Providing Treatment to Patients with Chronic Lower Back Pain - Assignment Example

 Physiotherapists’ Pain Beliefs and Their Influence on the Management of Patients With Chronic Low Back Pain Critical Appraisal Introduction The purpose of this paper is to identify the role played by physiotherapists’ beliefs in providing treatment to patients’ with chronic lower back pain. In order to identify if the selected research performed by Daykin and Richardson (2004) on the subject matter provides conclusive evidence that would lead to acceptance of the hypothesis presented earlier, this critical appraisal is performed with the help of Critical Appraisal Skills Programme (CASP) meant for qualitative studies. CASP is considered as an effective tool to identify if the research performed is sound enough and has substantial accountability to be included into practical interventions. Appropriateness of the Research Aim Following CASP allows the researcher to evaluate if the research question illustrated is elaborated and clear enough or not. After evaluating the research question presented in the beginning of the research paper, it was identified that the research question entailed the generalized view of research aim. Careful analysis of research question indicated that the research would require collection of data from different sources and rigorous data handling techniques for identifying emerging themes. However, it did not include the impact of patients’ profile and related physiotherapists responses on patient’s behaviour. However, the research aim appeared to display physiotherapists’ behaviour as an independent factor with no effect of other variables such as their own ethnic and social backgrounds on it. The research question usually investigates the importance of the research, earlier work in the same field and need for further exploration. Considering this criterion, overall research does answer the given questions, however its relevance to acute diseases and patients’ reactions is difficult to determine. The research question also fails to define how this research fills in the gap left between previous studies and desired level of information available (Haber and Lobiondo-Wood, 2008). On the other hand, there is a significant literary evidence present that defines how believing in what patient says affects the practice of a healthcare professional, the research question needed to define how patients’ input avoids making physiotherapists act like a novice but makes them prone to error caused by informative noise (Clarke and Iphofene, 2005; Jenson et al., 1994). Appropriateness of Qualitative Research Method Qualitative research can be defined as "any kind of research that produces findings not arrived at by means of statistical procedures or other means of quantification" (Strauss and Corbin, 1990). In scenarios where data collection involves personal histories and explanation of experiences and beliefs, in-depth interviews are more appropriate than any other qualitative method (Pope and Mayes, 2000; Denzin and Lincoln, 2000). Qualitative research usually requires rigor for the purpose of deriving relevant themes out of an extensive pool of data. Since this kind of research method does not provide any quantifiable and definite results, therefore it is important that data is handled using an exhaustive approach. For this particular study, the researchers have chosen to use triangulation of data gathered from multiple resources. According to Smith (2009), data triangulation adds to the rigour in data analysis and handling which further acts as a criteria for strength of evidences. The research method selected by Daykin and Richardson is further supported by Grounded Theory which is used as a tool for formation of defined themes leading to formation of a theoretical framework. Grounded theory itself is a rigorous method that entails drilling down the information from general data with the help of pre-established determinants leading to development of themes that later on help in evaluating the research outcomes (Mills et al., 2006). The selected research method, however managed to reduce noise introduced by gender-based differences with the help of selecting equal number of male and female subjects. Appropriateness of the Research Design In the light of selected research method, research design is selected appropriately. The research design entails interaction between the researchers, physiologists and selected subjects at six instances whereas the interaction took place before and after assessment and after patient’s discharge. This interaction at least six instances allowed the researchers to examine the alterations in the beliefs of physiotherapists in response to changes in interventions, related disclosures and other social factors. For the purpose of adding rigour to the data handling, research design entailed exhaustive analysis of individual interviews of patients and physiotherapists along with assessment observation to include behavioural patterns during actual sessions. Triangulation of data retrieved from different sources i.e. patients and physiotherapists views and researchers observation, helped in identifying the patterns and themes relevant to the research question since this technique appears to be efficient in qualitative research. Careful analysis reveals that overall research design does not employ any tool to mitigate biases that are inherent with diversity in patient’s backgrounds and personalities. Data analysis was supported by employment of Grounded theory that enabled the researchers to identify events of deviance and their respective causes along with related impacts on research design. Constant evaluation of developed codes and their amalgamation into common themes helped in development of conclusive evidence. Appropriateness of Recruitment Strategy to the Aims of Research The research was conducted in UK which has a centralized national health care mechanism. The selected sample consisted of randomly selected patients and physiotherapists that belonged to varied background. The element of random selection removed skewness from the selected sample. However, where it is assumed that work environment and professional model of the employer has a direct influence on the behaviour and philosophies of the employees, it can be expected that perceptions and beliefs of physiologists employed by NHS can be different from those employed in