Introduction to
Physiotherapy Research:
Physiotherapy is a Health care
profession concerned with human function & movement
aimed at maximizing its potential. It uses physical approaches to promote,
maintain & restore physical, psychological & social wellbeing, taking
account of variations in health status. The role of a Physiotherapist involves
administration and interpretation of tests related to bodily functions and
structures, and the provision of a range of therapeutic and preventive measures
to patients suffering from disabilities, dysfunctions and pain. But
by large, Physiotherapy is still a non-dosage specific field where still lot of
researches are being done to understand the exact or specific dosages required
in the treatments/ restoration/ prevention of various conditions.
Challenges faced by the
novice researcher:
New PG Physiotherapy candidates are
full of concerns regarding the application research knowledge in practice for
their PG thesis. Although few of the universities in India have incorporated
research at an under-graduation level, this is expected to be an observational
research, more or less limited to a retrospective study. Thus, many times, they
may neither be exposed to, nor be interested in research. Although the thesis
in PG is mandatory, most of the young learners consider clinical learning
devoid of research and Evidence Based Physical Therapy (EBPT). EBPT
incorporates the application of the learners’ clinical Physiotherapy knowledge
backed by latest evidences favouring the same considering the patients’ needs
and necessities. This requires a thorough knowledge of the client’s functional
aspects backed by the latest trends in the practice of that condition at a
global level. This also necessitates the formulation of a clinical research
question in current practice.
The Research Question:
The Research Question is the soul
of every thesis. It not only directs the end point of the thesis, but also
marks the pathway to be taken towards completion of the thesis. Research question
helps to understand contents of the thesis, including the methodology, tools,
outcome measures and statistical tests that may be used in the particular
thesis. It helps choose an appropriate protocol to be followed in completion of
the thesis and let the researcher understand the need for the study. A good
research question should guide towards appropriate references; explain about
the condition to be studied and treatments currently available. It should note the
gaps present in the current chain of evidences and the specific treatment to be
studied and guide towards collection of preliminary data in the condition to be
studied. It should also help the researcher anticipate results and potential
pitfalls and describe the significance of the research including potential
benefit for individual subjects or society at large.
Hypothesis:
The hypothesis directs the methodology
which considers the measures of exposure and outcome. It should be tested by
making a comparison between the two or more groups. It guides the authors to
develop a plan for data collection and management, determine the statistical
methods for analysis and also estimate the magnitude of the expected difference
between the two groups, as a basis for determining sample size (power calculation).
This will guide to assess study feasibility, sample recruitments and analysis.
Study Title:
This is the most important part of every
research as the title forms the face of the study. An improper title will be a
deterrent for any study and shall not arouse interest in the readers. The title
should be descriptive of the study and should be
concise, clear and non-ambiguous.
Challenges in writing Introduction:
The introduction is the prima facia
of the research. The introduction should be of the current study, rather than
about the known knowledge of the conditions and diseases. It should always be
in the funnel format, i.e. from broad global concerns to small local concern. Many
times, the young researcher writes in great lengths about everything else other
than their own study which may turn down review board and readers. Introduction
should be short and specific incorporating the need for conducting the present
research in around 2–3 pages maximum. Bold statements like “such evidences do
not exist” or “there have been no studies on this topic” etc. should be
avoided.
Conducting the Review:
The next challenge faced is
collecting literature for reviewing. Although textbooks do give some baseline
information, they can only answer background questions. For understanding
research in its better aspect, answers to the foreground questions must be
sought for which reading latest literature is mandatory. This can be obtained
by subscribing to various peer reviewed, indexed journals or going through
online databases. Database like the Google scholar may be useful to find
articles, but specific databases like Pubmed, Cochrane, PEDro and CINAHL are
also useful in Physiotherapy thesis. But the reader should be clear in understanding
methods to navigate through them e.g., using the key words, filters, bullions,
truncation symbols, MeSH terms etc.
Documentation of the reviewed
literature is also an art. A review should always have a story and a flow to
it. This may be from the historical to the newer perspectives or may be
compartmentalised based on the research question/s. Writing briefly about the
authors, their study, design, results, conclusion and applicability is desired.
Aim and Objectives:
Generally PG thesis may have a
single aim to answer to a specific research question. The study objectives should be clearly and precisely
stated. They should be simple, specific, and stated in advance to performing
the research and should be attainable, measurable and realistic.
Research design and
Statistics:
The research
design should be identified and should be appropriate to answer the research
question/s under study. The researcher may describe the type of research proposed
(e.g. experimental, correlational, survey, qualitative) and specific study
design that will be used (e.g. pre-posttest, control group, cross-sectional;
prospective longitudinal, cohort; blinded randomized control). The research
design, methods and procedures should help answer the specific research
question/s as mentioned in the study objectives.
