ed summaries and general concepts can be formulated, which may, upon further investigation, be found to be germane to a wider variety of settings. Case studies, therefore are not necessarily restricted

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Qualitative research methods in health technology assessment: a review of the literature.

Background and Purpose. The purpose of this qualitative study was to identify the dimensions of clinical expertise in physical therapy practice across 4 clinical specialty areas: geriatrics, neurology, orthopedics, and pediatrics. Subjects. Subjects were 12 peer-designated expert physical therapists nominated by the leaders of the American Physical Therapy Association sections for geriatrics, neurology, orthopedics, and pediatrics. Methods. Guided by a grounded theory approach, a multiple case study research design was used, with each of the 4 investigators studying 3 therapists working in one clinical area. Data were obtained through nonparticipant observation, interviews, review of documents, and analysis of structured tasks. Videotapes made during selected therapist-patient treatment sessions were used as a stimulus for the expert therapist interviews. Data were transcribed, coded, and analyzed through the development of 12 case reports and 4 composite case studies, one for each specialty area. Results. A theoretical model of expert practice in physical therapy was developed that included 4 dimensions: (1) a dynamic, multidimensional knowledge base that is patient-centered and evolves through therapist reflection, (2) a clinical reasoning process that is embedded in a collaborative, problem-solving venture with the patient, (3) a central focus on movement assessment linked to patient function, and (4) consistent virtues seen in caring and commitment to patients. Conclusion and Discussion. These findings build on previous research in physical therapy on expertise. The dimensions of expert practice in physical therapy have implications for physical therapy practice, education, and continued research.

Expert Practice in Physical Therapy

In the current climate of evidence-based practice, physiotherapy is urged to prove its worth via rigorous scientific research. However, there are concerns that limited methodologies are used to explore complex therapeutic issues, and that the profession relies too heavily on quantitative research studies to provide its evidence base. Qualitative research methods are able to explore the complexity of human behaviour and generate deeper understanding of illness behaviours and therapeutic interactions. Nevertheless, there is still a sense of distrust of qualitative research, related to the challenge of evaluating both the quality and usefulness of findings derived through qualitative methods. This discussion paper explores these issues. It examines some of the most frequently used techniques aimed at ensuring quality and value in qualitative research, such as sampling, triangulation, multiple coding, respondent validation and the use of audit trails, as well as addressing reflexivity. Because of the pluralistic and interactive nature of qualitative inquiry, the criteria used to judge quality need to be appropriate to each piece of research and should provide evidence to help readers to evaluate the calibre of the study and its relevance to their own area of work.

Making words count: the value of qualitative research

https://cris.brighton.ac.uk/ws/files/275475/Petty%20et%20al%20paper%201%202012.pdf

Ready for a paradigm shift? Part 1: introducing the philosophy of qualitative research

Background and Purpose. Theoretical models of physical therapist expertise have been developed through research on physical therapists sampled solely on the basis of years of experience or reputation. Expert clinicians, selected on the basis of their patients' outcomes, have not been previously studied, nor have the patient outcomes of peer-nominated experts been analyzed. The purpose of our study was to describe characteristics of therapists who were classified as expert or average therapists based on the outcomes of their patients. Subjects. Subjects were 6 therapists classified as expert and 6 therapists classified as average through retrospective analysis of an outcomes database. Methods. The study was guided by grounded theory method, using a multiple case study design. Analysis integrated data from quantitative and qualitative sources and developed a grounded theory. Results. All therapists expressed a commitment to professional growth and an ethic of caring. Therapists classified as expert were not distinguished by years of experience, but they differed in academic and work experience, utilization of colleagues, use of reflection, view of primary role, and pattern of delegation of care to support staff. Therapists classified as expert had a patient-centered approach to care, characterized by collaborative clinical reasoning and promotion of patient empowerment. Discussion and Conclusion. These findings add to the understanding of factors related to patient outcomes and build upon grounded theory for elucidating expert practice in physical therapy.

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Using clinical outcomes to explore the theory of expert practice in physical therapy

The purpose of this study was to develop a conceptual framework and a data-collection tool to begin a systematic analysis of the work of the physical therapist. The primary method of data collection was nonparticipant observation of physical therapist-patient treatment sessions. A team of two researchers performed each of the observations. Eight physical therapists, representing three levels of experience, were observed in four different adult outpatient orthopedic settings. Field notes constructed from the observations and transcribed data were used to develop coding categories. These categories were the basis for the development of five themes that describe some aspects of the therapeutic intervention: 1) how treatment time is allocated, 2) the types and uses of information gathered from the patient, 3) the impact of the therapeutic environment, 4) the degree of responsive therapeutic interaction, and 5) the therapist integration of nontherapeutic interaction with therapeutic interaction. These findings are a beginning for understanding the practice of physical therapy.

The novice versus the experienced clinician: insights into the work of the physical therapist.

This article discusses why many current physical therapy entry-level programs may not be designed to educate the type of physical therapy practitioner needed for the 1990s. We suggest a framework for analyzing curriculum content to determine how the curriculum is influencing student outcomes. This framework includes three reference points of analysis, as suggested by Eisner's model of implicit, explicit, and null curricula. We also describe a new kind of physical therapy practitioner, the “reflective practitioner” (Schon's model), and suggest how various curricular components can support the development of this type of practitioner.

Physical Therapist Curricula for the 1990s: Educating the Reflective Practitioner

Qualitative research methods have special relevance for physical therapy. Qualitative methods provide researchers with the tools to examine social settings and human behavior. The methods are well suited to studying the complex, multidimensional environments present in physical therapy practice and education. A thorough understanding of research methodology is a necessary prerequisite for disciplined research. This article presents an overview of the philosophy underlying qualitative research, a discussion of the application of qualitative methods, and a brief analysis of how to address reliability and validity concerns in qualitative research. Increased understanding of what qualitative research is and how it can be done should promote disciplined qualitative research in physical therapy.

Qualitative methods in physical therapy research: a form of disciplined inquiry.

The purposes of this study were to identify gender-related values, perceptions, and experiences of female physical therapists as these factors relate to female physical therapists' professional development and to offer an initial critique of the identified elements in comparison with a traditional model of professionalism. In-depth interviews were conducted with 10 physical therapists in two different states by the primary investigator. The interviews were analyzed utilizing qualitative data-analysis techniques, and a conceptual framework was developed from the literature and the interviews. Three major thematic categories were identified: (1) values, comprising the subcomponents of caring, relationship, empowerment, and context; (2) family role, comprising the subcomponents of enhancements, limitations, and coping strategies; and (3) sexism, comprising the subcomponents of leadership, money, and respect. These findings provide an initial basis for understanding more about factors that may both limit and enhance female physical therapists' professional development.

Gail M Jensen

Papers

The novice versus the experienced clinician: insights into the work of the physical therapist.

Physical Therapist Curricula for the 1990s: Educating the Reflective Practitioner

Qualitative methods in physical therapy research: a form of disciplined inquiry.

Perspectives on Gender and Professional Issues Among Female Physical Therapists

Chronic Musculoskeletal PainPsychological Strategies for Rehabilitation in an Interdisciplinary Setting.