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    The perceptions and experiences of Chiropractic Master’s students on practicing evidence-based practice during their clinical practicum at a teaching clinic in KwaZulu-Natal
    (2023) Tayob, Tasmiya; Varatharajullu, Desiree
    Evidence-based practice (EBP) integrates the best available research evidence in conjunction with clinical expertise with the consideration of patient values. A well-trained clinician should pose clinically relevant questions and access the clinically relevant literature to find, appraise, and use the best valuable evidence in routine clinical care. Patients who receive evidence-based therapy have better outcomes in comparison to patients who do not. Globally, EBP is accepted as a basis of healthcare professional education, which was initially used in medicine, but now extends to allied health professions. In order to achieve the best patient outcomes, healthcare professions should effectively incorporate adequate knowledge, skills and attitudes towards EBP into education programmes. The implementation of EBP is regarded as a key competence for the improvement of healthcare quality. Numerous professions have implemented EBP, such as nursing, physiotherapy, occupational therapy, social care, pharmacy, physical therapy, dietetics, podiatry, radiography, orthotics, speech and hearing therapy, psychology and chiropractic. Evidence-based practice has had an increasing impact on chiropractic education and its implementation in chiropractic care. The importance of EBP is essential as its implementation is a requirement at the Durban University of Technology (DUT) Chiropractic Day Clinic (CDC). Students are required to use EBP when managing and treating patients during their clinical practicum and, thus, it is essential that students are knowledgeable in EBP and know how to use it adequately. Aim of the study The aim of this study was determine the perceptions and experiences of registered Chiropractic Master’s students on the implementation of evidence-based practice during their clinical practicum at a teaching clinic in KwaZulu-Natal, South Africa. Methodology This study utilised a qualitative, exploratory and descriptive design. Purposive sampling was used, interviewing 14 Chiropractic Master’s students who have been clinically active for more than four months at a chiropractic teaching clinic in KwaZulu-Natal. Their perceptions and experiences with regard to the implementation of EBP were obtained through semi-structured interviews, which consisted of three key questions, encouraged by relevant probes. The data collected were stored electronically and then transcribed verbatim. Thereafter, the transcripts were coded and analysed by the researcher in order to identify themes along with relevant subthemes. The coded data were then interpreted by the researcher using the previously identified themes and sub-themes. Results There were four main themes identified in this study, namely perceptions and necessity regarding the roles of EBP; undergraduate education and its role in the implementation of EBP; the importance of clinical experience in the implementation of EBP; and the implementation of EBP. Overall, students had a positive perception with regard to EBP with some students reporting limitations to its practice, along with positive perceptions. The students believed that the chiropractic training at the DUT CDC provided a solid foundation but a lack of training in multiple aspects was found. These aspects are discussed comprehensively, including the insufficient training in theoretical and clinical aspects, as well as for pre-clinical preparation. In addition, limitations and barriers were identified, as well as measures of improvement in order to enhance the implementation of EBP were suggested. Conclusion In South Africa, this study is the first to explore the perceptions and experiences of Chiropractic Master’s students on the practice of EBP at a teaching clinic in KwaZulu Natal. The perceptions and experiences were based on various aspects, such as knowledge, application, skills, proficiency, confidence, support structures, training and challenges. Although Chiropractic Master’s students had positive perceptions regarding the implementation of EBP and found the chiropractic training at the DUT to have provided a solid foundation, there were suggested methods of improvement for the chiropractic curriculum to enhance the implementation of EBP. A lack of undergraduate training regarding EBP was one of the key factors that students found to have hindered a more efficient practice of an evidence-based approach. Therefore, it is recommended that the findings of this study be of aid to the Durban University of Technology Chiropractic Department to enhance the quality of the chiropractic curriculum by re-evaluating the context in which the concept of an evidence-based approach was set out in order to encourage EBP by students and consider a different, more coherent method of implementation.