The sampling
procedures should be specific and scientific. The researcher should always
describe the sampling approach including determination and justification for
sample size. A larger sample size may increase the cost and duration of the
study and will be unethical to expose human subjects to any potential
unnecessary risk without additional benefit. A smaller sample size can also be
unethical if it exposes human subjects to risk with no benefit to scientific
knowledge. Calculation of sample size has been made easy by computer software
programs. The principles underlying the estimation of the software sample size
should be well understood. The researchers have to identify the procedures that
will be used to recruit, screen and follow study volunteers as well as
specifically define the study sample (number and characteristics of subjects to
be included and excluded). In intervention studies, clarification of subject allocation
to treatment and comparison groups and criteria for discontinuation should be
defined.
Another challenge faced is on
statistics which is considered as a huge challenge. Thus, involving the
statistician from the earliest part of the research is an excellent idea.
Statisticians can help in understanding the basis of statistical tools, data
variables and tests before actual exploration of data. Choosing good and
appropriate, valid and reliable outcome measures is also an important step to a
successful thesis.
Why conduct the Pilot
Study?
Before the actual research, performing
the pilot study is another crucial step in Physiotherapy thesis. It is useful
in multiple ways. In observational studies, it may help understand the outcome
measure or may help in validating the research tools. In experimental studies,
it may help in rectification and finalization of the processes and the
procedures which may be used in the study. Pilot study is never meant to analyse
the end results. It will help the researcher understand if he is on the right
track. This also helps rectify any lacunae that may weaken the study as well as
prevent any potential confounders that may cause bias in the study. Permissions
for obtaining/ using outcome measures can also be done in this phase.
Materials and Methods:
The methodology should
be elaborate to explain every procedural detail to the level of replication of
the entire study in the similar given environment. Processes of sampling,
consent, measures, tests, and data entry need to be provided in elaborate
details. A very important consideration in the thesis
methodology is following the universal guidelines for the procedure
documentation. Researchers are advised to go through CONSORT guidelines (CONsolidated Standards Of
Reporting Trials) for experimental, STROBE guidelines (STrengthening the
Reporting of OBservational studies in Epidemiology) for observational and STARD
guidelines (STAtement for Reporting studies of Diagnostic accuracy) for
diagnostic studies.
Ethical Clearance and
Research Registration:
Another important step before
actual initiation of the study is getting clearance from the Ethics Committee.
This is mandatory for any medical research, including Physiotherapy research to
ensure that the researcher shall not violate the rights and dignity of their
subjects. It is advisable for every researcher to be certified in Good Clinical
Practices, in order to ensure safeguarding of their subjects. Methods for data collection and for avoiding/
minimizing subject risks should be included. Always include a timeline for
subject evaluations, duration of intervention and tentative budget for the
project. The researcher should document the methods for maintaining subject confidentiality
(plans for coding data and for securing written and electronic subject records)
and should indicate duration of storage of personal information post study
completion. These methods will vary with the research type (qualitative,
quantitative) and thus should sufficiently describe justification of the
approach for answering the defined research question. Methods should also be
described in adequate detail so that IEC members may assess the potential study
risks and benefits.
Also it is important to register
the study with national clinical trials registry (Clinical Trials Registry of India,
CTRI). Many Physiotherapy researchers are still unaware of the importance of
registering their studies to safeguard their intellectual rights. CTRI does
register Post graduation Physiotherapy thesis and also observational studies.
Also, it is advantageous publish of your hypothesis as a defensive
publications. Journals like ‘Journal of Medical Thesis’ does publish Research
Hypothesis which helps protect intellectual property of the researchers.
The master chart and
Scientific Misconduct:
Although the master chart seems to
be the last and inconspicuous part of the research, fact is that it is the most
important piece of evidence in every research. The basic analysis of the entire
study data is done from the master chart and thus, it should be created
properly without any fallacies. The PG candidate should be clear with the data
being analysed and should make the master chart elaborately. Avoid making
single headings for multiple components. E.g., for male/ female, yes/ no
options, make 2 different columns rather than a single column and enter ‘1’ for
every ‘yes’ or ‘no’. This is extremely important in summation and averaging. In
experimental studies, it is advised to make different sheets for control and
experimental groups. MS Excel has multiple, user friendly options and tools
which should be learnt before making the master chart. Also, many statistical
tests for parametric data can be performed in Excel, including descriptive
statistics, paired and unpaired t test, ANOVA, Correlations, covariance etc.
For all other tests, including non-parametric tests and Correlations etc.,
using statistical packages like the SPSS is beneficial. Take guidance from a
good statistician help but learn your own basic test procedures as well.
