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Blom AW, Artz N, Beswick AD, Burston A, Dieppe P, Elvers KT, Gooberman-Hill R, Horwood J, Jepson P, Johnson E, Lenguerrand E, Marques E, Noble S, Pyke M, Sackley C, Sands G, Sayers A, Wells V, Wylde V. Improving patients’ experience and outcome of total joint replacement: the RESTORE programme. PROGRAMME GRANTS FOR APPLIED RESEARCH 2016. [DOI: 10.3310/pgfar04120] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BackgroundTotal hip replacements (THRs) and total knee replacements (TKRs) are common elective procedures. In the REsearch STudies into the ORthopaedic Experience (RESTORE) programme, we explored the care and experiences of patients with osteoarthritis after being listed for THR and TKR up to the time when an optimal outcome should be expected.ObjectiveTo undertake a programme of research studies to work towards improving patient outcomes after THR and TKR.MethodsWe used methodologies appropriate to research questions: systematic reviews, qualitative studies, randomised controlled trials (RCTs), feasibility studies, cohort studies and a survey. Research was supported by patient and public involvement.ResultsSystematic review of longitudinal studies showed that moderate to severe long-term pain affects about 7–23% of patients after THR and 10–34% after TKR. In our cohort study, 10% of patients with hip replacement and 30% with knee replacement showed no clinically or statistically significant functional improvement. In our review of pain assessment few research studies used measures to capture the incidence, character and impact of long-term pain. Qualitative studies highlighted the importance of support by health and social professionals for patients at different stages of the joint replacement pathway. Our review of longitudinal studies suggested that patients with poorer psychological health, physical function or pain before surgery had poorer long-term outcomes and may benefit from pre-surgical interventions. However, uptake of a pre-operative pain management intervention was low. Although evidence relating to patient outcomes was limited, comorbidities are common and may lead to an increased risk of adverse events, suggesting the possible value of optimising pre-operative management. The evidence base on clinical effectiveness of pre-surgical interventions, occupational therapy and physiotherapy-based rehabilitation relied on small RCTs but suggested short-term benefit. Our feasibility studies showed that definitive trials of occupational therapy before surgery and post-discharge group-based physiotherapy exercise are feasible and acceptable to patients. Randomised trial results and systematic review suggest that patients with THR should receive local anaesthetic infiltration for the management of long-term pain, but in patients receiving TKR it may not provide additional benefit to femoral nerve block. From a NHS and Personal Social Services perspective, local anaesthetic infiltration was a cost-effective treatment in primary THR. In qualitative interviews, patients and health-care professionals recognised the importance of participating in the RCTs. To support future interventions and their evaluation, we conducted a study comparing outcome measures and analysed the RCTs as cohort studies. Analyses highlighted the importance of different methods in treating and assessing hip and knee osteoarthritis. There was an inverse association between radiographic severity of osteoarthritis and pain and function in patients waiting for TKR but no association in THR. Different pain characteristics predicted long-term pain in THR and TKR. Outcomes after joint replacement should be assessed with a patient-reported outcome and a functional test.ConclusionsThe RESTORE programme provides important information to guide the development of interventions to improve long-term outcomes for patients with osteoarthritis receiving THR and TKR. Issues relating to their evaluation and the assessment of patient outcomes are highlighted. Potential interventions at key times in the patient pathway were identified and deserve further study, ultimately in the context of a complex intervention.Study registrationCurrent Controlled Trials ISRCTN52305381.FundingThis project was funded by the NIHR Programme Grants for Applied Research programme and will be published in full inProgramme Grants for Applied Research; Vol. 4, No. 12. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Ashley W Blom
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Neil Artz
- School of Health Professions, Faculty of Health and Human Sciences, Plymouth University, Plymouth, UK
| | - Andrew D Beswick
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Amanda Burston
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Paul Dieppe
- Medical School, University of Exeter, Exeter, UK
| | - Karen T Elvers
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Rachael Gooberman-Hill
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Jeremy Horwood
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Paul Jepson
- School of Sport, Exercise and Rehabilitation Sciences, Birmingham, UK
| | - Emma Johnson
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Erik Lenguerrand
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Elsa Marques
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Sian Noble
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Mark Pyke
- North Bristol NHS Trust, Bristol, UK
| | | | - Gina Sands
- School of Health Sciences, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Adrian Sayers
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Victoria Wells
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Vikki Wylde
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
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Jindal AK, Singh G, Pandya K. Qualitative research in medicine - An art to be nurtured. Med J Armed Forces India 2015; 71:369-72. [PMID: 26663966 DOI: 10.1016/j.mjafi.2014.11.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Accepted: 11/14/2014] [Indexed: 11/17/2022] Open
Abstract
To acquire complete knowledge on a subject both qualitative and quantitative research methods need to be perused by researchers. However, over the period of time qualitative research teaching among medical professionals has reduced. Wisdom amongst doctors seems getting muddled in 'data'. Operational research as well as health systems research have been the basis of 'key' policy changes in situations and programmes including polio immunization to achieve desired objectives. Both qualitative and quantitative methods complement each other and cannot replace one another. We need to protect the 'endangered art' of qualitative research before it becomes extinct from medical schools.