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    A systematic review of the effectiveness of the use of the Activator Adjusting Instrument in treating spinal pain
    (2023-05-31) Melvill, Roxanne Patricia; Korporaal, Charmaine Maria
    Spinal pain is commonly encountered by chiropractors and there are several adjustment techniques used to treat spinal pain. Practitioners are required to practice evidence-based chiropractic care in order to best care for their patients and to provide information to guide informed consent. A systematic review provides a well-structured summation and analysis of the available evidence and the effectiveness of the intervention. An analysis would be able to determine the level of evidence in support of the use of the Activator Adjusting Instrument (AAI) in treating spinal pain. The AAI can be used as an adjustment tool (as the AAI technique) outside of the AMCT protocol and the AAI can be used within the AMCT protocol. Both of these uses of the AAI are included in this study. Objectives: The aim of this dissertation was to review published literature regarding the use of the AAI in treating spinal pain. The effectiveness of the use of the AAI in treating spinal pain was evaluated to present current evidence available for its use to treat the different areas of the spine in clinical practice. Method: A literature search was conducted with the following key terms: “Activator”, “Instrument Adjusting”, “Joint Dysfunction”, “Manual Therapy”, “Activator Technique”, “Activator Adjusting” and “Instrument assisted manipulation”. Databases searched were PubMed and Scopus. The articles were screened according to inclusion and exclusion criteria, after which a secondary hand and reference searches were performed. All electronic or paper English articles, which possessed the required key indexing terms, met inclusion and exclusion criteria, and represented randomised controlled study, non-randomised controlled study and observational study designs, were included. Data Collection and Analysis: Blinded review of the articles was then conducted by six independent reviewers, as well as the researcher, utilising the PEDro Scale (for randomised controlled trials), Newcastle-Ottawa Scale for (non-randomised controlled trials) and Liddle Scale (for observational studies). This allowed the methodological rigour of each article to be ranked. The ranking was compared to a critical appraisal of the article in order to achieve an overall decision with regards to the contribution of the article to the level of evidence to use the AAI in treating spinal pain. A total of 23 articles were identified and included in this systematic review. The review and ranking of these articles revealed limited evidence in support of the use of the AAI outside of the AMCT protocol (AAI technique) in the lumbar spine, sacroiliac, and coccygeal regions; however, there was no evidence in support of or against its use in the cervical, thoracic and full spinal regions. There is limited evidence supporting the use of the AAI within the AMCT protocol in treating the cervical spine. There is no evidence supporting or against the use of the AAI within the AMCT protocol for the remaining spinal regions. In the areas where limited evidence is available, spinal pain reduction as a result of the intervention (either AAI technique or AAI within the AMCT protocol) is comparable with the findings of manual manipulation. However, the majority of the spinal regions have no evidence available to base treatment guidelines and informed consent on, in clinical practice. Conclusion: Until further research is conducted surrounding the use of the AAI technique and the AAI within the AMCT protocol in the spinal areas where there is no evidence, practitioners are advised to use the AAI sparingly in these spinal regions, informing the patient of a lack of evidence, until such time as further studies have been carried out that produce reliable and valid evidence in these regions. It is evident that future research is required surrounding the use of the AAI technique as well as the AAI within the AMCT protocol in order for practitioners to apply evidence-based practice and compete informed-consent procedures with patients. Having more evidence in these domains will strengthen the literature and allow for improved clinical decision-making based on evidence that is of high quality and practical value.
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    A comparison of the perceptions, use and barriers to evidence based practice by chiropractors and general practitioners in the eThekwini municipality
    (2018) Koekemoer, Caitlyn; O'Connor, Laura; Padayachy, Keseri
    Background: Medicine was the first profession to embrace evidence-based practice (EBP) and has subsequently been the leading profession with its implementation. Many other healthcare professions, including chiropractic, have since embraced the EBP movement. Despite this acceptance, many practitioners report difficulty implementing it into practice. This study aimed to compare the perceptions, use and barriers to EBP by chiropractors and general practitioners (GPs) in private practice within the eThekwini municipality. Method: The study utilised a quantitative paradigm and a cross-sectional descriptive survey design. Once the Durban University of Technology (DUT) Institutional Research Ethics Committee (IREC) approval was obtained, chiropractors (n = 101) and GPs (n = 289) in private practice within the eThekwini municipality were invited to participate. A pre- validated questionnaire and letter of information and consent were administered by electronic mail or hand delivery. The data was analysed using SPSS Version 24.0, (IBM, Armonk NY, U.S.A.) and Statgraphics Centurion (Statgraphics Technologies Inc, Warrenton, Virginia, U.S.A.). A p-value <0.05 was considered as statistically significant. Descriptive and inferential statistics such as cross-tabulations, chi-squared and fisher‘s exact tests were utilised. Results: A 50.5% (n = 51) response rate from the chiropractor respondents and 50.9% (n = 147) with regards to the GP respondents was achieved with respondents having an overall positive perception of EBP, its necessity, use and benefit in patient care. The respondents also displayed a willingness to adopt and improve their use of and skills in EBP. The GP respondents‘ perceptions were more favourable towards the necessity of the application of EBP and the use of literature and research findings in daily practice when compared to those of the chiropractic respondents. The majority of respondents from both professions reported to read and use scientific literature and databases on a regular basis. Most of the GP respondents read scientific literature two to five times per week, while less than half of the chiropractic respondents reported to do the same. The greatest barrier to the use of EBP reported by both professions was insufficient time with significantly more GPs than chiropractors reporting it as their top barrier. Inability of the professional to generalise literature findings to their patient population and inability of the professional to apply research findings to individual patients with unique characteristics were the next main barriers experienced by both professions. Significantly more chiropractic than GP respondents ranked their inability to apply research findings to individual patients with unique characteristics as their top barrier to EBP. Lastly, significantly more chiropractic than GP respondents ranked a lack of collective support among their colleagues in their facility as their greatest barrier to EBP. Conclusion and Recommendations: Both professions were found to have a positive perception of EBP and to be utilising scientific literature and databases regularly. A lack of time was the greatest barrier to the use of EBP, a finding similar to studies conducted with other healthcare professionals. Mechanisms need to be developed to aid practitioners to make time for EBP.
