Exploring knowledge, confidence and barriers to evidence-based practice implementation of self-management strategy for low back pain during chiropractic training in France: a mixed method study

Non-specific low back pain (NSLBP), with or without radiation, is a leading cause of global disability. International guidelines recommend that healthcare providers extend self-management support (SMS) to patients to alleviate pain and disability. However, the adoption of SMS strategies remains suboptimal. This study aimed to evaluate the levels of knowledge and confidence associated with adopting evidence-based practice (EBP) recommendations on SMS and identify related barriers and facilitators among interns and clinicians at the Franco-European Institute of Chiropractic (IFEC) outpatient clinic. Methods:Using an explanatory sequential mixed-methods design (quantitative then qualitative), chiropractic interns and clinicians completed two self-reported questionnaires assessing 1) the levels of EBP endorsement (EBP Belief Scale) and application (EBP Implementation Scale), and 2) clinical practice orientation (Pain Attitude and Belief Scale). Semi-structured interviews underpinned by the Theoretical Domains Framework (TDF) were conducted among survey respondents to identify the key barriers and facilitators toward implementing SMS. A total of 48 interns and 23 supervising clinicians participated in the quantitative strand, while 10 interns and 10 clinicians took part in the qualitative strand.Despite positive beliefs towards EBP, interns and clinicians encountered various obstacles in practical implementation. Key TDF barriers included lack of time to apply SMS, familiarity with guideline recommendations, communication skills, and concerns over the potential impacts if patients failed to perform exercises. Additionally, confidence in delivering SMS and the recognition that providing SMS aligns with chiropractic duties emerged as important facilitators. The data suggests that while practitioners demonstrate a solid level of knowledge regarding the use of EBP in patients with low back pain, their actual implementation of these strategies remains moderate. Qualitative analysis further highlights the presence of specific beliefs and attitudes that mirror those reported in other healthcare professions. Among the main barriers, significant challenges related to knowledge, skills, and resources—particularly the lack of time—appear to hinder the systematic application of SMS in clinical practice.