Usage of Evidence Based Medicine Resources in Clinically Practicing Athletic Trainers

Context: Evidence based medicine (EBM) is a commitment to utilizing a combination of the best available evidence, clinical expertise, and patient preferences to inform clinical decisions. The primary goal of EBM is to provide the highest quality care to patients. Clinicians who do not utilize an evidence-based approach to clinical practice run the risk of denying patients potentially beneficial treatment options. Efficient access to evidence based resources is a crucial part of appropriately implementing EBM in athletic training practice. Therefore, poor accessibility could be a major barrier to implementing an evidence-bases approach to clinical practice in athletic training. Objective: The purpose of this study is to examine the how practicing athletic trainers\u27 (ATs) access literature within the participant\u27s clinical setting. Additionally, a second purpose is to determine the AT\u27s ability to formulate clinical research questions in order to find information related to participant\u27s patient population. Lastly, to examine whether ATs are utilizing evidence based sources (Journal Articles, Databases, and Textbooks) and non-evidence based sources (colleagues, internet forums, and anecdotal evidence) when looking for information to assist clinical decision making. Patients and Other Participants: A total of 155 (15.5% returned) clinically practicing ATs participated in the study. Participants were selected from a randomized list of 1,000 National Athletic Trainers\u27 Association (NATA) members who are certified membership status. Results: Nearly all of ATs surveyed did have access to current research through professional journals (96.8%, n=150) internet, and applicable databases (91.6%, n=142). Of those who did not have sufficient access, between (65.2%, n =101) of participants cited most commonly no subscription to medical or allied health journals as the barrier to applicable research. Of the internet resources utilized for across all 5 scenarios, the most commonly utilized internet resources included: Google (36.0%, n=56) and PubMed (33.4, n=52). The number of keywords selected were very comparable amongst four of the scenarios for clinical question 1 (3.72+/- 1.50), clinical question 2 (3.37+/-1.06), clinical question 3 (3.71+/-7.23) and clinical question 4 (3.42+/-1.10). Clinical question 5 demonstrated an average of (3.53+/-1.738) which is consistent with the forced choice options for the other four scenarios. Chi Squares were conducted to determine relationships between EBM training, accessibility, perceived confidence, and employer support. There was a significant relationship between availability of evidence based resources via professional journals and employment settings. Training in EBM and PICO both had a significant relationship on access to internet and internet databases. There was a statistically significant relationship between employer support and access to internet and internet databases but no significant relationship in access to professional journals. A significant difference was found between confident in finding EBM resources and internet and internet databases. PubMed, Ebsco Host, and Cochrane were valued at +1 for an EBM resource. Google and Internet Forums were -1 for a non-evidence based resource. Other was valued at 0 as the responses were both EBM and non-EBM resources. The scenarios that reflected the highest amount of evidence based resources was scenario 2 (0.13) and scenario 5 (0.12) regarding concussions and chronic ankle instability, respectively. Conclusions: Based on this information gathered through this prospective exploratory study, the majority of ATs have sufficient access to professional literature and knowledge of EBM concepts, but EBM is still not being utilized in the clinical setting. Despite high levels of accessibility to evidence-based resources the usage of non-evidence based resources remains high among ATs in all clinical settings. Resources such as Google and internet forums are most convenient but often do not contain high levels of evidence. Athletic trainers must be cautioned when utilizing non-evidence based resources and encouraged to seek out the best possible evidence available when looking for guidance for clinical decision making. This is suggestive that obstacles exist between EBM education and clinical application. Further education is required to educate ATs about the importance of EBM, translating conceptual EBM to practical applications, for the primary purpose of improving patient care and encouraging the growth of the athletic training profession. (Abstract shortened by UMI.)