formal training in search strategies for finding research relevant to
my practice (n=550)

t
0.75 0.41-1.39

ip
I am familiar with the medical research databases (eg, MEDLINE, PUBMED,
CINAHL, The Cochrane Library) (n=549) 1.49 0.78-2.83

cr
I received formal training in critical appraisal of research literature as part of my
undergraduate chiropractic education (n=547) 0.59 0.31-1.11

us
I am confident in my ability to critically review professional literature (n=546)
2.70 1.55- 4.70

I am confident in my ability to find relevant research to answer my clinical

1.79 1.03-3.12
questions (n=549)

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Table 7 Associations between using research literature and items enquiring about EBP skills and
knowledge

OR 95% CI
I learned the foundations for EBP as part of my undergraduate chiropractic
education (n=550) 1.28 0.74-2.22

I have received formal training in search strategies for finding research relevant to
my practice (n=550)

t
0.67 0.38-1.17

ip
I am familiar with the medical research databases (eg, MEDLINE, PUBMED,
CINAHL, The Cochrane Library) (n=549) 2.65 1.48-4.73

cr
I received formal training in critical appraisal of research literature as part of my
undergraduate chiropractic education (n=547) 0.65 0.36-1.15

us
I am confident in my ability to critically review professional literature (n=546)
1.98 1.19-3.31

I am confident in my ability to find relevant research to answer my clinical

1.84 1.11-3.05
questions (n=549)

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Table 8 Sources of research evidence

Most common Second most Third most

(n=534) common (n=502) common (n=490)

Primary research journals 39.0% 13.5% 18.0%

General media, eg newspapers, television 0.4% 1.4% 7.1%

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Professional newsletters, eg ASRF Clinical 27.0% 31.5% 22.4%

ip
Updates, CAA Newsletter, COCA News

Colleagues 7.1% 12.7% 19.8%

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Seminars 22.7% 36.7% 23.1%

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I speak to an expert in the area 4.0% 4.2% 9.8%

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Table 9 Barriers to evidence-based practice

First in Second in Third in

importance importance importance
(n=489) (n=458) (n=434)
Insufficient time 27.4% 14.0% 18.0%

Lack of information resources 11.4% 10.5% 10.0%

t
Lack of research skills 4.3% 6.1% 8.3%

ip
Poor ability to critically appraise the literature 2.6% 5.2% 8.5%

cr
Lack of generalisability of the literature 19.8% 25.1% 13.1%
findings to my patient population

us
Inability to apply research findings to 18.9% 22.7% 16.1%
individual patients with unique characteristics

Lack of understanding of statistical analysis 6.0% 8.5% 9.9%

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Lack of collective support among my 3.0% 3.5% 4.1%
colleagues in my facility

Lack of interest 6.3% 4.7% 12.0%

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