The remaining full-text articles were assessed for eligibility by the first author and a group of four review authors who underwent an inter-rater reliability process to ensure agreement. Sixty-two full-text articles were excluded at this stage. Results of search strategy and process of selecting research articles.
Flow diagram describing the process of searching and selecting articles on research utilization, evidence-based practice and knowledge translation in chiropractic to be included in the scoping review. Sixty-seven studies reported in 69 articles were included in the review. The number of studies increased steadily each year with the exception of and Fig. Based on area of clinical practice, the studies focused on: Authors affiliation with chiropractic educational institutions were as follows represented by at least one author: Articles by year of publication.
Studies by country of origin. Number of studies conducted in various countries around the world on research utilization, evidence-based practice and knowledge translation in chiropractic n Studies by study design.
Studies by area of practice. Included studies were classified into three major categories, namely evidence-based practice EBP , research utilization RU , and knowledge translation KT.
Each category was further sub-classified into major themes as follows: Studies by research category. Number of studies within respective categories evidence-based practice, research utilization and knowledge translation and corresponding themes. Varying perspectives about divergent attitudes toward chiropractic practice were reported in six studies [ 18 , 25 — 29 ].
An earlier study suggested that Canadian chiropractors held views that fell into three categories: Recently, a representative sample of Canadian chiropractors reported views that could be categorized into six strata [ 18 ].
Chiropractic school attended was found to be a significant predictor of orthodox versus unorthodox faction membership and professional practice characteristics in Canada [ 29 ]. Despite this, a similar proportion of respondents considered subluxation to be central to chiropractic intervention.
In Canada, large discrepancies in scope of practice were reported by private clinic websites naming distinct conditions treatable by chiropractic where professional association and college websites only identified 41 unique conditions [ 31 ]. Six studies reported on the influence of philosophical beliefs on practice behaviour e. However, the majority of survey respondents Five studies found that chiropractors generally held positive attitudes towards EBP, and were interested in improving their EBP skills [ 36 — 40 ].
Two studies surveyed Australian and German chiropractors respectively about the importance of research as a means to increase the credibility of the profession and to further explore inter-professional collaboration [ 37 , 39 ]. Clinicians indicated that they were willing to support research efforts, mostly as participants e. Few studies have evaluated the impact of implementing EBP care approaches [ 41 , 42 ].
One pragmatic RCT comparing an evidence-based treatment protocol with usual care for acute non-specific LBP found no important difference in outcomes [ 42 ]. However, the EBP treatment protocol generated results more rapidly than usual care and with fewer treatments. One uncontrolled descriptive observational study reported that protocols that were based on evidence-based CPGs produced better clinical outcomes with faster results, higher patient satisfaction, and at a lower cost than usual care [ 41 ].
A capacity building project enrolled 26 students in a credit university postgraduate programme on EBP and research. While the programme raised awareness about EBP and research, and provided participants with the needed tools to use and implement EBP, none of the students developed a research protocol of sufficient quality to obtain a passing mark on the final assignment, and only two undertook a PhD programme [ 43 ].
Twenty-one of the included studies Two themes emerged within the RU category: Three cross-sectional studies [ 44 — 46 ] and one prospective cohort study [ 47 ] specifically related to adherence to diagnostic imaging guidelines. Interestingly, a smaller proportion of US chiropractors Guideline compliance for managing neck pain [ 48 , 49 ], acute whiplash [ 50 ] and low back pain [ 51 , 52 ] was also generally acceptable.
Similarly, care delivered in individual chiropractic practices in the UK [ 53 ] and Northeastern Spain [ 54 ] were generally aligned with best practice. Two articles reported that a majority of clinicians in private practice used treatment not supported by current recommendations on nutrition [ 55 , 56 ]. Four studies indicated minimal use of evidence-based information sources e.
While there was general agreement with teaching standards, chiropractors highlighted some discrepancies between the curricula e. Online courses to acquire new knowledge seem to be the preferred mode of delivery of EBP information [ 55 , 56 ]. Furthermore, recommending essential literature to inform evidence-based clinical practice has been advocated [ 61 ]. Thirty-six of the 67 studies Articles corresponded to three themes: Knowledge-practice gaps for chiropractors were identified in several studies on a number of topics including: While clinicians reported routinely assessing physical impairments and pain, assessments of activity limitation and psychosocial function to help establish the prognosis were not commonly assessed [ 66 ].
