Appraising and Incorporating Qualitative Research in Evidence-Based Practice

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

Secondly, we determined that the article met the screening criteria (Decision Rule 2). The study involved observation of behavior in a natural setting. The observations were interpreted and tied to understanding and explanation, and the study adhered to ethical principles. For example, the authors included only those women who were in counseling or group therapy, in the event that any question the researchers asked triggered an emotional response.

Next, the RF-QRA was used to appraise the evidence and determine its level of qualitative evidence (Decision Rule 3). The four aspects of trustworthiness of qualitative research (credibility, transferability, dependability, confirmability) were assessed using the instrument. We found that the study was credible, dependable, and confirmable, but there was a relevant problem with transferability. To establish credibility, the authors used member checking; that is, at the completion of the interviews, participants read the analysis to see if the overall conclusions reflected their personal experiences. Credibility was additionally enhanced by having two researchers analyze the data independently and then discuss their conclusions. This technique also enhanced dependability. Another strategy present for dependability was the detailed descriptions of the research methods. The study was confirmable because the procedures and results appeared to be free from bias. Transferability, the ability to generalize the results of the study, was hampered by the narrow demographic characteristics of the sample. Study participants were all in counseling or group therapy, from two provinces in Canada (Saskatchewan and Ontario), and 78% had college or university education.

In summary, from appraisal of this qualitative study with the RF-QRA, we determined positive responses for three aspects of trustworthiness (credibility, dependability, and confirmability) and a relevant problem in one aspect (transferability). According to the qualitative level of evidence paradigm, we determined that this study was Level II evidence.

Finally, we determined the grade of recommendation for the evidence pertaining to the clinical question (Decision Rule 4). As there was only one study, and it was Level II evidence, we concluded that there was a Grade B recommendation for the qualitative evidence to answer the clinical question, "What can physical therapists do to be more sensitive to the needs of female survivors of childhood sexual abuse?" The article clearly presents nine suggestions for physical therapy practice that could contribute to a sense of client safety, the crucial issue for women who have survived sexual abuse. Each suggestion has specific behavioral directives for the physical therapist. For example, a suggestion is, "Establish a partnership with the client."25(p253) Sample associated behavioral directives include sharing control, actively involving the client in planning, and respecting boundaries.25

Recall that EBP has a total of five steps (Figure). In accordance with EBP Step Four, recommendations must be implemented in clinical practice, and in EBP Step Five, the clinician must evaluate the performance of the evidence and then make decisions regarding changing practice. Invariably, new questions arise at this point to start another EBP cycle. As new evidence becomes available, it must be included in subsequent EBP cycles.