Abstract
Background: Evidence-based practice, the ability to systematically evaluate and critically appraise research
in the literature and apply its findings in clinical decision-making is a pertinent framework in the support of
quality improvement in healthcare. Whilst chiropractors are essential providers of neuromusculoskeletal
healthcare, the extent to which chiropractors consult with research findings in their decision-making is
unclear. Little research pertaining to evidence-based practice in South Africa exists and thus more is required
to determine the attitude and utilisation thereof by chiropractors and assess how it compares to chiropractors
and health professionals in other regions.
Aim: To identify the attitudes and utilisation of evidence-based practice by chiropractors in South Africa.
Method: A cross-sectional, descriptive, quantitative analysis using the Evidence-Based Practice Attitude and
Utilisation Survey (EBASE). The EBASE questionnaire was originally developed by Leach and Gilham (2008)
to assess the attitudes, skills and utilisation of evidence-based practice amongst practitioners of the
Complimentary Alternative Medical (CAM) practices. In this study, the EBASE questionnaire was adapted to
assess the attitudes and utilisation of evidence-based practice amongst South African Chiropractors.
Methodology made use of an online self-administered survey of which was distributed to chiropractors across
the country. Databases of the Allied Health Professions Council of South Africa (AHPCSA) and Chiropractic
Association of South Africa (CASA) were utilised in the distribution of the survey link to members.
Procedure: Registered South African chiropractors were sent a survey link along with an information letter
and consent form via the utilisation of AHPCSA and CASA databases. If chiropractors were interested in
partaking in the survey after reading the information letter, they could click ‘agree’ and thereafter answer the
survey anonymously. The survey took approximately 10 minutes to complete.
Results: A total of 132 chiropractors completed the EBASE questionnaire, yielding a response rate of
14.35%. The majority of respondents were female, between the ages of 26 and 35, graduated after 2010
and had CASA membership. Majority of respondents agreed or strongly agreed that evidence-based practice
was necessary in the profession of chiropractic. A high proportion of the respondents considered themselves
to have above average skillsets in identifying answerable clinical questions, applying research evidence to
patient cases, sharing evidence with colleagues and using findings from clinical research. However, majority
indicated having below average to poor skills in conducting clinical research (i.e., clinical trials). Most
respondents expressed the domains of evidence-based practice to be a major component of their
chiropractic education, with the exception of conducting systematic reviews or meta-analysis in which
majority expressed having little to no training. Majority of participants had read or reviewed 1-5 pieces of
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professional literature or clinical research findings in the preceding month, with the minority having read more
than 16. Majority of chiropractors based a moderate (51-75%) proportion of their practices on clinical
research, with majority rating their most frequently used source of information in clinical decision making as
published clinical evidence. Minor to moderate barriers identified by the majority in the uptake of evidencebased
practice include lack of time as well as lack of clinical evidence in complementary alternative medicine.
Majority of respondents identified all facilitators as ‘very useful’ in the uptake of evidence-based practice.
Conclusion: The respondents of the survey displayed generally positive attitudes towards evidence-based
practice. Majority of participants considered themselves skilful in its implementation and expressed using
principles of evidence-based practice in their day-to-day lives. Relatively low number of barriers exist in the
uptake of evidence-based practice, with the exception of lack of time. Further research regarding evidencebased
practice is encouraged, especially at an undergraduate level.