In North Carolina, USA, less than half of the surveyed chronic back and neck pain patients were prescribed exercise the desired evidence-based practice after consulting GPs, chiropractors or PTs [ 69 ]. Agreement with and motivations to follow guideline recommendations varied in the UK [ 74 , 75 ], North America [ 72 , 76 ] and Australia [ 36 ]. Despite this however, chiropractors tended to recommend restricting daily activities.
A follow-up survey on behaviour, beliefs, and attitudes to LBP management among these same MSK health disciplines suggested that many private practitioners do not see their role as directly intervening to reduce work absenteeism due to LBP [ 74 ].
An apparent barrier to guideline uptake is the limited awareness of best practice initiatives [ 77 ] and existing CPGs [ 76 , 78 ]. In a study on tobacco cessation training, interviewed practitioners identified perceived intrusiveness or potential patient social discomfort or alienation as barriers to uptake, preferring not to discuss tobacco use with new patients [ 80 ].
In contrast, one study determined that perceiving EBP as helpful in clinical decision-making increased the likelihood of chiropractors reporting using CPGs [ 36 ]. Facilitators of EBP uptake also included free online databases at work, online educational materials, and access to critical reviews and full-text articles [ 40 ].
Overall, findings suggest that guideline implementation could be strengthened if multifaceted interventions were used. There is a need for high quality EBP continuing education programmes and increased support from professional organizations to develop collegial support for EBP, and greater collaboration between researchers and practitioners to design clinically applicable research [ 81 ].
To help reduce risk of patient harm, Canyon recommends that chiropractic organizations address barriers to documenting harm by developing formal risk assessment strategies and improving their level of understanding of crisis management [ 82 ]. In one study chiropractors felt that CPGs should be developed specifically for chiropractors and not be widely applicable for all healthcare professions [ 35 ].
Nine studies examined the effect of educational interventions on process of care [ 83 — 87 ] and professional behaviour change [ 88 — 91 ]. Five of these articles targeted chiropractors only [ 83 — 85 , 90 , 91 ]. These interventions also increased guideline adherence for managing spine pain or in using validated patient self-reported questionnaires. The few studies targeting chiropractors only [ 83 — 85 ] were underpowered, had a short follow-up [ 83 , 84 ], had no control group and failed to use validated outcome measures [ 85 , 91 ].
This scoping review reports on the current state of knowledge on evidence-based practice EBP , research utilization RU , and knowledge translation KT in chiropractic. The notion of two basic groups in chiropractic: Traditional views of chiropractic appear to negatively influence practice behaviour e.
Such discourse and dissonance, and the high degree of variability in scope of practice across US states [ ] and in other countries [ ] are sources of confusion among members of the public, other health disciplines and policy makers [ ]. This is important in light of efforts in Canada and elsewhere to support health system reform that encourages prevention, inter-professional collaboration, evidence-based practice, patient-choice, and protection of the public interest [ http: Multilevel strategies involving professional chiropractic leaders, teaching institutions, researchers and other stakeholders are needed to help transform the culture of chiropractic toward one that is guided by EBP principles [ ].
Studies included in the current review found that chiropractors generally held positive attitudes towards EBP, and were interested in improving their EBP skills [ 36 — 40 ].
However, the use of evidence-based information sources is suboptimal [ 32 , 39 , 55 , 56 ]. Recent studies in Canada [ ] and in the US [ 81 ] support these findings. Further research is needed to establish if similar determinants apply in chiropractic. While guideline compliance for managing acute whiplash [ 50 ] and low back pain [ 51 ] was deemed acceptable, the application of EBP and adherence to imaging guidelines [ 40 , 45 , 83 ] and best practice [ 55 , 56 ] appears suboptimal.
Identified barriers and facilitators to using EBP and guidelines in chiropractic are similar to those reported in reviews of physicians and allied care providers [ 5 , , ].
In contrast, having a favourable attitude toward EBP [ 36 ], free online databases at work, online educational materials, and access to critical reviews and full-text articles [ 40 , 55 , 56 ] were perceived as facilitators of RU.
However, the research to support this is limited. Well-designed evaluation studies targeting chiropractors with larger sample sizes, longer follow-up, use of a control group and validated outcome measures are needed.
