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Re: "Is the Research Sound?"
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Re: "Is the Research Sound?" - May 26, 2005 6:06:00 AM
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KAK
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Drew-
Thank you for your interesting and informative post!
John-
I didn’t expect anyone to be happy or sad or irritated. I was struck by your comment and understood your point about a lot of PT’s not investing in their professional growth. I don’t think they are the majority, but maybe I’m too optimistic. Also, I don’t believe reading research is the ONLY way to self educate.
Anyway, while out walking at lunch time I thought about whether most PT’s are that apathetic. I don’t think so. I thought it would be fun and informative to take a poll of my co-workers when I got back. Maybe I should have asked if they had read research within the past week. Anyway, the fun part has been kiboshed… :)
While I understand that not everyone has the same passion and time commitment to their profession that you do; I disagree that it is a lost cause to educate them on how to critically review research.
Kathy
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Re: "Is the Research Sound?" - May 26, 2005 7:02:00 AM
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PTupdate.com
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Sorry Kathy, did not want you to take my comments the wrong way. You are right, there are many different ways to continue to learn, and reading is just one of them. But, it does tend to be the easiet and often less expensive route.
Considering you can spend upwards of $1000 going to a course, compare what you learn there to what you could learn with the same amount invested into a bunch of journals or instructinoal videos.
Just last night, while watching the last American Idol (go ahead, laugh your butts off), I read a good article in JBJS called "Early Quadriceps Strength Loss After TKA" Not everybody has to be a PT dork (not saying I am one) and read so much, but I do feel that most just do not take the extra time.
Just look how much one can learn by logging on to this site, or NOIgroup for an hour or two each week. With thousands of practicing PT's across the counry, did you ever notice there are about 20 who even participate here?
How do we motivate the PT's to learn more and perhaps even invest in research ideas and methods? Who knows. With such a low population of practicing PT's, most employers just want a warm body with a license in the clinic, who cares what their skills are!
Duffy
_____________________________
John M. Duffy, PT
Board Certified Orthopaedic Clinical Specialist
www.PTupdate.com
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Re: "Is the Research Sound?" - May 26, 2005 7:51:00 PM
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Bournephysio
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There is some good information about qualitative research and some awful information. The choice of whether to use qualitative or quantitative methods should be based on the question you want answered, not on whether or not you believe in alternative realities. Qualitative research is a very legitimate and valuable method(s) of doing research.
Qualitative research has absolutely nothing to do with Quantum mechanics. The claim that it does is a huge disservice to qualitative research. This puts qualitative research on the same level as Deepak Chopra and John Barnes. Invariably the comparison shows a complete misunderstanding of quantum mechanics/relativity or even what Einstein accomplished. The current discussion is no exception. If this is how leaders in qualitative research actually describe it, it is now wonder that the scientific community has been so slow in embracing it. I'm sure glad that the people who taught me about qualitative research did not do this.
Doug
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Re: "Is the Research Sound?" - May 26, 2005 8:13:00 PM
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mcap56
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I am a quantitative researcher. However, I fully appreciate the need for qualitative studies. The example I always use with my students is low back pain.
Many of the studies on low back pain have as their outcome some measurement scale or return visit to doctor or return to work. Let's take RTW as our outcome variable. You could do a study with multidisciplinary intervention and find that 80% of them returned to work. You could even do a randomized trial comparing multidsciplinary care with the usual treatment. Let's say 80% of the MD treatment and 40% of the usual care groups return to work.
That is a great quantitative study and a great result. But what do we actually know about those who returned to work. Sure we could see how long they stay and measure lost time over the next year. We could even ask them to fill out an Oswestry or two.
But what does this mean? How did they return to work. What is it like for them at work? Are they getting to work but suffering through excrutiating pain all day? How is management treating them? Their coworkers? How are they coping? Can they stay at their job?
You could administer additional scales or other quantitative measures. But someone needs to sit down with them and talk to them. Give them freedom to explore the topic and see what themes emerge. There just is no substitute for talking to people about these things. These interviews are done in a structured manor that ensures validity (the qualitative folks would know a lot more than me about this).
Look at drug trials. They routinely check for side effects and list the percentages affected. But how do these patients feel on the drug? What if they are experiencing effects that are not being screened for. Ever work with patients that seem to complain about the same thing on a particualar medication even though it is not a listed side effect?
