Evidence-Based Physiotherapy: Physiotherapists Attitudes and Experiences in the Wessex Area - Essay Example

? Programme: Faculty: Unit: Number: Article Sue, B. & Rose, W. (2001). Evidence-Based Physiotherapy: Physiotherapists’ Attitudes and Experiences in the Wessex Area. Physiotherapy, Vol. 87 No. 3, pp: 115-124 Purpose This is a study done with the main aim of exploring physiotherapists’ views and experiences which they have accrued on evidence based practices. Further, the authors wanted to gain a deeper understanding of their understanding of the practices, their advantages and disadvantages is any and how they can be improved for replication. As Bury and Mead (1998) puts it, evidenced based practices have evolved for a long time and are much inclined to getting the best treatment and diagnosis based on both research and clinical trials. The basis of the research to use physiotherapists’ in conducting the research has acquired credibility since this are experienced persons in the area of physiotherapy and are best suited to advise on future use of the practices building on their various experiences (Newham 1997). Literature Review According to Mason (1996), research is supposed to inform and influence people and at the same time justify various actions employing new sources of knowledge. It is widely expected that readers will take the research findings word by word and thus it is important to support your assertions quoting other related works to make them credible. Literature review involves scanning entire pages of journals, books, magazines, speeches etc. and coming up with areas you consider as meeting points and applying in the writing to bring out the relationship. As Aveyard (2010) puts it, literature review is an integral part of any research report as it accords the researcher an important opportunity to strengthen the paper through the citing reliable authors who have previously dealt on the same topic. Review of literature gives readers the confidence that the area under study has been given serious thoughts by other writers. A paper without literature review will be containing only the author’s thoughts and opinions rendering it difficult for the researcher to convince the readers. As Newham (1997) puts it, a literature review is a sound foundation for the paper and the citation of other works makes the work worthy and useful as it will form a continuous foundation for future studies. The researchers of this paper have used reliable citations from other writers in the same field and have really created a sound basis for the paper and for future works in the area. The authors quoted are very few. The number should have been considerable in order to convince the readers that more reading prior to the actual research has actually taken place. However, the number of citations depends on other works on related topic. There are some topics which are yet to be extensively researched on and thus the minimal citations. The researchers have reviewed quite a number of writers to build up a valid and reliable paper. Using write-ups from other authors in the same field builds a strong foundation for the paper. Study Approach The researcher employed the use of qualitative research design and used focused group discussions and in-depth interviews to collect data for analysis. The use of the qualitative approaches is advantageous in that they generate general information/verbal information which is not in numerical form which is analyzed using the content or using holistic analysis approach. Further, in qualitative research study design, the researcher explains/comprehends the research findings using inductive reasoning. The researchers opted to use the qualitative approach in this study since qualitative data gathering method (e.g. focused group discussions and in-depth interviews etc.) are rigorous and flexible which means that changes and refinement of research ideas and setting are effected easily during study process (Hurley 2000; Creswell 2003). Qualitative data gathering tools are based on the general understanding the research setting. In addition, qualitative data gathering tools give rise to rich and well-grounded information/descriptions/explanations and other unforeseen information for future development or enrichment of the study findings. As Mays and Pope (1996) puts it, qualitative approach evokes more realistic research contexts not obtained by mere statistical analysis and numeric available through quantitative approaches.  The approach used by the researchers is valid and reliable in that, if quantitative approaches had been used, then they would be forced to formulate hypotheses for determination using the measurable data. Again, quantitative methods, being deductive, will require that the formulated aspirations of the researcher would be confirmed in an empirical manner using a data set (Kitzinger 1995). According to Hansen (2006), a hypothesis postulated in the quantitative method holds no value in many times as the question, so what? arises. In such a case, it means that the researchers’ thoughts and objectivity is influenced by subjective preferences and biases which are not applicable to this type of research.  Another positive in the methodology used was the consideration of a small group of physiotherapists from outside the designated region to ensure controllability of the findings. However, it would have been better if the researchers took into consideration other medical practitioners as participants. This would lead to an equal representation of the entire medical universe. Methodology The researchers used the focused group methodology and in-depth interviews. Focused group discussions are better placed in such kind of researches as it leads to more information and experiences which cannot be given in an administration tool (e.g. a questionnaire). This is so because the group discussions have been proved to be good data collection settings as participants are feel free and can give a lot of information while is a group as opposed to when alone. Further, other participants ideas may act as triggers for thought and make others remember past experiences which enrich the information. In-depth interviews are equally important in reliability. Focused group discussions help people in exploring and clarifying their views in better manner than during interviews. Such discussion also helps the researcher to capture the different forms of communicating. According to Kitzinger (1995), gaining access to a variety of communication is important since some of the ideas and concepts cannot be captured in certain settings. Research Ethics Before carrying out any research, researchers are required to adhere to some certain norms in order to promote the objectives of the research. To Moore (1997), this are also meant to ensure that erroneous conclusions and