Furthermore, the lack of consistency of effect in these studies may be related to the intervention strategies used. There is general agreement that implementation strategies are more effective if they address identified barriers to change [ ], and that the effectiveness of strategies depends on the organizational context in which they are implemented [ ]. Examples of theory-based KT interventions in chiropractic are those aiming to reduce spine imaging [ ] or to increase use of multimodal care for neck pain [ 72 ] Trial Registration: Future dissemination and implementation efforts should aim to address knowledge-practice gaps identified in our review, including risk factors for scoliosis progression [ 62 ], establishing prognosis for whiplash [ 63 ], routinely using validated outcomes measures and patient-reported health outcomes other than pain and disability scales [ 30 , 64 , 65 ], the ongoing use of passive therapy to manage acute whiplash [ 50 ] and patient care concerned with public health issues [ 67 — 69 ].
Knowledge gained from this review provides a deeper insight on ways in which we can help end users engage in group discussions. For clinicians, strategies aimed at closing the evidence-practice gap can reduce inappropriate practice variations and improve process of care and patient outcomes.
Chiropractors recognize the important of research to raise the credibility of the profession [ 37 , 39 ] and are willing to support research efforts, mostly as participants e.
Chiropractic Practice-Based Research Networks PBRNs in Canada [ ], Europe [ ], USA [ ] and Australia [ ] offer the opportunity for clinicians and patients to engage in meaningful clinical research to enhance the management of musculoskeletal care.
PBRNs can facilitate recruitment and help retain participants, two essential but challenging aspects of clinical research [ , ]. Furthermore, PBRNs may be ideal environments to increase understanding of barriers to professional behaviour change and to pilot test implementation of CPGs and best practices prior to scaling up interventions [ ]. Interprofessional collaboration is an essential component for moving toward integrated health care [ , ]. Findings from this scoping review indicate that chiropractic is actively engaged in interprofessional primary care research in the area of musculoskeletal disorders.
As research capacity continues to grow in the chiropractic profession, it is envisioned that health service and KT research will increasingly influence practice, programmes and policy. Curricula [ ] should be designed to foster the attributes known to support an EBP approach i.
EBP content should be situated in authentic contexts and using real life scenarios that resemble the types of cases graduates are most likely to encounter in their future clinical practice [ , ]. Faculty could promote EBP competencies by working closely with clinicians; together they can provide a more holistic view of EBP i. To increase the likelihood of successful change however, faculty members could benefit from continuing professional development; not only on the EBP process itself, but on how to teach and evaluate EBP i.
Other important initiatives to promote the application of EBP include the development and dissemination of clinical practice guidelines and related tools by the Council on Chiropractic Guidelines and Practice Parameters http: Together, these initiatives should facilitate the shift of the chiropractic profession toward EBP, which ultimately may translate in the delivery of safer and more effective patient centered care [ ].
This review complies with key steps outlined in the Joanna Briggs Institute manual for conducting scoping reviews, [ ] including using an a-priori protocol, a search of several databases, consulting an experienced health sciences librarian to ensure our strategy was appropriate, keeping the search strategy unrestricted to study design, screening titles and abstracts followed by full-text screening for relevance using at least two independent reviewers, and using a standardized data abstraction form adapted to the focus of the review.
Nonetheless, this review also has some limitations. The quality of included articles was not assessed as part of this scoping review. Further research is required into effective EBP training programmes for chiropractors to improve attitudes, skills and uptake of EBP.
There is a need for robust dissemination and implementation research to increase guideline adherence and improve patient health outcomes. Large integrated clinical and administrative databases can better our understanding of practice patterns and variations, incident reporting and safety measures in chiropractic, knowledge-practice gaps, and provide additional compelling evidence from chiropractic outcomes.
One important barrier to conducting clinical research is recruitment. However, this figure should be interpreted with caution considering several of the studies could not determine the number of invited subjects who actually opened the invitation letter or e-mail for surveys.
Planned targeted dissemination strategies of the review findings include: Findings from this review suggest that the majority of chiropractors hold favourable attitudes towards, and beliefs about, EBP. Clinicians are encouraged to consider newer resources aimed at facilitating the uptake of best practice and guidelines.
The views expressed in this article are solely those of the authors and do not necessarily represent the official views of the CCGI. Funds provided by the Canadian Chiropractic Research Foundation. The views of the funding body have not influenced the content of this article. The datasets supporting the conclusions of this review are available in the Additional files 2. Data Abstraction Table, and Additional files 3. Thematic analysis of data. AEB was the principal investigator of the study and was responsible for securing the funding Canadian Chiropractic Research Foundation and administration of the funds of the scoping review, and the conceptualization, design, analysis and interpretation, and a majority of the manuscript preparation.
KJS contributed to the conceptualization and the design of the study. He was responsible for data collection, analysis, assisting in the interpretation of findings, and worked with the primary author to prepare the manuscript for publication and contributed content to the background and discussion sections.
