This study used an augmented version of Kirkpatrick’s four-level model of training criteria as a theoretical framework to evaluate a hybrid teaching approach to continuing education (CE) for physical therapists who treat patients with low back pain. This model provides a framework for relating changes in practitioner knowledge to changes in practice. Forty-three orthopedic physical therapists who attended a CE course on evidence-based practice participated in the study. The hybrid CE course consisted of online (reading assignments and quizzes) and onsite components (traditional lecture and skill review laboratory). It addressed evidence for application of a clinical prediction rule to identify patients most likely to benefit from spinal manipulation treatment for low back pain. The participants received surveys to determine their preferences and frequencies for treating patients with low back pain prior to attending the CE course, 6 weeks and 6 months post-attendance. Self-reported use of lumbar spinal manipulation increased by greater than 47% 6 weeks and 6 months post-CE course participation. While preferential use of several of the interventions which were less supported by an evidence base decreased post-CE, the overall preference for use of lumbar spinal manipulation by course participants remained lower than expected.




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