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 R21AT 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

SKILLS Mean = 44.3

USE Mean = 10.3

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

practicemodules/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) times (3) 16+ times (4) Mean Range=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 clinical Practice 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-education institution websites to assist my clinical decision making 35.6%43.8%11.1%4.2%5.3%1.0 Use of EBP

PART C ItemNone 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- based clinical practice/ evidence- based chiropractic 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 the colleges together to share ideas, materials and teaching strategies in the realm of evidence-informed practice (EIP)

evidenceinform 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