recommendations are not made which might later not be implementable. First of all it is important to bring the participants to the same level of understanding as the researcher. This will assist them in making an informed consent about their participation. In this research study, the researchers, took them through the objectives and introduced the entire research work giving the necessary explanations to aid in making informed consents, which the did through signing a form. This was a critical stage in the study as research ethics demands that participants have as much as possible about the study. Further, it is always important to explain to the participants of any benefits. Also, it is advisable to ensure that risks are minimized and benefits maximized (Shamoo and Resnik 2009). In research this is referred to as beneficence. Another important aspect and which was properly captured in the research study is the element of confidentiality of the collected data. This is evident through the transcribed focused group discussions. Confidentiality is an important means of ensuring responsiveness to participants’ information. In researches, no findings should be made public other than those across individuals. In the review report, the findings are first of all shared by the participants for validation and value adding. Research ethics further advocates for honesty, integrity and fairness for participants. This is meant to ensure justice of the participants. The researchers captured this aspect vividly by allowing equal chances to all participants eliminating the element of bias. All the above can be summarized using Shamoo and Resnik (2009) assertions that, in a research study where the participants are human, foreseen and unforeseen risks should me eliminated or minimized depending on their impacts. The participants should be accorded the necessary respect and be treated with the dignity they deserve. Further, they should be made aware that the information/data they are about to give will be treated with utmost integrity and care. Participants should be given a free will to make choices without being coerced. The researcher ensured that vulnerability is eliminated by categorizing the participants in terms of age and other factors to ensure that pertinent issues across the divide are captured without violating participants’ rights. All these issues are captured and taken into consideration in the entire research process. Sampling Sampling was done using random sampling. The population of physiotherapists’ was first determined through their management. Restriction was placed that for one to participate in the study had to be a physiotherapist and managing such services in a good setting. Such settings included having academic teaching ties, working in one of the eleven district hospitals or the thirteen community settings. Further, physiotherapists’ from any other university hospital outside the area were considered for the study to attain heterogeneity and thus enable generalizability of the research findings. Random selection allows equal chances for all thus reducing the chances of selection bias. A sample of 10-12 participants was selected for the focused group discussions. This is the ideal sample for a group discussion as they encourage freedom of expression and not a crowd where some participants will not be free to talk and express their ideas. Another important sampling aspect used by the researchers is the stratification of the participants into categories to ensure homogeneity in responses. A population is always stratified by several factors which renders their responses un-equal. For example, age group is an important factor since some old people cannot give their views in the presence of the youth and vice versa. Work environment also influences response outcome and it is important to get views based on the different working scenarios. If the results are meant for generalization, then more participants from other regions should have been considered. If not, a large sample should have been considered to increase the confidence level meaning that the findings fit a large area and not just a small area as is the case. Further, if found to be a problem getting participants from different other regions, the issue of snowballing can be used. In this case, the available participants will assist the researchers in identifying other persons (physiotherapists) from the other regions who can be participants. Snowball samples have advantages in that they are economical and 100% response rate is assured. The only disadvantage is that, snowball samples have almost the same traits and may end up being a large sample giving the same results; making no difference at all. Data Collection Focused group discussions and in-depth interviews were used in this case to collect data. The facilitators used guiding questions t set the discussions focus. The facilitators were guided by an experienced researcher to guide the process. The discussions were audio-taped and transcribed for confidentiality, privacy and security of the information. Further, notes were made of various observations made during the discussions. Observations are key in focused group discussion as they are used to bring coherence between what is being said and what is meant. Further, it shows the level of commitment from the participants. However, to get quality information, the researchers should have used a questionnaire with open questions first and then controlling the responses using the focused group discussions and the in-depth interviews. This would lead reliable and valid data. Data Analysis Since it was qualitative design method, analysis involved physical examination of the transcribed focused group discussions and the in-depth interviews. First the information was coded independently by two researchers to ensure validity and eliminate bias. One advantage of independent coding is ensuring that no information is lost during coding. Such systems ensure that the intended message from the participants is maintained throughout the study. Pertinent issues in the collected data were further analyzed using interpretive and reflexive approach in order to iron them out. Interpretive and reflexive approach in data analysis ensures that the misguided and un-informative analysis which may lead to erroneous conclusions and recommendations does not arise at all. To ensure comparisons between the different sampled regions, and having used a detailed questionnaire, it will have been important after coding to come up with cross-tabulations and if possible carryout Chi-square tests to establish the possibility of relationships and independence which are key factors in research outcome (Freed et al. 1991). Further, since qualitative research methodology was used, the researchers’ presented the findings in prose form, however, it would