other healthcare settings. Therefore, application of this research on other health care systems i.e. private hospitals, individual practitioners, social work authorities, geriatrics specialists, can be difficult due to lack of generalization. Secondly, no indication has been provided as to why the selected sample size is suitable for the research aim. Where the selected sample inferred that almost all of them used biomedical approach, the research failed to recognize the possibility of population having biopsychosocial approach and related changes in the interventions used by them. There is a significant amount of research present which support the idea that patient’s perception of their illness and related pain is affected by organic instead of psychological beliefs (Pons et al., 2012). Application of such notion would affect the basic perception of this selected research methodology as it considers patients’ psychological beliefs as the empirical part of the received responses. On the other hand, number of heads recruited for the purpose of this research is rather limited. Similar research conducted by Clarke and Iphofene (2005) and Jenson et al. (1994) has recruited more than hundred subjects. Selection of limited sample gives rise to the doubts arising due to sample error. Collection of Data and its Relativity to Research Aims Data collection for this research has been performed with the help of primary data collection through semi-structured interview questions and assessment observation. As stated earlier, in-depth interviews is the most appropriate method used for data collection where participants’ personal beliefs and experiences bear certain value for the research objectives (Denzin and Lincoln, 2002). It was assumed that whatever information was being provided, it had some relevance to the research aim. Although semi-structured questions allow the respondents to provide information on the basis of their background and personality profile, the belief that all the input is relevant leads to noise in collected data that compromises the validity of that input. No apparent measures have been taken to reduce biases attached with the questionnaires. On the other hand, frequency and selected intervals of data collections seem appropriate for understanding the transitions in the perceptions and beliefs of two types of samples. Relationship between Researcher and Participants & Other Ethical Considerations The research methodology entailed that necessary ethical approvals had been taken from the ethical committee before commencing the research. On the other hand, ethical consent has been taken from the participants of the research. The use of pseudonym ensured that the information of the participants had been kept confidential from the recipients of this research. Further, ethical compliance of professional codes of conduct also requires the researcher to show that research, and information acquired will not be used to cause any physical and psychological harm to any human participants and use of radioactive, biological and hazardous material shall be abstained (BPS, 2010; Smith, 2003; NHMRC, 2007; OOR, 2003). Sufficiency of Data Analysis The work of Daykin and Richardson (2004) entails in-depth discussion of the analytical process. From recruitment of applicants to research methodology employed, the methodology used allows the researchers to analyze data in the presence of pre-determined variables such as background of the participants. According to Jeanfreau and Jack Jr. (2010), data collection and method triangulation leads to more rigour in data handling and adds further credibility to the evidences acquired as a result of data analysis. Such data analysis and handling helps in identifying theory that is present in the information gathered for the purpose of research with the help of investigating, documenting and describing the knowledge, experiences, behaviour, opinions, values, attitudes and/or feelings of the individual study subjects in relation to a phenomenon (Smith, 2009). Application of Grounded theory illustrates that data undergoes rigorous analysis and data is drilled down through line by line analysis, and comparative study leads to development of themes after focused coding (Charmaz, 2006). Inputs given by the physiologists and their patients were compared and imperative analysis lead to development of focused codes. Further generalization of these codes and identification of the common elements in research findings lead to development of a theory which states that there is definite relationship between physiologists’ beliefs and their respective practices. Sufficiency of data analysis is evaluated on the basis of its simplicity, coherence, completeness, robustness and relevance to the audience. Evaluation of the data analysis sufficiency on the basis of this criterion helped in reaching a conclusion that rigorous data analysis has been performed which helped in identification of common themes from multiple interviews and observations (Richards, 2005; Bazeley, 2007). Data analysis is further required to be trustworthy, credible, transferable, dependable and confirmable. However, in the given research, data analysis bears other three characters; its transferability to general population is doubtful due to risk of sample error. Appropriateness of Mixed Research Method vs. Qualitative Analysis Where usage of grounded theory is appropriate in qualitative studies, it seems more suitable in social sciences instead of biological studies. Furthermore, there are various research methodologies available that helps in providing quantitative data for identifying the outcomes. These quantitative research methodologies facilitate the use of scientific questionnaires such as Oswestry Disability Questionnaire, the Screening Questionnaire for predicting outcome in acute and sub-acute back pain, the Chronic Pain Coping Inventory (Pons et al., 2012). Usage of such quantitative research along with the selected grounded theory would have helped in reducing the bias arising from patients’ perception of the pain. Clear Statement of Finding Discussion of the data gathered and respective conclusion lead to a statement of findings which illustrates that the participating physiotherapists’ beliefs about pain and its management influenced the outcomes of therapeutic encounters with patients having chronic low back pain. Followed by the statement of findings was a