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    The knowledge, attitudes, perceptions and perceived barriers of chiropractors within the eThekwini Municipality towards evidence-based practice
    (2018) Naidoo, Divashni; O'Connor, Laura; Mshunqane, Nombeko
    Background ABSTRACT In the chiropractic profession, it has been an established goal to utilise evidence-based practice (EBP) in clinical practice in order to empower chiropractors to develop effective treatment protocols. However, the extent to which chiropractors are utilising EBP, and the factors associated with its implementation in practice is unknown. The lack of research in this regard suggests that further studies need to be undertaken within the chiropractic profession in South Africa in order to fully understand the relationship of factors which contribute to the adoption and application of EBP by chiropractors in clinical practice. Therefore, the aim of this study was to investigate the knowledge of, attitudes towards, perceptions of and perceived barriers towards EBP by chiropractors within the eThekwini municipality. Method A pre-validated cross sectional descriptive survey was administered to chiropractors practicing within the eThekwini municipality (n = 101) by hand delivery. The questionnaire was validated by means of a focus group and pilot testing. Participants gave informed consent prior to participation. Data were analysed using using SPSS Statistics 24.0 and Statgraphics Centurion 15.1 (2006) to determine the descriptive and inferential statistics while the open- ended questions were analysed qualitatively using manifest coding. Results A response rate of 51% (n=51) was obtained. The majority of respondents were male (51%), mean age of 37.8 years, practicing for less than 19 years, working in full time practice (76.5%) between 40 and 49 hours per week (45.1%). The majority of the respondents had a positive attitude and perception towards EBP with respondents showing a willingness to improve skills (72.6%) and utilisation (52.9%) of EBP. Respondent 15 explained that “it is very important to have the skills in order to utilise EBP. Once you have the skills, utilising EBP becomes easy”. Responses highlighted that respondents are engaging with scientific literature when necessary and possess the skills necessary to utilise EBP. The majority of respondents believe that they had a strong academic foundation in their knowledge and skills related to accessing and interpreting information, yet 47.1% reported not having received formal training in search strategies to access literature. However, most felt confident about their knowledge and skills to utilise EBP. Insufficient time (66.7%), lack of generalisability of the literature findings to their patient population (49.0%) and the inability to apply research findings to individual patients with unique characteristics (45.1%) were the three top barriers identified. Respondent 12 described: “most articles are vague or time consuming and searching for relevant, up to date and reliable articles is a difficult process that can take a lot of time” as a possible barrier to utilising EBP. Conclusion The respondents in this study had a favourable attitude towards, and perception of, EBP and its usefulness to chiropractic practice. However, like other healthcare professionals they felt that they had insufficient time to utilise EBP. This study also highlighted the importance of academic institutions providing the necessary skills required to utilise EBP. It is recommended that workshops focusing on EBP principles and training are arranged to assist practitioners in integrating EBP into practice
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    The knowledge, attitudes and perceptions of health care professionals at the Mahalapye District Hospital about the World Spine Care model in the Central District of Botswana
    (2018) Chihambakwe, Mufudzi; O'Connor, Laura; Orton, Penelope Margaret
    Background: The World Spine Care (WSC) is a non-governmental organization that provides evidence-based spinal care to underserved communities around the world. The WSC opened a clinic in the Mahalapye District Hospital (MDH) in 2011 (Haldeman et al., 2015:2304). The WSC aims for long term presence in Botswana. They will require ‘buy in’ from the local community including the health care professionals of the region. Little is known about how WSC has been received by other health care professionals in the settings where they are present. Hence, this study aimed to determine the knowledge, attitudes and perceptions of health care professionals working at the MDH about the WSC. Method: A qualitative exploratory descriptive study was conducted using semi-structured interviews. Twenty health care professionals were interviewed at the Mahalapye District Hospital to ascertain their levels of knowledge, attitudes and perceptions. The interviews were semi- structured and conducted in English and later transcribed verbatim. The transcripts were then analyzed using the thematic analysis described by Graneheim and Lundman (2003:105). Thereafter codes, categories and themes were formed. Results: A variety of health care professionals from different departments were interviewed. Three overarching themes emerged from the data: knowledge