So, there is a place for both!!! You will see more in the years to come.
One last point, I don't know what it is but most people I come accross seem to run from stats, in all disciplines. There are very few medical professionals that understand research.
One major mistake I think PTs are making is a P-value obsession. But, that's another post.
Mcap
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Re: "Is the Research Sound?" - May 27, 2005 1:17:00 AM
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Andrew M. Ball PT PhD
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Doug,
I don't recall ever having met you at any of the APTA roundtable discussions on qualitative research. I'm also curious to know who taught the qualitative portion of your PhD, and how (if at all), you incorporated qualitative methods into your dissertation research. What was the make-up of your dissertation defense council? Givn your topic (qualitative or quantitative), how did members of your council respond and critique your work based upon their qualitative or quantitative training.
Sounds like you got a lecure or two in qualitative methods in your PT program from someone who doesn't actually do qualitative research. Your response to my analogy is therefore understandably . . . misguided and ill-informed.
Either you don't truly understand qualitative research, you don't truly understand quantum mechanics, or you don't fully appreciate the point that very well respected qualitative researchers have made (I didn't just make all this up), regarding the philosophical underpinnings distinguishing quantitative research from qualitative research, and Newtonian physics from quantum/theoretical physics. Ask yourself this, what experiment did Einstien do in proving his theory of relativity? The answer is none, it is a theory --- but one that has proven useful to quantitative researchers that followed in a variety of contexts. The point is that there is an ebb and flow (or should be), between observation and description of phenomenon, hypothesis generation, and hypothesis testing --- quantitative methods are insufficient for all three purposes. Comparing qualitative research, or the quantum comparison, to John Barnes shows a lack of understanding about the differences in philosophy between qualitative and quantitative researchers, and a lack of understanding regarding objective definition of the term, "multiple constructed realities." We're not talking about multiple dimensions here, only the fact that in the real world, under similar conditions with similar patients, with the same clinician, we often observe different outcomes --- quanitative researchers seek to ELIMINATE all variables in describing and testing that situation, while qualitative researchers are more interested in IDENTIFICATION of what those variables are. Variables can't truly be controlled if we don't know what they are --- and it's far more interesting in my opinion, to understand the effects of the contaminating variables to the human condition, as opposed to eliminating and ignoring them as the quantitative reseacher does.
It's different information, but just as useful to the clinician.
Finally, and this is the biggest point, no qualitative researcher I know cares about quanitative researchers embracing qualitative methods. The philosophical constructs are very different and it's a VERY RARE researcher that can cross into both camps in researching a particular topic. The goal is to arrive at greater situational understanding through ethnography and phenomonology; and generate new ideas and hypothesis through grounded theory. The bridge between qualitative and quantitative is generally in hypothesis generation and quantitative testing --- this occurs. Quantitative researchers may not respect the qualitative method, but they sure to seem to appreciate and enjoy testing the theories generated via qualitative methods
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Re: "Is the Research Sound?" - May 27, 2005 2:29:00 AM
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Barrett
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This discussion is a wonderful example of what might be accomplished by a small group of passionate clinicians. Why the therapy community doesn’t enthusiastically participate in far greater numbers is a mystery that will probably remain for many years. I try to remember the autodidact Charles Hayes’ quote: “At self-university the tuition is your desire.”
In the Bullypit nearly a year ago I began a thread titled “Ceteris Paribus” which said in part, “Among other weaknesses in the model, several of which are way over my head mathematically, there is this-the concept of “ceteris paribus.” This is a Latin phrase meaning “all other things being equal.” This got my attention because I think it speaks directly to the central problem in outcome studies in physical therapy management for painful problems, or, at least, the main problem I have long had with such things. As Goertzel puts it, “Econometricians inhabit the mythical land of Ceteris Paribus where everything is constant except the variables they choose to write about….Of course, (they) know they don’t live there, but the mathematics works much better when they pretend they do.”
This was about the problems inherent to purely quantitative research and I’d recommend looking at it along with “When Thoughtfulness Dies.”
Drew’s right, qualitative research acknowledges the uncertainty inherent to conclusions that arise from observation in a way that Einstein and others popularized and proved to be appropriate. It is not that we live in or experience the world as do the things they sought to observe (materials too small to measure or in the presence of enormous speed or immense gravitation) but that something similar about human behavior may confound us if we only try to assign it a number.
