Self-reported attitudes, skills and use of evidence-based practice among Swiss chiropractors: a national survey

STUDY OBJECTIVES The high burden of disease associated with musculoskeletal disorders severely impacts patients' well-being. As primary care providers, Swiss chiropractors ought to contribute towards identifying and using effective treatment strategies. An established approach is the full integration of evidence-based practice (EBP). This study aimed to investigate the attitudes, skills and use of EBP among Swiss chiropractors, as well as investigating potential facilitators and barriers for its adoption. METHODS AND MATERIAL All 329 members of the Swiss Association of Chiropractic (ChiroSuisse) were invited in March 2021 to participate in this cross-sectional survey. Data were acquired anonymously online, using the Evidence-Based practice Attitude and utilization SurvEy (EBASE). The survey encompassed 55 questions measuring attitudes (n = 8, response range 1-5; total score range of 8-40), skills (n = 13, response range 1-5; total score range of range of 13-65) and use of EBP (n = 6, response range 0-4; total score range of 0-24). RESULTS 228 (69.3%) chiropractors returned complete EBASE questionnaires. This sample was representative of all ChiroSuisse members with respect to gender, age groups and proportion of chiropractic residents. Respondents generally held positive attitudes towards EBP, as indicated by the high mean (31.2) and median (31) attitude sub-score (range 11-40). Self-reported skills had a mean sub-score of 40.2 and median of 40 (range 13-65). Knowledge about EBP-based clinical practice had been primarily obtained in chiropractic under- or postgraduate education (33.8% and 26.3%, respectively). Use of EBP achieved a lower sub-score, with mean and median values of 7.4 and 6, respectively (range 0-24). The most commonly identified barriers preventing EBP uptake were lack of time (67.9%) and lack of clinical evidence in chiropractic/manual therapy-related health fields (45.1%). CONCLUSION Swiss chiropractors held favourable attitudes and reported moderate to moderate-high skill levels in EBP. Nevertheless, similar to chiropractors in other countries, the self-reported use of EBP was relatively low, with lack of time and lack of clinical evidence being the most named barriers

The Clinical Practice Guideline Initiative: A joint collaboration designed to improve the quality of care delivered by doctors of chiropractic

The article offers information on the Clinical Practice Guideline Initiative designed to improve the quality of care for musculoskeletal (MSK) conditions provided by chiropractic doctors. Topics discussed include management of back and neck pain, the relative risks of treatments of MSK conditions, and clinical decision making. Also mentioned are utilization of clinical practice guidelines (CPGs), and diagram depicting structure of the Clinical Practice Guidelines Initiative

Diagnostic imaging for spinal disorders in the elderly: a narrative review

The high prevalence of neck and low back pain in the rapidly aging population is associated with significant increases in health care expenditure. While spinal imaging can be useful to identify less common causes of neck and back pain, overuse and misuse of imaging services has been widely reported. This narrative review aims to provide primary care providers with an overview of available imaging studies with associated potential benefits, adverse effects, and costs for the evaluation of neck and back pain disorders in the elderly population. While the prevalence of arthritis and degenerative disc disease increase with age, fracture, infection, and tumor remain uncommon. Prevalence of other conditions such as spinal stenosis and abdominal aortic aneurysm (AAA) also increase with age and demand special considerations. Radiography of the lumbar spine is not recommended for the early management of non-specific low back pain in adults under the age of 65. Aside from conventional radiography for suspected fracture or arthritis, magnetic resonance imaging (MRI) and computed tomography (CT) offer better characterization of most musculoskeletal diseases. If available, MRI is usually preferred over CT because it involves less radiation exposure and has better soft-tissue visualization. Use of subspecialty radiologists to interpret diagnostic imaging studies is recommended

Évaluation d’implantation d’une expérience novatrice : le réseau intégré de services aux aînés des Bois-Francs

