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Faculty of Health Sciences

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Subject: search.filters.subject.Evidence-based practice

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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 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