Chiropractic attitude and utilisation of evidence-based practice

Evidence-Based Practice (EBP) assists with decision-making related to patient care, to improve outcomes and patient satisfaction. This study aimed to analyse the attitudes, skills, and utilization of EBP among South African chiropractors, focusing on perceived skill levels, training, use and identifying facilitators and barriers to EBP application.

A descriptive cross-sectional quantitative 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).

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. The results showed:

• A third of respondents stated they have poor clinical research skills.
• Over half of the respondents (53.0%) expressed no interest in learning and enhancing new or existing skills to incorporate current outcomes into their practices.
• Respondents reported average skills in locating professional literature (33.3%), searching online databases (34.8%), and retrieving evidence (41.7%).
• Conducting clinical research was deemed to have the lowest degree of competence (33.3%).
• Conducting systematic reviews or meta-analyses was seen as a minor component of chiropractic education (28.0%).
• Applying research evidence to clinical practice (43.9%), doing clinical research (41.7%), and critical thinking (44.7%) were identified as key components of the chiropractic curriculum.
• 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.
• Yet, 38.6% of respondents’ practices were based on less than 50% of clinical research evidence.
• Published clinical evidence was ranked 6th as a source of information for clinical decisions.
• Chiropractors’ personal intuition was the most frequently used source of information (SD = 4.6).
• Consultation with the literature, such as CPGs (SD = 4.9), textbooks (SD = 5.2) and published clinical evidence (SD = 5.3) were used only moderately.
• The least frequently used source was published experiments (SD = 6.9).
• Practitioners did not often use patient preference (SD = 6.1) or consultations with other colleagues or experts (SD = 5.0) for clinical decision-making.

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.

The authors concluded that 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.

If I disregard the dismal response rate for a minute and assume that these findings are relevant, I have to ask the following question:

How on earth can the authors justify their conclusions from this survey?

I would correct them and conclude as follows:

The perceived skill levels, training, use of EBP by South African chiropractors are frightening.