The effectiveness and feasibility of an online educational program for improving evidence-based practice literacy: An exploratory randomized study of US chiropractors

Michael Schneider, Roni Evans, Mitchell Haas, Matthew Leach, Louise Delagran, Cheryl Hawk, Cynthia Long, Gregory D. Cramer, Oakland Walters, Corrie Vihstadt, Lauren Terhorst

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9 Scopus citations


Background: Online education programs are becoming a popular means to disseminate knowledge about evidence-based practice (EBP) among healthcare practitioners. This mode of delivery also offers a viable and potentially sustainable solution for teaching consistent EBP content to learners over time and across multiple geographical locations. We conducted a study with 3 main aims: 1) develop an online distance-learning program about the principles of evidence-based practice (EBP) for chiropractic providers; 2) test the effectiveness of the online program on the attitudes, skills, and use of EBP in a sample of chiropractors; and 3) determine the feasibility of expanding the program for broader-scale implementation. This study was conducted from January 2013 to September 2014. Methods: This was an exploratory randomized trial in which 293 chiropractors were allocated to either an online EBP education intervention or a waitlist control. The online EBP program consisted of 3 courses and 4 booster lessons, and was developed using educational resources created in previous EBP educational programs at 4 chiropractic institutions. Participants were surveyed using a validated EBP instrument (EBASE) with 3 rescaled (0 to 100) subscores: Attitudes, Skills, and Use of EBP. Multiple regression was used to compare groups, adjusting for personal and practice characteristics. Satisfaction and compliance with the program was evaluated to assess feasibility. Results: The Training Group showed modest improvement compared to the Waitlist Group in attitudes (∆ =6.2, p < .001) and skills (∆ =10.0, p < .001) subscores, but not the use subscore (∆ = -2.3, p = .470). The majority of participants agreed that the educational program was 'relevant to their profession' (84 %) and 'was worthwhile' (82 %). Overall, engagement in the online program was less than optimal, with 48 % of the Training Group, and 42 % of the Waitlist Group completing all 3 of the program courses. Conclusions: Online EBP training leads to modest improvements in chiropractors' EBP attitudes and skill, but not their use of EBP. This online program can be delivered to a wide national audience, but requires modification to enable greater individualization and peer-to-peer interaction. Our results indicate that it is feasible to deliver an online EBP education on a broad scale, but that this mode of education alone is not sufficient for making large changes in chiropractors' use of EBP.

Original languageEnglish (US)
Article number27
JournalChiropractic and Manual Therapies
Issue number1
StatePublished - Aug 2 2016

Bibliographical note

Funding Information:
This research was made possible by Grant Number R21AT007547 from the National Center for Complementary and Integrative Health (NCCIH; formerly NCCAM) at the National Institutes of Health (NIH). The views expressed in this article are solely those of the authors and do not necessarily represent the official views of the NCCIH, NCCAM or NIH. We would like to acknowledge the assistance of our research coordinator Christine McFarland and senior research associate Kris Gongaware with the management of the survey website and data collection. There were also several faculty members from the participating chiropractic institutions who we would like to acknowledge for their assistance with developing the booster lessons: Barry Taylor, John Stites, Thomas Grieve, David Peterson, and Ron LeFebvre.

Funding Information:
The study was an open-label, prospective, parallel-groups randomized controlled trial with a delayed waitlist control. Volunteers came from a random sample of chiropractors who completed the first phase of the study. They were randomized using a computer-generated algorithm, prior to which group allocation was concealed from all participants and study personnel. The study was funded by the National Institutes of Health/National Center for Complementary and Integrative Health (R21 AT007547), with Institutional Review Board approval (exempt status) granted by the University of Pittsburgh (PRO12060417) and all other participating institutions. This study was conducted January 2013–September 2014.

Funding Information:
The online educational program was developed and adapted from competencies and resources created through previous National Center for Complementary and Integrative Health funded EBP educational grants awarded to four chiropractic institutions [11–15]. Participants were randomly assigned to either immediate access to an online educational program (training group) or a wait-list control group. Following randomization, participants in the training group were sent an e-mail with a link to the host website to register for the program and to create a user account; this provided access to the EBP program at no cost. Participants in the waitlist group were sent a different e-mail explaining that they would be receiving instructions about registration within 9 months. Both groups were given 30 days to register, after which the registration process was closed. The program was delivered on a Moodle learner management system at the host website.

Publisher Copyright:
© 2016 The Author(s).


  • Chiropractic
  • Evidence-based practice
  • Knowledge translation
  • Online education


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