Distance Education Online Intervention for Evidence Based Practice Literacy 

Michael Schneider, DC, PhD

Roni Evans, DC, PhD

Mitch Haas, DC

Cheryl Hawk, DC

Cynthia Long, PhD

Matthew Leach, PhD, RN, ND

Lauren Terhorst, PhD

• University of Pittsburgh – coordinating site

• Four chiropractic colleges with R25 educational grants– Palmer - Northwestern - Western States -

National

• University of South Australia• Council on Chiropractic Guidelines and

Practice Parameters and Congress of Chiropractic State Associations

Collaborative Research Effort

This research was made possible by Grant Number R21AT007547 from the National Center for Complementary and Integrative Health (NCCIH; formerly NCCAM) at the National Institutes of Health (NIH).

The views expressed in this presentation are solely those of the authors and do not necessarily represent the official views of the NCCIH or NIH.

1. Phase 1:• Online EBP survey of DCs• Demographics• Three subscores: attitudes, skills, and use

2. Phase 2: • Randomize to active and wait-list groups• Active group gets access to online educational

courses• Four monthly booster exercises• Research questions:

– Feasibility of providing online education – Effectiveness of education on EBP subscores

Two-Phase Randomized Trial

• Published in Chiro & Manual Therapies

(May 4, 2015)• Demographics of ~1,300 DCs• Mean subscores:

– Attitudes - High– Skills - Medium– Use – Low– Similar to other health care

professions!

Phase I: Results

ATTITUDES

Mean = 31.4

SKILLSMean = 44.3

USE

Mean = 10.3

 http://www.chiromt.com/content/23/1/16/abstract

• Effect of exposure to online educational modules and ‘booster’ sessions

• Significant increase in Attitudes and Skills subscores (but small effect) – within and between groups

• No significant change in Use subscore

Phase II: Preliminary Results

• DCs have good attitude about EIP and express interest in learning more about it

• I.T. infrastructure to conduct future online surveys about EIP

• EIP online educational modules and booster exercises

• Preliminary data for getting additional NIH funding for EIP research

Good News

http://www.csh.umn.edu/evidenceinformedpracticemodules/index.htm

1. Free Access to all Online EIP Modules!

Courtesy of University of Minnesota (Roni Evans DC, PhD)

2. Free Access to all Booster Exercises!

Courtesy of University of Pittsburgh and CEIPE(resources on CEIPE website)

• They don’t get enough EIP training • They lack critical appraisal skills• They rarely use online databases

(PubMed)• They rarely use research findings to

make changes in their clinical practice

Not so good news: DCs tell us that…

 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=0-5

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)

MeanRange=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 clinicalPractice

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-educationinstitution websites to assist my clinical decision making

35.6% 43.8% 11.1% 4.2% 5.3% 1.0

Use of EBP

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-basedclinical practice/ evidence-basedchiropractic

4.8% 25.5% 5.5% 22.8% 17.0% 5.6% 4.9% 1.8% 12.2%

Conducting systematic reviews or meta-analysis

47.6% 6.3% 6.5% 21.8% 3.7% 1.9% 0.5% 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%

Training/Education in EBP

Chiropractic’s

Patient Values

Best Evidence Available

Clinician Experience

EIP Paradigm = Critical Thinking

Clinical Scenario

PICO

Sort results: Valid?

Key Words: Search PubMed

Determine relevance

ASSESS

ASK

ACQUIRE

APPRAISE

APPLY

5 A’s of EIP = Process of Critical Thinking

• “What evidence is s/he using to make those claims”?

• “That doesn’t make sense…it’s not biologically plausible”.

• “That makes sense…but there’s not a lot of evidence to back up those claims”.

• “I know that I don’t know…but I know how to find out”.

• “I’m not sure about the best approach in this case, let me see what sort of evidence is available”.

(“Trickle-down education”)

Bringing th

e colle

ges together to

share

ideas, materia

ls and te

aching st

rategies in

the realm

of evid

ence-in

formed practi

ce

(EIP)

evidence inform

inform think critically

Health Professionals are dedicated to EIP and Lifelong Learning

Goal of Educators:

Foster critical thinking in students, creating

DCs who have a passion for lifelong learning and EIP