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Affiliation(s)
- A K Jindal
- Commandant, Military Hospital Nasirabad, C/o 56 APO, India
| | - Gurpreet Singh
- Resident, Dept of Community Medicine, Armed Forces Medical College, Pune 411040, India
| | - Kapil Pandya
- Dept of Community Medicine, DADH, 17 Mountain Division, C/o 99 APO, India
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Bailey K, Abrams P, Blair PS, Chapple C, Glazener C, Horwood J, Lane JA, McGrath J, Noble S, Pickard R, Taylor G, Young GJ, Drake MJ, Lewis AL. Urodynamics for Prostate Surgery Trial; Randomised Evaluation of Assessment Methods (UPSTREAM) for diagnosis and management of bladder outlet obstruction in men: study protocol for a randomised controlled trial. Trials 2015; 16:567. [PMID: 26651344 PMCID: PMC4676182 DOI: 10.1186/s13063-015-1087-1] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 11/26/2015] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Lower urinary tract symptoms (LUTS) comprise storage symptoms, voiding symptoms and post-voiding symptoms. Prevalence and severity of LUTS increase with age and the progressive increase in the aged population group has emphasised the importance to our society of appropriate and effective management of male LUTS. Identification of causal mechanisms is needed to optimise treatment and uroflowmetry is the simplest non-invasive test of voiding function. Invasive urodynamics can evaluate storage function and voiding function; however, there is currently insufficient evidence to support urodynamics becoming part of routine practice in the clinical evaluation of male LUTS. DESIGN A 2-arm trial, set in urology departments of at least 26 National Health Service (NHS) hospitals in the United Kingdom (UK), randomising men with bothersome LUTS for whom surgeons would consider offering surgery, between a care pathway based on urodynamic tests with invasive multichannel cystometry and a care pathway based on non-invasive routine tests. The aim of the trial is to determine whether a care pathway not including invasive urodynamics is no worse for men in terms of symptom outcome than one in which it is included, at 18 months after randomisation. This primary clinical outcome will be measured with the International Prostate Symptom Score (IPSS). We will also establish whether inclusion of invasive urodynamics reduces rates of bladder outlet surgery as a main secondary outcome. DISCUSSION The general population has an increased life-expectancy and, as men get older, their prostates enlarge and potentially cause benign prostatic obstruction (BPO) which often requires surgery. Furthermore, voiding symptoms become increasingly prevalent, some of which may not be due to BPO. Therefore, as the population ages, more operations will be considered to relieve BPO, some of which may not actually be appropriate. Hence, there is sustained interest in the diagnostic pathway and this trial could improve the chances of an accurate diagnosis and reduce overall numbers of surgical interventions for BPO in the NHS. The morbidity, and therapy costs, of testing must be weighed against the cost saving of surgery reduction. TRIAL REGISTRATION Controlled-trials.com - ISRCTN56164274 (confirmed registration: 8 April 2014).
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Affiliation(s)
- K Bailey
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.
- Bristol Randomised Trials Collaboration (BRTC), University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.
| | - P Abrams
- North Bristol NHS Trust, Bristol Urological Institute, Level 3, Learning and Research Building, Southmead Hospital, Bristol, BS10 5N, UK.
| | - P S Blair
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.
- Bristol Randomised Trials Collaboration (BRTC), University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.
- Bristol Randomised Trials Collaboration, University of Bristol, St. Michael's Hospital, Level D, Southwell Street, Bristol, UK.
| | - C Chapple
- Sheffield Teaching Hospitals NHS Trust, Room H26, H-Floor, Royal Hallamshire Hospital, Glossop Road, Sheffield, S10 2JF, UK.
| | - C Glazener
- Health Services Research Unit, University of Aberdeen, 3rd Floor, Health Sciences Building, Foresterhill, Aberdeen, AB25 2ZD, Scotland.
| | - J Horwood
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.
- Bristol Randomised Trials Collaboration (BRTC), University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.
| | - J A Lane
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.
- Bristol Randomised Trials Collaboration (BRTC), University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.
| | - J McGrath
- Exeter Surgical Health Services Research Unit - Urology, Royal Devon and Exeter Hospital, Barrack Road, Exeter, Devon, EX2 5DW, UK.
| | - S Noble
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.