Consciente de l'existence de problèmes liés à la coordination des services rendus aux aînés sur son territoire, la Table de concertation des services de santé et de services sociaux des Bois-Francs dans la région Mauricie et du Centre-du-Québec implanta en février 1997, après deux ans de planification, un nouveau modèle de coordination des soins et des services aux personnes âgées en perte d'autonomie. Ce modèle est novateur car il combine le guichet ou porte d'entrée unique, la gestion de cas, le plan de services individualisé et la présence de trois niveaux de concertation : stratégique, tactique et clinique. Il a aussi la particularité de couvrir tout le continuum de soins et de services aux aînés. Le présent article décrit les principaux résultats de l'évaluation d'implantation et de processus. Cette évaluation visait à documenter les activités et fonctions centrales du mécanisme de coordination des services afin de voir dans quelle mesure le modèle implanté et son fonctionnement s'approchent ou non du modèle visé et ce, dans la perspective d'apporter des ajustements qui pourraient s'avérer nécessaires. Les principaux résultats sur la clientèle rejointe, sur les fonctions assumées par l'équipe de gestion de cas et sur l'organisation de travail sont ici abordés et discutés à la lumière d'autres études sur la coordination des soins et des services aux personnes âgées en perte d'autonomie. Des suggestions sont faites en regard de ces résultats et de ceux portant sur l'efficacité et les coûts tirés d'une autre recherche afin d'améliorer l'efficacité et l'efficience de ce modèle de coordination de soins et de services aux aînés. Sans être généralisables d'emblée, plusieurs composantes de ce nouveau modèle pourraient être réutilisées auprès d'autres clientèles.Assessment of the implementation of an innovative experience: network of integrated services for the elderly in the Bois-Franc region Conscious of problems related to coordination of services for the elderly on its territory, the working group on health and social services of the Bois-Francs in the Mauricie and Centre-du-Québec regions implemented in February 1997, after two years of planning, a new coordination model of services for the frail elderly. This model is innovative because it combines the unique entry, case management, individualized services plan as well as the presence of three levels of concertation : strategic, tactical and clinical. The model also has the characteristic of offering comprehensive services to the elderly. This article describes the major results of an assessment of the implementation and process of this model. This assessment aimed at documenting the activities and functions of the coordination mecanism of services in order to see to what extent the model implemented and its functionning is close or not to the one proposed and this, in a perspective of bringing the necessary adjustments. The major results on clientele reached, various functions of a team of case managers and organization of work are discussed in the light of other studies on coordination of services for frail older people. Suggestions regarding these results and those pertaining to efficiency and cost in another study are made in order to improve the efficiency of the model. Many components of this new model could be applied to other clientele.Evaluación de la implantación de una experiencia novedosa: la red integrada de servicios para ancianos de los Bois-Francs Consciente de la existencia de problemas de coordinación de servicios para ancianos de su teritorio, la mesa de concertación de los servicios de salud y de servicios sociales de los Bois-Francs en la región Mauricie y del Centro-del-Québec estableció en febrero 1997, despues de dos años de planificación, un modelo nuevo de coordinación de cuidados y de servicios a los ancianos con perdida de autonomia. Este modelo es novedoso porque combina el portillo único de entrada, la gestión de caso, el plan de servicios individualisados y la presencia de tres niveles de concertación: estrategico, táctico y clínico. Tiene tambien la particularidad de cubrir el continuum de cuidados y de servicios a los ancianos. Este articulo describe los resultados principales de la evaluación y del proceso de establecimiento. Esta evaluación queria documentar las actividades y funciones centrales del mecanismo de coordinación para ver como el modelo establecido y su funcionamiento se acercan o no del modelo previstado a dentro una perspectiva de llevar ajustos si necesario. Los resultados principales sobre la clientela, sobre las funciones asumidas por el equipo de gestión de caso y sobre la organisación del trabajo estan discudidos a la luz de otras investigaciones sobre la coordinación de cuidados y de servicios a personas ancianas en perdida de autonomia. Se hacen sugerencias a la vista de estos resultados y de los apuntados sobre la eficacia y de los costos de otra investigación para mejorar la eficacia de este modelo de coordinación de cuidados y de servicios a los ancianos. Sin ser generalizables de entrada componentes del modelo nuevo podrian ser reutilisadas con otras clientelas.Avaliação da implantação de uma experiência inovadora: rede integrada de serviços aos idosos de Bois-Francs Consciente da existência de problemas relacionados à coordenação dos serviços prestados aos idosos em seu território, a mesa redonda sobre os serviços de saúde e os serviços sociais de Bois-Francs na região de Mauricie e do Centro do Quebec implantou, em fevereiro de 1997, após dois anos de planejamento, um novo modelo de coordenação dos cuidados e serviços prestados às pessoas idosas com perda de autonomia. Este modelo é inovador porque ele inclui o balcão ou a porta de entrada única, a gestão de casos, o plano de serviços individualizado e a presença de três níveis de acordo: estratégia, tática e clínica. Ele também tem a particularidade de englobar todo o processo de cuidados e serviços prestados aos idosos. O presente artigo descreve os principais resultados da avaliação da implantação e do processo. Esta avaliação teve como objetivo documentar as atividades e funções centrais do mecanismo de coordenação dos serviços, para verificar em que medida o modelo implantado e seu funcionamento se aproximam ou não do modelo esperado e estudar as possíveis mudanças necessárias. Os principais resultados obtidos junto a esta clientela, nas funções assumidas pela equipe de gestão de caso e na organização de trabalho, são abordadas aqui e discutidas em relação a outros estudos sobre a coordenação de cuidados e de serviços aos idosos com perda de autonomia. Os autores trazem algumas sugestões com respeito a estes resultados, e aos que tratam sobre a eficácia e os custos, tirados de uma outra pesquisa para melhorar a eficácia e a eficiência deste modelo de coordenação de cuidados e de serviços prestados aos idosos. Sem que este novo modelo possa ser aplicado a todas as circunstâncias, várias de suas características poderiam ser utilizadas junto a outros clientes

Research resource environment in Canada. Gathering knowledge in advance to inform chiropractic research priorities.