A question: How many clinicians are truly comfortable with that question, “On a scale from 1 to 10, how would you describe your pain today?
Isn’t this an example of how we’ve been forced to use quantitative reasoning though it makes no real sense to do so?
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Barrett L. Dorko P.T.
http://barrettdorko.com
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Re: "Is the Research Sound?" - May 27, 2005 2:43:00 AM
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SJBird55
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Mentioning Newton and Einstein and quantum doesn't explain qualitative research at all, in my opinion. Barrett, numbers are assigned in both qualitative and quantitative research. The link below is a nice, easy read on the debate of qualitative and quantitative research.
http://www.socialresearchmethods.net/kb/qualdeb.htm
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Re: "Is the Research Sound?" - May 27, 2005 2:53:00 AM
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Barrett
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The presence of the numbers isn't the issue and no one has said that numbers aren't present in one and not the other.
The issue is what the numbers represent.
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Re: "Is the Research Sound?" - May 27, 2005 3:23:00 AM
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Jon Newman
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[QUOTE] A question: How many clinicians are truly comfortable with that question, “On a scale from 1 to 10, how would you describe your pain today?
Isn’t this an example of how we’ve been forced to use quantitative reasoning though it makes no real sense to do so?
[/QUOTE]I'm troubled by this practice and have been for a long time. Not because it a bad idea but because of why the practice seems to continue. All of us have had to ask this question to patients and I'd be willing to be that most of us have prefaced the question at one time or another with a statement like; "I know this is hard to do but..", "I hate to try to have you express your pain as number but...", etc, etc. We seem to recognize the inadequacy of the method but continue to use it anyway.
I reflected on why I was doing this and came up with just a few answers that include learned habit; policy and procedure and because it's good enough for reimbursement.
That said, 0-10 scales have demonstrated statistical muster in the quantitative world.
Still I find myself drawn more toward the Roland Morris and Oswestry type questionnaires (for back pain). But as I weigh my observations against their self reports I begin to feel the weight of their inadequacy also.
I haven't come up with a better alternative other than my observation of their movement and language and I find this difficult to document in terms someone other than the patient and I care about.
jon
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[URL=http://www.sonymusic.com/clips/selection/30/064887/064887_03_03_30.wav]Evidence[/URL]
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Re: "Is the Research Sound?" - May 27, 2005 3:28:00 AM
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Shill
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Since you asked, I for one am quite comfy with asking patients to rate their pain. Gives me an idea of whether they feel they are improving.
Seems quite logical to me.
Steve Hill PT
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Re: "Is the Research Sound?" - May 27, 2005 3:49:00 AM
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Jon Newman
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Hi Shill,
If the only thing the number is telling you is whether the patient is improving or not, I have to wonder why use it at all? That is, if I can tell and the patient can tell they are improving, what purpose does the number serve?
jon
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[URL=http://www.sonymusic.com/clips/selection/30/064887/064887_03_03_30.wav]Evidence[/URL]
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Re: "Is the Research Sound?" - May 27, 2005 4:15:00 AM
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Yogi
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0-10 is easy, only takes a few seconds, and it works for insurance, maybe we can consider it a necessary evil, and go on with what we really use to form our judgments. I don't see it as a big deal.
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Re: "Is the Research Sound?" - May 27, 2005 4:32:00 AM
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Yogi
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Drew, good pearl above, on descibe and test, and the variables, eliminate and identify.
Come on guys, even Clinton admitted to trying it, no one knows what the stoned Orangutans did? I guess it's so off the wall no one cares. I'm dying to tell, so my prediction was that they sat around and ate Orangutang food, and did not attend to tasks, and that was what the study showed. Tax dollars at work.
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Re: "Is the Research Sound?" - May 27, 2005 4:34:00 AM
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Yogi
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Yogi, And your point is?
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Re: "Is the Research Sound?" - May 27, 2005 4:35:00 AM
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Yogi
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Nothing, I just thought it was funny. Sorry for wasting space.
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Re: "Is the Research Sound?" - May 27, 2005 6:19:00 AM
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mcap56
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The 0-10 scale may be quick and easy but it is not potentially without cost. In many cases we may try to get patients to engage in activities that may hurt a bit. We may try to get someone with increased bodily awareness to stop focusing on their pain. When a chronic patient comes in, I would like to see if their function is improving, not the same as a change in pain status. The 0-10 thing brings them right back to it. Not always a good thing.