- Bristol Randomised Trials Collaboration (BRTC), University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.
| | - R Pickard
- Institute of Cellular Medicine, University of Newcastle, 3rd Floor, William Leech Building, Newcastle upon Tyne, NE2 4HH, UK.
| | - G Taylor
- University of Plymouth, Plymouth, Devon, PL4 8AA, UK.
| | - G J Young
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.
- Bristol Randomised Trials Collaboration (BRTC), University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.
| | - M J Drake
- North Bristol NHS Trust, Bristol Urological Institute, Level 3, Learning and Research Building, Southmead Hospital, Bristol, BS10 5N, UK.
- School of Clinical Sciences, University of Bristol, 69 St Michael's Hill, BS2 8DZ, Bristol, UK.
| | - A L Lewis
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.
- Bristol Randomised Trials Collaboration (BRTC), University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.
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Young A, Gomersall T, Bowen A. Trial participants' experiences of early enhanced speech and language therapy after stroke compared with employed visitor support: a qualitative study nested within a randomized controlled trial. Clin Rehabil 2012; 27:174-82. [PMID: 22837542 PMCID: PMC3757994 DOI: 10.1177/0269215512450042] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To explore trial participants' experiences of the process and outcomes of early, enhanced speech and language therapy after stroke with support from an employed visitor. DESIGN Qualitative study nested within a randomized controlled trial. PARTICIPANTS Twney-two people who, after stroke, had a diagnosis of aphasia (12), dysarthria (5) or both (5) and who participated in the ACT NoW study. SETTING Eight English NHS usual care settings. METHOD Individual interviews. Thematic content analysis assisted by a bespoke data transformation protocol for incorporating non-verbal and semantically ambiguous data. RESULTS Participants highly regarded regular and sustained contact with someone outside of immediate family/friends who engaged them in deliberate activities/communication in the early months after stroke. Participants identified differences in the process of intervention between speech and language therapists and employed visitors. But no major discriminations were made between the impact or value of this contact according to whether provided by a speech and language therapist or employed visitor. Participant-defined criteria for effectiveness of contact included: impact on mood and confidence, self-recognition of progress and the meeting of individual needs. CONCLUSIONS As in the randomized controlled trial, participants reported no evidence of added benefit of early communication therapy beyond that from attention control. The findings do not imply that regular contact with any non-professional can have beneficial effects for someone with aphasia or dysarthria in the early weeks following a stroke. The study points to specific conditions that would have to be met for contact to have a positive effect.
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Affiliation(s)
- Alys Young
- School of Nursing Midwifery and Social Work, University of Manchester, Manchester Academic Health Sciences Centre, UK.
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Garrett R, Immink MA, Hillier S. Becoming connected: the lived experience of yoga participation after stroke. Disabil Rehabil 2011; 33:2404-15. [DOI: 10.3109/09638288.2011.573058] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Ansdell G, Davidson J, Magee WL, Meehan J, Procter S. From “This F***ing life” to “that's better” … in four minutes: an interdisciplinary study of music therapy's “present moments” and their potential for affect modulation. NORDIC JOURNAL OF MUSIC THERAPY 2010. [DOI: 10.1080/08098130903407774] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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McIver S, McGartland M, O'Halloran P. "Overeating is not about the food": women describe their experience of a yoga treatment program for binge eating. QUALITATIVE HEALTH RESEARCH 2009; 19:1234-45. [PMID: 19690205 DOI: 10.1177/1049732309343954] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
As part of a larger mixed-methods study, data from 20 personal journals were analyzed to examine the experience of a 12-week yoga treatment program for binge eating among a sample of 25 women who were obese. Qualitative analysis revealed a positive shift experienced by the women during the program, summarized by a general structural description: disconnection versus connection. Women's comments suggested that the program appeared to encourage a healthy reconnection to food, as well as the development of physical self-empowerment, through cultivating present-moment awareness. Specifically, women perceived an overall reduction in the quantity of food they consumed, decreased eating speed, and an improvement in food choices throughout the program. The women also reported feeling more connected to and positive about their physical well-being. These evolving outcomes were summarized through two major themes: the way their physicality changed, and the way their food consumption changed over time. Findings provide insights relevant to therapeutic processes that might occur within eating disorder interventions that draw on meditation-based approaches.
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Abstract
ThePLoS Medicine Editors argue that the appropriate use of qualitative methods can play an important role in the research process.
