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Qualitative – Essay Grade D This qualitative study by Littlewood et al. (2015) aims to identify sensible barriers and facilitators for rotator cuff tendinopathy patients participating in a self-managed exercise intervention, with the use of a multicentre RCT. Compared to quantitative research, qualitative is less prominent due to the fact that it collects data straight from the actual source, whereas for quantitative, the results are being examined and personal assumptions are made (Bowling, 2014). In this paper the CASP tool will be used again but specific to a mixed methods research design.

Evidence within the health care section is developing rigorously and therefore health care professionals are required to be able to research the appropriate literature to identify and perform current and sufficient interventions for the benefit of the patient (Greenhalght, 2010). A multicentre RCT was used in order to compare the self-managed loaded exercise programme with the usual physiotherapy care that such patients undergo. The single exercise intervention has been investigated once more and did not associate with the clinical reasoning. This qualitative study was therefore chosen by the authors alongside the RCT to identify the barriers and facilitators.

A qualitative approach was appropriately conducted in the methods by the authors, since information necessary to obtain sufficient results, was gathered by interviewing people. Marshall and Rossman (2016), state that qualitative research relies on a more holistic approach to social interaction rather than using numbers and values to obtain desired results. A mixed method was used, having both a qualitative study and an RCT conducted in the method. Bowling (2014) also explains that the research queries are better understood

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together, rather than each method alone and with the union of the two, the strengths of the research process is much more productive than using each approach alone.

Phenomenology was the qualitative approach, which has not been stated but insinuated. With reference to Al-Busaidi (2008), phenomenology obtains the most in depth information involving just the participant, since the researcher is only allowed to use information from primary source of evidence. This method therefore, was appropriately used for this study, since the opinions of the participants on a self-managed exercise programme can be obtained successfully. It can be argued that grounded theory could have been used instead since a process was used to obtain the information during the interviews to extract the necessary information (Priya, 2013).

The sampling method that appeared to be used when choosing the location of the participants was cluster sampling. As Polgar and Thomas (2013) point out, cluster sampling refers to the random selection of the population within a group instead of a single element of the population. Despite the fact, that it is the most economical form of sampling, bias can arise since it does not reflect the exact variety of the community. Convenience sampling was used in recruiting the physiotherapists within the selected departments. Thompson (2012), correctly argued that cluster sampling shows less variation in results and therefore offers an efficient way of sampling. Cluster focuses on participants from different areas however cluster sampling is not as precise as simple sampling. This is suitable as physiotherapists were recruited from 3 clearly stated areas. Convenience sampling however, falls under nonprobability sampling and this is the least satisfactory method of sampling (Etikan, 2016). What makes this type of sampling a negative option is the likelihood of selection bias being

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present as already mentioned, due to this convenience and that this type of sampling should not be representative of the targeted population.

The setting of the data collection was stated but not justified as to why the specific departments were chosen, in those locations. The process of selecting the sample was not random. 13 physiotherapists from the 31 were used in the study. Nothing was mentioned about the remaining ones. The data collected was clear and the method was explicit. There were no inclusion criteria but there was an exclusion. One-to-one semi-structured interviews were clear-recorded using a digital voice recorder. Interviews are key in obtaining information regarding participants’ opinions and experiences (Polgar & Thomas, 2013). Voice recording is intrusive to the participants, it is not cost effective and disclosure is less therefore more patients are likely to refuse to take part. Data collection therefore interferes with the reliability and validity of the study (Polgar & Thomas, 2013). Regarding the ethical point of the research study, the participants have given an information sheet in order to discuss any of their concerns and then give their consent before the start of the study. Nevertheless, there was no approval evidence from any ethical committee.

A systematic process was undertaken, where the end results were split into 6 themes and presented into a chart. Respondent validation was not undertaken. Polgar and Thomas (2013) further note that data analysis in relation to qualitative data includes procedures where by the researchers collect, record and analyse what is said and performed by the subjects. The accuracy of qualitative data analysis can be tested using data saturation. This factor ensures that sensible and targeted information is gathered from the participants. In this paper however, no new relevant emerging data was achieved. Therefore, the themes concluded are reproducible.

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The data obtained from the qualitative study, was analysed independently using a framework method of analysis. Description of the analysis process was described in depth and quotes of the answers were displayed. The relation that links the interviewer with the participants was not considered appropriately, although the participants knew he was a physiotherapist. The researchers did not examine their own role, so there is possible investigator bias, therefore the data collection might not have been random. There is no clear statement on the findings. Both barriers and enablers were discussed but there is uncertainty of the effectiveness of the interventions.

The framework present in the results is coding and finding the main themes. This means that they read the data, assign it to categories and then determine the main themes based on which categories fit the most. The coding scheme is commonly based on the research question, however as the research progresses, the coding changes accordingly (Miles, Huberman & Saldana, 2014). In this trial, this did not occur, therefore it can be argued that investigator triangulation could have been used. Flick, Kardoff and Steinke (2004) have indicated that this framework promotes the participation of more and various interviewers in order to even out the influences the subjects have on the individuals. This approach can reduce bias and increase credibility.

Overall, the research question has been answered, but not precisely. With reference to other studies too, there is evidence to show a difference in patients undergoing this exercise programme, however the prescription parameters are not clear. In general, it has been noticed that what is done in clinical practice is not always what the physiotherapists prefer and therefore challenges arise regarding this matter.

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On the whole, the factors that contribute to the effectiveness of qualitative research are: validity, reliability and generalisability (Leung, 2015). With reference to the above information, the study is poor in all factors considered. Validity however is good in some aspects and in some others, poor as explained above. To be fair, some of the barriers and enablers were identified, but the views obtained are not representative of all physiotherapists in the RCT and there was no mention on how the evidence can be reproduced to other groups of people.

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