To our knowledge this study represents the first survey of practicing DCs directly related to EBCP. We found that participants held favorable attitudes toward EBCP and consider this model to be an important component for the current practice and advancement of the chiropractic profession. The positive perceptions reported in this survey are comparable to the positive self-reported perceptions of other healthcare professionals [26–29, 31–34]. Our results suggest that the majority of DCs with diplomate-level training in orthopedics embrace EBCP while serving as the first measure of EBCP perceptions within a subset of practicing DCs.
Respondents reported the majority of their EBCP knowledge originated from the postgraduate orthopedic diplomate training program. While postgraduate training in chiropractic orthopedics may incorporate aspects of EBCP, these competencies are not officially part of the curriculum (ACO Executive Board, personal communication, July 2, 2013). Despite this, it is evident that chiropractic orthopedic diplomates perceive their postgraduate educational program as a source of EBCP training. It is likely this originates from the informal inclusion of EBCP concepts into the training program.
This survey found that the majority of respondents were interested in having access to EBCP educational material. These findings are consistent with the results of other surveys intended to highlight factors facilitating EBCP in other healthcare disciplines [26, 29, 34]. Current continuing chiropractic education opportunities focused on the principles of EBCP are uncommon and may represent an unmet subject area. Also, because the Council on Chiropractic Education has recently established EBCP competency requirements for U.S. chiropractic education,  providing postgraduate EBCP educational opportunities for DCs trained prior to the implementation of these educational competencies is important. Future efforts should be directed toward developing focused postgraduate EBCP educational opportunities for DCs.
The information sources used to inform clinical decision-making reported in this survey were nearly identical to those used by other CAM practitioners . These findings prioritized clinical information obtained from traditional knowledge, published clinical evidence, and clinical practice guidelines as the most frequently used source of clinical information. Interestingly, patient preference was rated as one of the least frequently used sources of information. Because the primary objective of EBCP is to integrate the clinician’s clinical expertise, the patient’s values, and the best research evidence,  these results may indicate respondents de-emphasize incorporating the patient’s preference into clinical decision-making. Traditional knowledge was also reported as the most common source of information for clinical decision-making. Unfortunately, traditional knowledge was not further defined and we are uncertain how each respondent interpreted this source of information. Whether respondents assumed traditional knowledge to indicate intuitive ways of knowing or knowledge resulting from clinical experience has a substantial impact on the interpretation of this finding. Further refinement of this response identifies an area of improvement for future evaluations of the Chiropractic E-BASE questionnaire. A persistent criticism of EBCP is that it neglects aspects of clinical decision-making not resulting from clinical research,  even though the core concept of this model is to incorporate the clinical expertise, patient preference, and the best available evidence when making clinical decisions . Whether DCs perceive clinical decision-making to originate from the amalgamation of clinical experience, patient preferences, and the best available research evidence is another area of improvement for future refinement of the Chiropractic E-BASE questionnaire.
It is imperative that the results of this survey be considered in the context of self-rated perceptions. It has been argued that the accuracy of self-reporting is poor  and result in over-estimating competence of actual EBCP performance and knowledge [27, 38, 39]. Future investigations into whether responses to the Chiropractic E-BASE questionnaire are associated with actual performance are warranted. It is also important to assess the EBCP perceptions of a broader sample of DCs.
This project has 3 important limitations. First, while every attempt was made to maximize the response rate, we are unable to assess the generalizability of our sample to the total population of chiropractic orthopedic diplomates. Our sample was a convenience sample of ACO members limited to those with email addresses who did not previously opt-out from SurveyMonkey™ surveys.
Second, the pretesting phase of the Chiropractic E-BASE questionnaire for this project was not a substitution for formal validation techniques. Validation of the Chiropractic E-BASE questionnaire is an important next step in this line of inquiry. Therefore, the results of this survey are descriptive and are intended to inform future development of the Chiropractic E-BASE questionnaire.
Lastly, the number of respondents decreased as the survey progressed through each section, presumably from dropout. There were 15 respondents who failed to complete the survey, which corresponds to 10% of all respondents. Respondents who failed to complete to survey were not contacted to investigate the reason for dropout.