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Whitley R, Crawford M. Qualitative research in psychiatry. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2005; 50:108-14. [PMID: 15807227 DOI: 10.1177/070674370505000206] [Citation(s) in RCA: 91] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This paper is an overview of qualitative research and its application to psychiatry. It is introductory and attempts to describe both the aims of qualitative research and its underlying philosophical basis. We describe the practice and process of qualitative research and follow this with an overview of the 3 main methods of inquiry: interviews, focus groups, and participant observation. Throughout the paper, we offer examples of cases where qualitative research has illuminated, or has the potential to illuminate, important questions in psychiatric research. We describe methods of sampling and follow with an overview of qualitative analysis, appropriate checks on rigour, and the presentation of qualitative results. The paper concludes by arguing that qualitative methods may be an increasingly appropriate methodology to answer some of the demanding research questions being posed in 21st century psychiatry.
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Affiliation(s)
- Rob Whitley
- Department of Psychiatry, McGill University, Montreal, Quebec.
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Weaver T, Tyrer P, Ritchie J, Renton A. Assessing the value of assertive outreach. Qualitative study of process and outcome generation in the UK700 trial. Br J Psychiatry 2003; 183:437-45. [PMID: 14594920 DOI: 10.1192/bjp.183.5.437] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND It is unclear why intensive case management (ICM) failed to reduce hospitalisation in the UK700 trial. AIMS To investigate outcome generation in the UK700 trial. METHOD A qualitative investigation was undertaken in one UK700 centre. RESULTS Both intensive and standard case management practised individual casework, employed assertive outreach with comparable frequency, and performed similarly in the out-patient management of emergencies and in-patient discharge. However, ICM was advantaged in managing some non-compliance and undertaking casework that prevented psychiatric emergencies. Absence of team-based management and bureaucratised access to social care limited the impact of these differences on outcomes and the effective practice of assertive outreach, although this was relevant to only a sub-population of patients. CONCLUSIONS The impact of ICM was undermined by organisational factors. Sensitive anticipatory casework, which prevents psychiatric emergencies, may make ICM more effective than an exclusive focus on assertive outreach. Our findings demonstrate the value of qualitative research in evaluating complex interventions.
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Affiliation(s)
- Tim Weaver
- Department of Social Science and Medicine, Imperial College, London, UK.
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Peters M, Abu-Saad HH, Vydelingum V, Murphy M. Research into headache: the contribution of qualitative methods. Headache 2002; 42:1051-9. [PMID: 12453040 DOI: 10.1046/j.1526-4610.2002.02238.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Michele Peters
- European Institute of Health and Medical Sciences, University of Surrey, United Kingdom.
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Verhoef MJ, Casebeer AL, Hilsden RJ. Assessing efficacy of complementary medicine: adding qualitative research methods to the "Gold Standard". J Altern Complement Med 2002; 8:275-81. [PMID: 12165185 DOI: 10.1089/10755530260127961] [Citation(s) in RCA: 114] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Randomized controlled trials (RCTs) have an important place in the assessment of the efficacy of complementary and alternative medicine (CAM). However, they address only one, limited, question, namely whether an intervention has-statistically-an effect. They do not address why the intervention works, how participants are experiencing the intervention, and/or how they give meaning to these experiences. Therefore, we argue that the addition of qualitative research methods to RCTs can greatly enhance understanding of CAM interventions. Qualitative research can assist in understanding the meaning of an intervention to patients as well as patients' beliefs about the treatment and expectations of the outcome. Qualitative research also assists in understanding the impact of the context and the process of the intervention. Finally, qualitative research is helpful in developing appropriate outcome measures for CAM interventions. Greater understanding of CAM interventions has the potential to improve health care delivery.
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Affiliation(s)
- Marja J Verhoef
- Department of Community Health Sciences, University of Calgary, Alberta, Canada.
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Barbour RS. The case for combining qualitative and quantitative approaches in health services research. J Health Serv Res Policy 1999; 4:39-43. [PMID: 10345565 DOI: 10.1177/135581969900400110] [Citation(s) in RCA: 158] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A judicious combination of qualitative and quantitative methods can play a valuable role in health services research. This paper reviews the main reasons for combining methods: for different stages in a project; to compensate for the shortcomings of individual methods; and for the purpose of 'triangulation'. It examines the potential for qualitative approaches to contribute to quantitative work--by providing insights into the process of data construction, identifying relevant variables to be studied, furnishing explanations for unexpected or anomalous findings, and generating hypotheses or research questions for further investigation. Similarly, qualitative work can be enhanced by using quantitative techniques--albeit often in a modified form--in analysing data, developing sampling strategies, and amalgamating findings from separate qualitative studies. Although there is potential to develop multi-method approaches, there remains an important role for rigorous studies employing either qualitative or quantitative methods.
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Affiliation(s)
- R S Barbour
- Department of General Practice, University of Glasgow, UK
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