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      An investigation of Australian osteopaths’ attitudes, skills and utilisation of evidence-based practice: a national cross-sectional survey

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          Abstract

          Background

          Osteopaths are an integral member of the health care team, playing a pivotal role in the provision of care for patients with musculoskeletal disorders. Osteopaths, like other health care providers, are under increasing pressure to deliver evidence-based health care and to improve patient outcomes. However, the extent to which osteopaths engage in evidence-based practice (EBP), particularly in Australia, is not well understood. This study therefore set out to investigate the attitudes, skills and use of EBP, and perceived barriers and enablers of EBP uptake, among osteopaths practicing in Australia.

          Methods

          National cross-sectional survey of Australian registered osteopaths. Eligible participants were invited by email and other digital media recruitment strategies to complete the online Evidence-Based Practice Attitude and Utilisation Survey (EBASE).

          Results

          A total of 332 osteopaths completed the survey. The demographic characteristics of respondents were generally consistent with the characteristics of the Australian osteopathy workforce. The respondents were mostly favourable of EBP, with the majority agreeing or strongly agreeing that EBP assists in making decisions about patient care (86.7%) and improves the quality of patient care (75.6%). While most respondents (88.3%) had some training in EBP, most reported a moderate level of perceived skill in EBP. The majority of respondents engaged infrequently (0–5 times) in EBP activities within the last month, and most indicated that a very small or small proportion of their clinical practice was based on clinical research evidence. Leading barriers to the uptake of EBP were lack of time and lack of clinical evidence in osteopathy. Key enablers of EBP uptake were access to the internet and online databases at work, and access to full-text articles and EBP education materials.

          Conclusions

          Osteopaths participating in the survey were largely supportive of evidence-based practice, yet engaged infrequently in EBP activities. An important next step in this research is to identify suitable strategies that effectively improve EBP uptake in osteopathy, and perchance, improve patient outcomes.

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          Most cited references48

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          Evidence-based medicine.

          Evidence-based medicine, whose philosophical origins extend back to mid-19th century Paris and earlier, is the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients. The practice of evidence-based medicine means integrating individual clinical expertise with the best available external clinical evidence from systematic research. By individual clinical expertise we mean the proficiency and judgment that we individual clinicians acquire through clinical experience and clinical practice. Increased expertise is reflected in many ways, but especially in more effective and efficient diagnosis and in the more thoughtful identification and compassionate use of individual patients' predicaments, rights, and preferences in making clinical decisions about their care. By best available external clinical evidence we mean clinically relevant research, often from the basic sciences of medicine, but especially from patient centered clinical research into the accuracy and precision of diagnostic tests (including the clinical examination), the power of prognostic markers, and the efficacy and safety of therapeutic, rehabilitative, and preventive regimens. External clinical evidence both invalidates previously accepted diagnostic tests and treatment and replaces them with new ones that are more powerful, more accurate, more efficacious, and safer. Good doctors use both individual clinical expertise and the best available external evidence, and neither alone is enough. Without clinical expertise, practice risks becoming tyrannized by external evidence, for even excellent external evidence may be inapplicable to or inappropriate for an individual patient. Without current best external evidence, practice risks becoming rapidly out of date, to the detriment of patients. The practice of evidence-based medicine is a process of life-long, self-directed learning in which caring for our own patients creates the need for clinically important information about diagnosis, prognosis, therapy, and other clinical and health care issues, and in which we (1) convert these information needs into answerable questions; (2) track down, with maximum efficiency, the best evidence with which to answer them (whether from the clinical examination, the diagnostic laboratory from research evidence, or other sources); (3) critically appraise that evidence for its validity (closeness to the truth) and usefulness (clinical applicability); (4) integrate this appraisal with our clinical expertise and apply it in practice; and (5) evaluate our performance.
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            Barriers to evidence-based medicine: a systematic review.

            Evidence-based medicine (EBM) has emerged as an effective strategy to improve health care quality. The aim of this study was to systematically review and carry out an analysis on the barriers to EBM.
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              Adopting evidence-based practice in clinical decision making: nurses' perceptions, knowledge, and barriers.

              Evidence-based practice (EBP) provides nurses with a method to use critically appraised and scientifically proven evidence for delivering quality health care to a specific population. The objective of this study was to explore nurses' awareness of, knowledge of, and attitude toward EBP and factors likely to encourage or create barriers to adoption. In addition, information sources used by nurses and their literature searching skills were also investigated.
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                Author and article information

                Contributors
                matthew.leach@unisa.edu.au
                tobias.sundberg@ki.se
                gary.fryer@vu.edu.au
                speedysherpa@yahoo.co.uk
                Oliver.Thomson@uco.ac.uk
                jon.adams@uts.edu.au
                Journal
                BMC Health Serv Res
                BMC Health Serv Res
                BMC Health Services Research
                BioMed Central (London )
                1472-6963
                17 July 2019
                17 July 2019
                2019
                : 19
                : 498
                Affiliations
                [1 ]ISNI 0000 0000 8994 5086, GRID grid.1026.5, Department of Rural Health, , University of South Australia, ; Adelaide, Australia
                [2 ]ISNI 0000 0004 1936 7611, GRID grid.117476.2, Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), , Faculty of Health, University of Technology Sydney, ; Sydney, NSW Australia
                [3 ]ISNI 0000 0004 1937 0626, GRID grid.4714.6, Musculoskeletal and Sports Injury Epidemiology Center (MUSIC), , Institute of Environmental Medicine, Karolinska Institutet, ; Stockholm, Sweden
                [4 ]ISNI 0000 0001 0396 9544, GRID grid.1019.9, College of Health & Biomedicine, , Victoria University, ; Melbourne, Victoria Australia
                [5 ]Department of Pain Management, Greenwich Hospital, Sydney, Australia
                [6 ]ISNI 0000 0004 0395 028X, GRID grid.468695.0, University College of Osteopathy, ; London, United Kingdom
                [7 ]Clinical-based Human Research Department, Centre for Osteopathic Medicine Collaboration (COME), Pescara, Italy
                Author information
                http://orcid.org/0000-0001-8151-7279
                Article
                4329
                10.1186/s12913-019-4329-1
                6637614
                31315615
                752112fa-25b3-436c-acd8-c11ed2845536
                © The Author(s). 2019

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 19 February 2019
                : 8 July 2019
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2019

                Health & Social care
                attitude,barriers,enablers,evidence-based practice,osteopathy,skill,survey,training
                Health & Social care
                attitude, barriers, enablers, evidence-based practice, osteopathy, skill, survey, training

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