Haven't we all had the patient that gives you a pain scale, verbal diary. "I went to the store and it was like a 3/10. But then, after sitting through a movie it was 9/10. Now, just sitting here, it's not too bad about 4-5/10. Today I have to take a long trip and it may go up to about 7."
I have seen this, and yes.............read this!!!!!!!!!!!!!!
Mcap
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Re: "Is the Research Sound?" - May 27, 2005 6:42:00 AM
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Jon Newman
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I don't disagree that the number is easy and I'm not suggesting that I never use it. I'll see if I can tie my point with the topic of this thread.
It seems most who post here understand the concept that pain can be somewhat complex, especially when coupled with function. Using the 0-10 scale habitually because of its ease also implies to us and others involved in health care that pain is a simple phenomena reducible to a number upon request.
I believe qualitative research may need to be considered to gain greater insight to the nature of pain and the management of painful conditions.
jon
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[URL=http://www.sonymusic.com/clips/selection/30/064887/064887_03_03_30.wav]Evidence[/URL]
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Re: "Is the Research Sound?" - May 27, 2005 8:09:00 AM
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JLS_PT_OCS
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I readily admit to patients that "they make us ask this" when I do the 0-10 thing. I have found it nearly worthless overall. I do it becuase JCAHO and my facility mandate it.
Qualitiative research can give us answers about how better to measure our patient's pain state. The Oswestry Disability Index would never have even come about if it were not for qualitative research.
That would make the jobs of us quantitatively-oriented people even harder than it already is...
J
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Jason Silvernail DPT, OCS, CSCS
"It isn't what you're able to do that requires your courage but rather what you have come to understand and are willing to express." - Barrett Dorko,PT
**I no longer post on RehabEdge**
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Re: "Is the Research Sound?" - May 27, 2005 9:27:00 AM
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Bournephysio
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"I don't recall ever having met you at any of the APTA roundtable discussions on qualitative research."
Probably because I wasn't there.
"I'm also curious to know who taught the qualitative portion of your PhD, and how (if at all), you incorporated qualitative methods into your dissertation research."
No one taught qualitative methods in my PhD since I had already taken a methods course in my Masters program. Qualitative in my Masters program was taught by Susan Harris who previously was the editor of Physical Therapy, currently the editor of Physiotherapy Canada and a highly respective PT researcher. I believe we also had one or two guest lecturers who did qualitative. Who taught you Quantum mechanics? My masters and PhD are very quantitative.
There is a huge gap in logic here. You have completely failed to show that qualitative research is more related to quantum mechanics than quantitative research is. The whole premise is laughable when you consider that theories themselves are represented by pure mathematics. The uncertainty in quantum mechanics is highly quantifiable.
This thought that qualitative comes out of quantum mechanics seems to come out the misconception that qualitative research recognizes that the act of measuring something has the potential to appreciably change that variable while quantitative research does not recognize it. This is completely false. It is also not what quantum mechanics is saying. The Heisenberg uncertainty principle (notice its not the Einstein uncertainty principle) states that you can not know precisely where an object is and its momentum (where it'll be next). This is only really relevant at very small scales. At larger scales (where the qualitative research we are talking about occurs) probabilities average out which is also why the "incorrect" or "incomplete" Newtonian theories are so powerful: They work almost perfectly at the scale most research is done at.
Don't forget that Einstein did not believe that this uncertainty was a fundamental part of nature: "God does not play dice" So why even use Einstein's name why not Heisenberg or Schroedinger? Popularity. People recognize Einstein as a brilliant scientist. Why quantum mechanics? Quantum mechanics is well known but little understood. By combining well known scientists with well known little understood theories to describe your "science" "theory" or "technque" you can confuse the public that there is substance. This is typical of John Barne's and Deepak Chopra's arguments. While it may work on the public it won't work nearly as well in the scientific community. Thats why it is harmful for qualitative research. There is substance but that will not shine through if people have to dig through a bunch of crap. Qualitative researchers may not care but it is bad for Science and progress.
Doug
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Re: "Is the Research Sound?" - May 27, 2005 10:55:00 AM
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Yogi
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mcap, yeah that's true, alot of people get real familar with it. Jon, you tied your point to the topic excellently, I couldn't agree more.
Handling pain is tough all the way around. Where's the magic wand? Oh, I forgot, fridge magnets.
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