have been important to consider presenting the results in table form since this forms a bird’s-eye-view and are easy to understand even by non-physiotherapists thus making generalizability of the findings easier. Trustworthiness Trustworthiness of data means reading the same message from the data at any given time. According to Davies and Dodd (2002), data validity and reliability measures consistency since if not consistent then it is questionable. Such trustworthiness is pegged on all the research stages from problem definition to the final report. If the problem has some missing information, it means that research tool will have some missing gaps, leading questions and lack of accuracy. Further, the research questions and objectives should be clear as they guide the development of the research tool. The research tool should be in such a way that it is valid and appropriate for the study and should also be appropriate to the participants (Davies and Dodd 2002). To ensure trustworthiness of the data, the researchers first of all ensured that the data was investigated manually to avoid confusion whatsoever. Further, data coding was done independently for the focused group discussions and the in-depth interviews and this arrangement was put down. Interpretive and reflexive reading of the transcripts was done comparing the responses with the observational notes recorded during the discussions. This was meant to ensure that the potential influence of the responses are explored and determined. Another important aspect which was introduced after data analysis to ensure trustworthiness was the convening of a conference to seek consensus from participants who had participated in the research study. This was mainly to ensure that the reported findings are validated and other ideas incorporated in the final report (Denzin 1978). This in research is called attaining full cycle in that the researcher goes back to the starting point to gain a deeper understanding of the recorded responses. In case of any miss-understandings, then self-correcting takes place. According to Denzin and Lincoln (1998), validity and reliability of data can further be enhanced through asking the questions consistently and efficiently and the data collection session timings should be reasonable. In this case, the focused groups’ discussions took about one hour while the facilitator was under the supervision of an experienced researcher. This is a good practice since it maintains freshness of mind thus giving the participants able time to think properly. Further, the sessions should be practical. They should have a good number of participants; not too large and not too small. In this case, the participants for the focused group discussions were between 10 and 12. According to the researchers, focused group discussions with less than a certain number of participants did not meet the required threshold and hence no data collection was done in such cases. Usability is another area in which trustworthiness of data can be controlled. In usability, the researcher tries to understand the usability of the data collected. In this case, this is assured through the convening of the conference. If the data is not used as understood during collection and subsequent analysis, then the participants advise the researcher in coining a meaning to fit in the research objectives. Before the actual research study, in this case, the tool should have been tested for validity and reliability using the alpha test and confirming that the alpha values are greater than the allowed 0.7 (Strauss and Corbin 1990). If less than 0.7, the tool is said not to be reliable for the research study. Conclusions and Implications The conclusions of the research report are based on the findings generated from the collected data/information. The report states the importance of good understanding of the word ‘evidence based practice’ and creating awareness on the use of the practices in health service provision. This emanates from the fact different meanings and experiences were generated from the participants. Further, the reports notes that although integrating clinical trials and research findings to get the best medical solution is the best option, the linking of both may be difficult for the psychiatrist meaning that separation of duties is the only option resulting to more costly medical care and thus more deaths since the majority will not be able to afford the bills. Further, the research study report emphasizes the need for more research. The implication is, more practitioners will then be involved translating to a larger sample and higher precision. This further means that the findings can be easily generalized. Reference Aveyard, H., (2010). Doing a literature review in health and social care. 2nd edn. Maidenhead: Open University Press. Bury, T and Mead, J (Eds) (1998). Evidence-based Healthcare: A practical guide for therapists, Butterworth-Heinemann, Oxford. Creswell, J.W., (2003). Research design: Qualitative, quantitative and mixed methods approach. (2nd Edn). Thousand Oaks: Sage Publications Davies, D., and Dodd, J. (2002). Qualitative research and the question of rigor. Qualitative Health research, Vol. 12 No. 2, pp. 279-289. Denzin, N. K. (1978). The research act: A theoretical introduction to sociological methods. New York: McGraw-Hill. Denzin, N. K., and Lincoln, Y. S. (Eds.). (1998). The landscape of qualitative research: Theories and issues. Thousand Oaks: Sage Publications. Freed, M. et al. (1991). Handbook of Statistical Procedures and Their Computer Applications to Education and the Behavioural Sciences. NY: American Council on Education, Macmillan Publishing Company Hansen, E.C., (2006). Successful qualitative health research: A practical introduction. Maidenhead: Open University Press. Hurley, M (2000). Linking Research with Practice: The missing link – Collaboration. Physiotherapy, Vol. 86 No. 7 pp. 330-340 Kitzinger, J (1995). Introducing Focus Groups. BMJ Vol. 311, pp. 300-301 Mason, J (1996). Qualitative Researching. Sage: London Mays, N and Pope, C. (Eds) (1996). Rigor and Qualitative Research: Qualitative Research in Health Care, BMJ Publishing Group, London. Moore, A. (1997). Research, the Collaborative Approach: Clinicians and academics. Physiotherapy, Vol. 83 No. 5 pp. 220-234. Newham, D. (1997). Physiotherapy for best effect. Physiotherapy, Vol. 83 No.1 pp. 5-11. Peat, M. (1981). Physiotherapy: Art or science? Physiotherapy Canada, Vol. 33, pp. 170-176. Shamoo, A. and Resnik, D. (2009). Responsible Conduct of Research. 2nd ed. New York: Oxford University Press. Strauss, A., and Corbin, J. (1990). Basics of qualitative research: Grounded theory procedures and techniques. Newbury Park, CA: Sage Publications, Inc. Wainer, H., and Braun, H. I. (1988). Test validity. Hilldale, NJ: Lawrence Earlbaum Associates. Read More