Anne Parry

New paradigms for old : Musings on the shape of clouds

Summary Credibility, validation of clinical practice and growth and development of the profession are benefits physiotherapists expect from research. Whoever believes that the randomised controlled trial should not be the sole approach to research into practice may be attracted to other methodologies. It is widely accepted in many areas that the research question should indicate which approach and method should be used. The author argues, however, that this is an oversimplification: a researchers personal world view influences generation and formulation of research questions and every research tool or procedure is embedded in commitment to particular versions of the world and to knowing the world. Some of the inextricable links between research design and underlying philosophy are examined by exploring the concept of paradigm and its relevance to physiotherapy as a nascent science. The author discusses the old measurement-oriented paradigm, the newer interpretivist paradigm, and finally, the empowerment paradigm, with regard to research and client-focused care.

Physiotherapy and methods of inquiry : conflict and reconciliation

Summary The author discusses the differences between ‘the scientific method’ and qualitative methods of inquiry like ethnography and grounded theory in terms of their philosophical bases and historical and contemporary contexts, the frameworks for research they demand, and their appropriateness to the various purposes of research in physiotherapy. She highlights the differences between verifying either theories or preconceived professional notions and evaluating the effects of treatments and practice from the perspective of either patients or practitioners. Triangulation is proposed as a reputable means of reconciling the strongly felt beliefs of the protagonists of different approaches to research to meet the needs of both physiotherapy and the National Health Service.

Redefinition of life experience following total hip replacement: a qualitative study

Purpose: We drew on a qualitative research design to examine patients’ experiences of coping following total hip replacement (THR) by obtaining their perspectives through participants’ personal language. Method: Post-operative patients who were able to explore their experiences and express them verbally were purposively sampled from an out-patient orthopaedic department of a UK hospital. Narrative interviews were conducted with the participants at two points in time. Interviews were transcribed verbatim and analysed using Coffey and Atkinson’s model (1996). Results: They employed different psychological coping mechanisms to adjust themselves to the new stressful situations that led to reinterpretation of the meaning of life. They used problem-focused, emotion-focused, comparative, spiritual and self-oriented coping strategies and shifted their focus from disease-related problems to other aspects of their lives. Conclusion: The participants in this study used a range of coping strategies to accommodate to the challenges of their hip condition and the consequences of the THR. They placed greater emphasis on positive gains from their experiences and alleviated the harmful effects of pain and physical limitations by reinterpreting the meaning of life. It is suggested that the findings of the study could have clinical implications when applying patient-reported outcome measures over time. Implications for Rehabilitation Qualitative studies of this type show how people change their values over the course of an illness and reinterpret the meaning of life. An understanding of the complexity of experiences following THR surgery is important when evaluating the outcomes of treatment using patient-reported outcome measures. Recognizing the importance of psychological strategies to coping is important in rehabilitation and may account for differences in outcome.

Physiotherapy Journals — Why bother?

Summary Editors may be damned because they do publish and damned because they do not. The small proportion of physiotherapists writing for publication suggests that the majority of them also fear being damned or rejected. Both the history and the present of writing about physiotherapy appear to be inseparable from womens perceptions of their capacity for constructing knowledge and their silence in literature in general. Physiotherapists must become more aware of the power of words for transmitting knowledge, sharing experiences and creating frames of reference for knowledge. They must acknowledge a crisis of identity, which verges on extreme denial of self and dependence on external approval, emerge from it and refuse to play the conventional female role that depends on external authority for direction and patronage. The struggle is one of conflicting world views. Physiotherapists try to get their voices heard in a world that values only dispassionate reason, rationalisation and scientific thought. However, all knowledge is constructed and all theories are only models for approximating experience. They can create a system of authority for physiotherapy based on personal and individual experience as well as scientific sources. Writing and publishing are the major ways in which they can all gain access to and connect the knowledge and ideals of physiotherapists worldwide in order to reveal the kind of truth they value. Todays physiotherapists are responsible for constructing the knowledge of physiotherapy and using their journals to articulate a position that will enable physiotherapists to play a key role in shaping provision of care in the 21st century. This paper was read as a plenary lecture at the international conference on ‘The Science and Art of Physiotherapy’, Hong Kong Convention and Exhibition Centre, July 23–25, 1993.

The Golden Heresy of Truth

Since 1915, Physiotherapy has recorded the work of physiotherapists through epochs of the 20th century, from the focus on war wounds in the early issues through the polio epidemics of the 1950s to the AIDS pandemic. It charts the development of physiotherapists from appliers of modalities of treatment to deliverers of care to the role they now play in the provision of care and assessment of health gains a t outcome from treatment. It also reveals the heresies that were our truth which have lately received the stamp of scientific fact. Looked at with late 20th-century sensibilities, George Russell’s verse on the plaque in the stairwell at Bedford Row commemorating the Founders of the Society of Trained Masseuses seems florid:

Making our Mark

A new year brings new opportunities, new ambitions, new plans. For physiotherapists it means hopes that the money the Goverment has pledged to the Health Service will improve patient care, ease staff shortages and lead to more realistic salaries. For the Chartered Society of Physiotherapy it means improved services for members – without an increase in annual subscriptions. For all concerned with physiotherapy, 1999 will bring the re-launched CSP Congress in Birmingham and the international gathering of the World Confederation for Physical Therapy in Japan. And for the Journal it means a change of style.

Writing Case Reports

09 3). Illus. 156 pages.

Book and Media Reviews

29.95 APT members,

Ginger Rogers Did Everything Fred Astaire Did Backwards and in High Heels

42.95 non-members. ‘How to’ manuals on writing for publication are a growth industry. We have even published a ‘how to write . . .’ series in Physiotherapy. Although most publications are prescriptive, apart from the single page of instructions sent out to our reviewers, there is little advice about ‘how to write a book review’. Let me tackle it by answering nine easy questions on this book. 1. What is the book trying to do? In this case, a bit more than the title says. It aims to take the fear and mystery out of writing case reports and the peer review process specifically for publication in Physical Therapy. 2. Does it do it? While the mystery of writing and reviewing is debunked, the very comprehensiveness of the book might engender fear in some novice authors. The ten chapters cover everything from reasons for writing case reports t o preparing for peer review and are divided into two sections: ‘Preparing t o write’ and ‘Start writing!’ If it doesn’t frighten you or you overcome the terror, the content is valuable to seasoned authors too. 3. What’s new? The packaging and specific application to case reports is new, rather than much of the content. Sources of material, levels of measurement, confirmation of validity and reliability, identifying and writing for a particular audience, using theory and existing knowledge about practice to substantiate assertions and structure have all been written about extensively, most of it aimed a t researchers in the biomedical sciences who already have a history of writing for peer-reviewed journals and, therefore, many possible mentors. Clinicians writing for publication are often brought down by the devil in the detail. Therefore, although this book covers much the same as others, a major selling point is its friendly, well-thought-out presentation focused entirely on the needs of clinicians. 22314-1488, USA, 1996 (ISBN 1 887759 4. Is the balance of contents about right? Yes. Quite rightly a third of the book is given over to preparation.