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
Collaborative Research Effort
• 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
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.
Two-Phase Randomized Trial
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
Phase I: Results
• 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!
ATTITUDES
Mean = 31.4
SKILLS
Mean = 44.3
USE
Mean = 10.3
http://www.chiromt.com/content/23/1/16/abstract
Phase II: Preliminary Results
• 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
Good News
• 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
1. Free Access to all Online EIP Modules!
Courtesy of University of Minnesota
(Roni Evans DC, PhD)
http://www.csh.umn.edu/evidenceinformed
practicemodules/index.htm
2. Free Access to all Booster Exercises!
Courtesy of University of Pittsburgh and CEIPE
(resources on CEIPE website)
Not so good news:
DCs tell us that…
• 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
Use of EBP
None
Small
(26-50%)
(2)
Moderate
(51-75%)
(3)
Large
(76-99%)
(4)
All (100%)
(0)
Very small
(1-25%)
(1)
(5)
Mean
Range=0-5
2.7%
21.2%
21.0%
32.3%
21.0%
1.8%
2.5
0 times
(0)
1-5 times
(1)
6-10 times
(2)
11-15 times
(3)
16+ times
(4)
Mean
Range=0-4
3.4%
41.9%
22.6%
8.7%
23.4%
2.1
7.9%
39.0%
23.5%
9.9%
19.7%
1.9
7.8%
48.3%
17.4%
7.5%
19.0%
1.8
11.0%
52.1%
14.8%
6.3%
15.8%
1.6
28.6%
36.5%
12.4%
6.4%
16.1%
1.4
23.2%
48.9%
11.3%
4.3%
12.3%
1.3
22.5%
51.8%
13.5%
4.7%
7.5%
1.2
35.6%
43.8%
11.1%
4.2%
5.3%
1.0
PART D Item
What percentage of your practice
do you estimate is based on clinical
research evidence (i.e. evidence
from clinical trials)?
PART D Items
*I have read/reviewed professional
literature (i.e. professional
journals & textbooks) related to my
practice
*I have used an online search
engine to search for practice
related literature or research
*I have read/reviewed clinical
research findings related to my
practice
*I have used professional literature
or research findings to assist my
clinical decision making
*I have used an online database to
search for practice related
literature or research
*I have used professional literature
or research findings to change my
clinical
Practice
I have consulted a colleague or
industry expert to assist my clinical
decision making
I have referred to magazines,
layperson / self-help books, or nongovernment/non-education
institution websites to assist my
Training/Education in EBP
PART C Item
Applying
research
evidence to
clinical
practice
Critical
thinking /
critical
analysis
Evidencebased
clinical
practice/
evidencebased
chiropractic
Conducting
systematic
reviews or
meta-analysis
Conducting
clinical
research
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
8.1%
23.4%
5.7%
23.4%
13.1%
3.7%
3.9%
1.8%
17.0%
10.8%
8.4%
5.3%
21.7%
29.0%
2.7%
3.8%
3.4%
14.9%
4.8%
25.5%
5.5%
22.8%
17.0%
5.6%
4.9%
1.8%
12.2%
47.6%
6.3%
6.5%
21.8%
3.7%
1.9%
0.5%
1.2%
10.4%
42.2%
6.3%
6.1%
26.5%
4.0%
2.4%
0.9%
1.8%
9.8%
Chiropractic’s
Best
Evidence
Available
Clinician
Experience
Patient
Values
EIP Paradigm = Critical Thinking
ASSESS
Clinical Scenario
ASK
PICO
ACQUIRE
Key Words: Search PubMed
APPRAISE
Sort results: Valid?
APPLY
Determine relevance
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”)
evidence inform
think
critically
inform
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