of WSC and the management of spinal related disorders at the MDH, the perceived role of WSC, challenges to integration and possible solutions. The HCPs had varying levels of knowledge of the WSC depending on the amount of interaction they had with WSC. Some HCPs who had greater inter-professional interaction with WSC displayed more positive attitudes towards WSC. Many of the HCPs had a positive perception of the WSC though they were not confident in their knowledge of the WSC scope of practice which has limited referral by HCPs WSC. This is mainly due to an unclear referral pathway within the hospital and limited knowledge of WSC’s scope of practice. Increased awareness and an improved system of referral was a strong recommendation made. Many mentioned an unclear referral pathway for their patients. Those who had interacted with WSC generally had pleasant personal interactions with the WSC. Several of the HCPs had themselves been patients of the WSC. Most HCPs felt that WSC was beneficial to patients and made suggestions for WSC to expand to other centres across Botswana. Conclusion: Overall there was a positive perception of WSC however more effort to increase knowledge of what WSC offers and how it can be integrated into the hospital is necessary. Future studies should assess the perceptions of patients as well as knowledge and attitudes of HCPs towards WSC at other sites.
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    An investigation into the patient management protocols of selected cervical spine conditions by chiropractors in KwaZulu-Natal
    (2016) Lombard, Barend Jacobus; De Busser, Nikki Lauren
    Background: Neck pain is an extremely common condition and the treatment of neck pain forms an integral part of chiropractic practice. The optimal treatment of neck pain is provided when practitioners incorporate available evidence, experience, and knowledge regarding the clinical presentation of the patient into their treatment regimes. Current evidence suggests that a combination of manual therapy, specifically manipulation and/or mobilization, and rehabilitation may offer the optimum treatment for mechanical neck pain. However, numerous factors other than available evidence, experience and clinical presentation may influence treatment choices made by practitioners. Through the assessment of practice patterns, one may asses if the optimal treatment for a neck pain is being provided by practitioners and assess if factors specific to a practitioner may influence the treatment of neck pain. Objectives: The aim of this study is to determine the chiropractic treatment and management of mechanical neck pain, to compare this to evidence based recommendations for the conservative treatment of mechanical neck pain and to assess if factors other than the available evidence may influence the treatment of mechanical neck pain. Method: A quantitative, cross-sectional descriptive survey compiled using available literature and validated by means of a focus group and pilot testing, was administered to chiropractors practicing in KwaZulu-Natal. Upon completion of the questionnaire, the data was coded into an Excel spread sheet and imported into IBM SPSS version 20 for statistical analysis. This research protocol was approved by the Durban University of Technology Institutional Research Ethics Committee (REC 82/13) and the study took place from March to July 2014. Results: Ninety-six practitioners responded to the study which is a response rate of greater than 70%. Practitioners favoured the use of spinal manipulation, auxiliary therapeutic techniques (specifically those which were manual in nature), rehabilitation, and numerous forms of education. Specific variations in treatment pattern existed when comparing various patient presentations indicating that practitioner based factors impacted on treatment choices made by practitioners. The most significant findings included the increased utilisation of auxiliary therapeutic techniques by female practitioners, the increased utilisation of traction by practitioners identifying with the straight philosophy of chiropractic. Other significant findings included the increased utilisation of cervical collars by practitioners of increased age and experience and the increased utilisation of auxiliary therapeutic techniques by practitioners who did not attend health related conferences at least once every second year or did not attend short courses or subscribe to journals or magazines since qualification. Conclusions: This study indicates that treatment for mechanical neck pain offered by chiropractors in KwaZulu-Natal is in line with current evidence based recommendations for the treatment of mechanical neck pain, with practitioners commonly using modalities which were recommended, whilst rarely using modalities which were not recommended. The use of rehabilitation was, however, slightly lower than expected. Patient presentation and practitioner based factors were found to influence the treatment of mechanical neck pain; however, as a whole these variations were small with the majority of practitioners favouring the use of modalities which were recommended within the literature. Future studies should address the gap in the literature regarding the conservative treatment of cervical radiculopathy.