Objective: To better understand the research resources and environment within the Canadian chiropractic profession. Methods: All members of the Canadian Chiropractic Association (n=7200) were invited to access an electronic survey on research capacity, activity, and resources. Canadian chiropractic stakeholder organizations received an invitation to participate in a related survey. Results: 505 CCA members completed the survey (7.0% completed response rate, 65% males, 19% with graduate degrees). Researchers (26 full-time and 67 part-time) produced over 530 authorships in the past five years. Clinical research and systematic reviews were the most common areas of involvement. Regular meetings were rarely reported between researchers and chiropractic stakeholder organizations. Stakeholders indicated using research for member education, negotiation with government or funders, direct inquiries, and increased credibility. Fewer than half of the organizations regularly evaluated their research needs. Conclusions: Chiropractic research resources in Canada are growing, but inconsistent communication and coordination between researchers and knowledge users persists. (JCCA. 2017 61(3):178-183) KEY WORDS: chiropractic, research, capacity, resources Objectif: Mieux connaitre les ressources et les conditions de recherche dans le domaine canadien de la chiropratique. Methodologie : Tous les membres de l'Association Chiropratique Canadienne (n = 7 200) ont ete invites a acceder a un sondage en ligne sur la capacite, les activites et les ressources de recherche. Les associations canadiennes de chiropratique concernees ont recu une invitation a participer a un sondage apparente. Resultats : 505 membres de la CCA ont repondu au sondage (taux de reponse de 7 %, 65 % des repondants etaient des hommes, 19 % etaient diplomes). Au cours des cinq dernieres annees, les chercheurs (26 a plein temps et 67 a temps partiel) ont publie plus 530 articles. La recherche clinique et les examens systematiques etaient les activites suscitant le plus d'interet. Des rencontres regulieres entre chercheurs et associations de chiropratique concernees ont ete rarement signalees. Les intervenants ont indique qu'ils effectuaient des recherches pour informer les membres, negocier avec le gouvernement ou des bailleurs de fonds, presenter des demandes de renseignements et accroitre leur credibilite. Moins de la moitie des associations evaluaient regulierement leurs besoins de recherche. Conclusions : Il existe de plus en plus de ressources de recherche en chiropratique au Canada. Mais on observe toujours un manque de coherence dans la communication et la coordination des efforts entre les chercheurs et les utilisateurs des connaissances. (JCCA). 2017 61(3):178-183) MOTS CLES: chiropratique, recherche, capacite, ressource

Intensive care unit clinicians identify many barriers to, and facilitators of, early mobilisation: a qualitative study using the Theoretical Domains Framework

Question: From the perspective of intensive care unit (ICU) clinicians, what are the barriers to and facilitators of implementing early mobilisation? Design: A qualitative study using focus groups, with analysis using the Theoretical Domains Framework. Participants: Physicians, nurses, respiratory therapists and physiotherapists from the ICUs of three university-affiliated hospitals in Montreal, Canada. Methods: Four focus group meetings were conducted with 33 participating ICU clinicians. Two researchers independently performed thematic content analysis on verbatim transcriptions of the audio recordings using the Theoretical Domains Framework. Results: Data saturation was reached after the third focus group. Thirty-six barriers were categorised in 13 domains of the Theoretical Domains Framework. The key barriers to early mobilisation were: lack of conviction and knowledge regarding the available evidence about early mobilisation; lack of attention to the provision of optimal care; poor communication; the unpredictable nature of the ICU; and limited staffing, equipment, time and clinical knowledge. Twenty-five facilitators categorised in ten TDF domains were also identified. These included individual-level facilitators (intrinsic motivation, positive outcome expectations, conscious effort to mobilise early, good planning/coordination, the presence of ICU champions, and expert support by a physiotherapist) and organisational-level facilitators (reminder system, pro-early mobilisation culture, implementation of an early mobilisation protocol, and improved ICU organisation). Conclusions: A broad array of barriers to and facilitators of early mobilisation in the ICU were identified in this study. Clinicians can consider whether these barriers and facilitators are operating in their ICU. These may inform the design of tailored knowledge translation interventions to promote early mobilisation in the ICU