Few of the researchers tend to indulge
in research malpractices during this phase by falsification and fabrication of
their data. This is strongly condemned and the researchers have to understand
that such malpractices can easily be detected by basic analysis of the master-chart.
Also ensure that the master chart does not disclose the identity of the
subjects in any way as this is considered as breach of confidentiality. Hence,
coding of the case report forms before making the master chart is a good
practice.
Results, Discussion and
Conclusion of the Study:
This is another crucial part of any
Physiotherapy thesis. Often good studies lose their value due to improperly
interpreted and explained results. The PG candidate should choose appropriate,
self-explanatory graphs and tables for explanation of their results.
The discussion should focus on the
important findings and rationalisation of these findings and should avoid repetition
of results. Utilising a good reviewed literature is extremely helpful in this
stage. Also, the confounders of the study should be well identified and
expressed in the discussion (unless they are being written separately as
limitations).
The conclusion should be a good
amalgamation of the aim, objectives, research question and hypothesis. Any
conclusion, whether it accepts or rejects the null hypothesis, is an important
contribution to Physiotherapy research. Conclusion should only be based on the
results obtained and should not have any comments outside the preview of the
study, including indirect study implications. Any suggestions or added
information can be written as a scope for further study.
References Guidelines:
References should always be recent,
complete and preferably in the Vancouver format. The details can be found in
most of the standard journal and sites. References should be given to all the
published articles, books, websites (mentioning the date of viewing them), and
even to unpublished but accepted works.
Summary:
Physiotherapy thesis has been an
integral part of every Post Graduate Physiotherapy candidate and is association
with them for a lifetime. In today’s electronic era, every published or
unpublished thesis can utilised by future researchers as a reference. But it
should be remembered that every research is completed only when published in a
good peer reviewed indexed journal. Thus, it becomes not only important and
ethical, but even legal to lay down all the facts associated with the study in
a truthful and honest manner. Malpractices like plagiarism, although may seem
easy, but are deterrents in the future prospects of the candidate. Almost all
of the universities and journals run anti-plagiarism software’s and getting
indulged in such act may not only cause rejection of this wonderful piece of
literature, but may also blacklist the candidate for life. Research is all
about a bit of dedication, understanding, honesty and hard work on the researchers’
side and about a lot of truth, facts and probabilities of the findings for
verification of these facts, which under any costs, must not be altered, but be
expressed with all its integrity. Only then can the candidate truly contribute
to his professions growth and stability in a noble way.
References:
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Nicholls DA, Gibson BE. The body and Physiotherapy. Physiother Theory Pract. 2010
Nov;26(8):497-509.
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Physiotherapy in India – A Cross-sectional Survey to Study the Awareness and
Perspective among Referring Doctors. Journal of Medical Thesis 2014 May-Aug; 2(2)
: 11-15
3. Portney LG.
Evidence-based practice and clinical decision making: It’s not just the
research course anymore. Journal of Physical Therapy Education.
2004;18(3):46-51.
4. Kaplan SL. Et
al Developing Evidence-Based Physical Therapy Clinical Practice Guidelines.
Pediatric Physical Therapy. 2013; 257-70
5. Fathalla MF. A Practical Guide for Health
Researchers. WHO Regional Publications Eastern Mediterranean Series 30
6. Writing a Research Policy – WHO. Recommended format for a
Research Protocol. Available at http://www.who.int/rpc/research_ethics/format_rp/en/
[Viewed on February 22, 2016]
7. Indrayan A. Statistical fallacies in orthopedic research. Indian J Orthop. 2007 Jan;41(1):37-46.
8. Amezcua M. [Myths, challenges, and fallacies in nursing research]. Rev Enferm. 2003 Sep;26(9):36-44. Spanish.
9. Babu AS, Veluswamy SK, Rao PT, Maiya AG. Clinical trial registration in physical therapy journals: a cross-sectional study. Phys Ther. 2014 Jan;94(1):83-90.
10. Shyam AK. Editorial: Hypothesis, Intellectual Property and
Journal of Medical Thesis: Concept of Defensive Publication. Journal Medical
Thesis 2014 Jan- April: 2(1); 1-2
Shimpi Apurv P.
Associate Professor and Head,
Department of Community
Physiotherapy, Sancheti Institute College of Physiotherapy, Pune
Editorial Board member, Journal of Medical
Thesis
Email: apurvshimpi@sha.edu.in
This article is Published as Guest Editorial in Journal of Medical Thesis as:
Physiotherapy Thesis - Challenges, Common Fallacies and Means
to Overcome Them. Journal Medical Thesis. 2016 Jan-Apr;4(1):3-6. doi: 10.13107/jmt.2347-5595/096
http://journalmedicalthesis.com/2016/01/guest-editorial-physiotherapy-thesis-challenges-common-fallacies-and-means-to-overcome-them/