detailed discussion of the themes that emerged during the course of research. These themes were segregated into three parts that involved development of craft knowledge, good and difficult patients and pain beliefs within the therapeutic encounter. Development of themes illustrated that patients’ mileage plays a vital role in physiotherapists’ confidence. Clinical examination of similar patients previously helps the physiotherapists gain understanding of the said patient. Without actually acquiring patients’ mileage, physiotherapists consider themselves being incapable or less capable of conducting patients’ assessment and suggesting necessary interventions. Another important aspect of findings was physiotherapists’ ability to have realistic outcomes out of a particular intervention as a result of patients’ mileage. In addition to that, gaining professional expertise and further training also helps in developing craft knowledge. Personal experience also emerged as a fundamental factor that affected physiologists’ overall beliefs. Another theme directed that patients’ profile and overall behavioural history also has a significant impact on the beliefs of the physiotherapists. Unrealistic patients’ expectations and related psychological factors make it difficult for the physiotherapist to practice freely. Terms like hypochondriac and heart-sink patients defined how physiotherapists perceive these patients to be. According to physiotherapists, a good patient is one with straight forward muscular tears and fractures. Furthermore, patients who were active, willing to listen and cooperate during treatment, were the ones labelled as good patients. It was found that difficulty faced while treating a patients has a tendency of affecting physiotherapists’ self-efficacy and expectations about the effectiveness of the treatment provided. Also, treating such patients further affects the sympathetic behaviour of the physiotherapists. Another important aspect of the findings was labelling of patients with chronic pain as difficult patients. However, this term was used generally with exceptions anticipated by physiotherapists. Third theme that emerged in findings was therapeutic encounters of patients and physiotherapists belief systems. The theme showed explicitly that physiotherapists use biomedical approach while evaluating a patient’s individual case which further affects their assessment of chronic pain’s causes. It was found that due to employment of biomedical orientation while treating a patient, patient’s psychological needs were neglected by the physiotherapists; instead they were labelled as good or bad or the basis of behaviour exhibited during treatment. It was found that the research findings were consistent with the discussion performed earlier and leads to a development of theory (Letts et al., 2007). Value and Application of the Research The research bears a certain value for future application as it defines how the perceptions and beliefs of the physiologists have a direct relationship with the quality of interventions that in turn affect patients’ quality of life. The research further defined how the application of biopyschosocial regime is more effective than the biomedical application alone. It defined that therapists using biomedical approach tend to evaluate the patients with the help of their pre-determined scientific knowledge ignoring equal importance of consideration paid to psychological therapeutic interventions. This particular outcome is further supported by more studies that elaborate how usage of biopsychosocial approach i.e. motivational interviewing, operant behavioural therapy, cognitive therapy etc helps in introducing more effectiveness into patient’s treatment (Osborn, Raichele and Jensen, 2006; Miller and Rollnick, 2002). Whereas there are various studies that acknowledge that professionals like physiotherapists are under no ethical obligations to influence the stressful situations faced by the patients and make an attempt to reduce the psychological distress, however the usage of biopsychosocial approach not only affects patient’s perception of the physiotherapist but also helps in turning into a good patient which further affects physiotherapists’ course of treatment. Conclusion Critical analysis of the research performed by Daykin and Richardson (2004) helped in evaluating the gaps present between earlier studies and the desired level of information required for understanding the factors affecting quality of treatment of patient with LBP. Careful analysis of this research helped in understanding that Daykin and Richardson (2004) have performed rigorous research for the purpose of establishing a correlation between physiotherapists’ perception and their treatments provided to patients with chronic LBP. During this examination it was found that research aim was defined rather generally with no indication about effects of patients’ behaviour on physiotherapists’ beliefs. The research methodology included using qualitative data triangulation of the responses received through semi-structured interviews and assessments’ observation, coupled with usage of grounded theory. Such research methodology was rigorous enough to ensure credibility of the research. One of the weaknesses of the research is its sampling performed only in NHS settings along with inclusion of physiotherapists using biomedical approach only. Therefore, generalization of the research findings would be difficult to perform. Secondly, no indication has been provided if the selected sample is suitable for the purpose and represents general population. It was also found that researchers’ assumption that all the responses of the patients are relevant to the research, may have lead to noise in the information collected. Where there are biases attached to such responses due to cultural and social aspects, no measures have taken to remove this hindrance. For the purpose of this research, using mixed research method instead of purely qualitative approach and measurement of patients’ intensity of chronic LBP would have helped in identifying actual intensity of pain and psychological effects of patients’ beliefs about it. The research can be used by physiotherapists in their practices as it illustrates that patients’ behaviour and physiotherapists’ beliefs have a tendency of affecting their performance while treating chronic LBP. 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