Appraising and Incorporating Qualitative Research in Evidence-Based Practice

Journal of Physical Therapy Education, Winter 2004 by Henderson, Roberta, Rheault, Wendy

The Rosalind Franklin-Qualitative Research Appraisal Instrument (RF-QRA) consists of four items, one for each aspect of trustworthiness in Cuba's Model. Each item is qualified with a clarifying question. Commonly used strategies to confirm each aspect of Cuba's Model are offered for reference; however, the user can consider any additional strategy when applicable. For example, suggested strategies for confirmability are triangulation, external audit, and field journal. A dichotomous judgment is required; either a positive judgment regarding the aspect of trustworthiness, or a negative judgment indicating the presence of a relevant problem, a problem that influences a result that pertains to the clinical question. For the confirmability example, the appraiser must declare whether or not the study is confirmable by answering the clarifying question and identifying any relevant problems using the suggested (or additional) strategies.

The RF-QRA was designed to be a simple and quickly administered instrument that could be used by clinicians with varying knowledge of qualitative research. An additional major advantage of the instrument is the ability to assign a level of evidence to a qualitative study that can be used to designate a grade of recommendation, representing all available evidence pertaining to a clinical question, in Sackett's familiar and widely used framework that was intended for quantitative research.

The instrument was validated by three physical therapy faculty with expertise in qualitative research. Twenty-six Doctor of Physical Therapy students used the instrument and offered feedback that was used to make revisions. For example, revisions were made in the four clarifying questions on the basis of student feedback.

Clinical Example

The following example illustrates use of this methodology for incorporating qualitative research in EBP. Recall that EBP Step One is formulating a clinical question. The clinical question that we asked was: "What can physical therapists do to be more sensitive to the needs of female survivors of childhood sexual abuse?"

Evidence-Based Practice Step Two is searching, that is, locating evidence pertinent to the clinical question. Although we located review articles on nursing strategies for survivors of sexual abuse21-23 and on related issues for family physicians,24 we found only one study related to physical therapy, a qualitative study titled Toward Sensitive Practice: Issues for Physical Therapists Working With Survivors of Childhood Sexual Abused The study was conducted in Canada at two geographically separate universities.

In EBP Step Three, we used the four Decision Rules to evaluate the evidence. First, we ascertained that the paper satisfied both assumptions for inclusion of qualitative research in EBP (Decision Rule 1). The study was published in Physical Therapy, a peer-reviewed journal, and the problem researched was important to the clinical question. Because physical therapists have a unique relationship with their clients that differs from the relationship nurses and physicians have with clients, and because physical therapists use touch extensively in their daily interactions with clients, only the study involving physical therapists was included.