SDF contributed to the conceptualization and design of the study and assisted in the interpretation of findings. He worked with the primary author to prepare the manuscript for publication and contributed content to the background and discussion sections and editing of the draft and final manuscript. FZ contributed to the conceptualization of the study.
He was responsible for data searching, data collection, analysis and interpretation of findings, and worked with the primary author to prepare the manuscript for publication and contributed content to the background and discussion sections. JB contributed to the design of the study. She was responsible for the search strategy design, data searching and data collection.
She worked with the primary author to prepare the manuscript for publication and contributed content to the methods and results sections. JC contributed to the conceptualization of the study.
He was responsible for data collection and interpretation of findings, and worked with the primary author to prepare the manuscript for publication and contributed content to the discussion sections. AT contributed to the conceptualization and the design of the study.
She was responsible for data collection, analysis, and interpretation of findings, and worked with the primary author to prepare the manuscript for publication and contributed content of all sections of the manuscript. Register a new account? Forgot your user name or password? Search for this keyword. Latest content Current issue Archive Authors About. Log in via Institution. Promoting research utilisation in nursing: Unharnessing the power of information for practice Nurses are generally positive about evidence-based practice, but we know little about what determines their use of research findings.
The organisation Organisational characteristics, including size, location, and centralisation of decision making, have been associated with research utilisation, but conclusions about the importance of specific variables are inconsistent, 14 perhaps because their effects vary in different settings. The environment An information friendly environment links the clinical nurse to a variety of information brokers, the healthcare literature, and other evidence-based resources.
Conclusions In the future, information systems will integrate clinical data about patient treatments and preferences, available resources, expert opinion, and research evidence to provide nurses with current, patient specific information to address complex clinical issues. Evidence-Based Nursing Apr; 1: Evaluating automated information systems. Nurs Econ ; 5: Organizational integrative mechanisms and adoption of innovations by nurses.
Nurs Res ; Champion VL, Leach A. Variables related to research utilization in nursing: J Adv Nurs ; Barriers to using research findings in practice: Appl Nurs Res ; 4: Use of research-based knowledge in clinical practice. J Nurs Adm ; Literature search and retrieval in the workplace. Comput Nurs ; Assessment of nursing research utilization needs in Ontario health agencies.
Can J Nurs Adm ; 8: Do nurses have the information resources and skills for research utilization? Can J Nurs Adm ; Blythe J, Royle JA. Assessing nurses' information needs in the work environment. Bull Med Libr Assoc ; J Contin Educ Nurs ; Nursing for the twenty-first century: Explicate the relevance of evidence-based research findings for nursing practice in an environment of continuous quality improvement.
Use appropriate technology to identify important sets of empirical literature and synthesize these findings to determine their relevance for enhancing the scientific basis of nursing practice. Demonstrate the ability for critical evaluation of elements of the research process.
Demonstrate the ability to plan for implementation of research-based advanced nursing practice. Demonstrate the ability to accomplish a research utilization project within a team structure.
Learning Outcomes Emphasis is on applying concepts and processes of research utilization in advanced practice nursing. The practice of nursing research: The must-have textbook for now and the future American Psychological Association.
Publication manual of the American Psychological Association 5th ed. Get one of the following two texts on literature reviews Galvin, J. A guide for students of the social and behavioral sciences 3rd ed.
Qualitative and quantitative approaches 2nd ed.
Research utilization is the process of synthesizing, disseminating, and using research-generated knowledge to make an impact on or change in the existing nursing practice. The research utilization process was developed years ago to address the problems of using research findings in practice.
Nurses’ research utilization (RU) as part of evidence-based practice is strongly emphasized in today’s nursing education and clinical practice. The primary aim of RU is to provide high-quality nursing care to patients.
The Utilization of Nursing Research: The Utilization of Nursing Research During s & early s, research utilization became an important buzz (ring) word. Several changes in nursing education and nursing research were encouraged to develop a knowledge base for nursing practice. Jul 13, · 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.
Nursing Research Utilization Assignment Grading Criteria Student Name Due Date Nursing Research Utilization Project Proposal: Topic Selection Week One Select a clinical issue or work setting problem. This issue will be the focus of the ongoing individual assignments over the next six weeks. The primary goal of this course is to promote an evidence-based approach to advanced nursing practice. Evidenced-based research findings for nursing practice will be evaluated in terms of racial, ethnic, and socioeconomic relevance.