Qualitative research: exploring the multiple perspectives of osteopathy

This paper is offered as an introduction to qualitative research, with the hope that it informs and stimulates osteopaths and researchers who are unfamiliar with this area of research. This paper discusses the potential contribution of qualitative research in exploring the complex and multiple aspects of osteopathy and how the findings of qualitative studies may contribute to the knowledge base of osteopathy. A definition of qualitative research is provided, and a number of different methodologies are discussed. Finally it suggests examples of how the findings of qualitative research could potentially help inform osteopathic practice. © 2011 Elsevier Ltd

‘Talking a different language’: a qualitative study of chronic low back pain patients' interpretation of the language used by student osteopaths

Background: A growing body of research evidence has identified psychosocial factors to be important in the management of low back pain (LBP). Evidence suggests that healthcare professionals have a considerable influence on patients' attitudes and beliefs. Few studies have investigated how patients experiencing LBP interpret the language used by their osteopath during their consultation and the impact of language on their attitudes and beliefs of their LBP. Objectives: To explore and describe how patients with acute or chronic LBP interpret the language used by student osteopaths when explaining their diagnosis, and the impact their interpretation has on their attitudes and beliefs of their LBP. Method: Semi-structured qualitative interviews were conducted with a purposive sample of nine patients experiencing LBP who had recently attended an osteopathic teaching clinic in the UK. Interviews were transcribed verbatim and elements of grounded theory were used as a framework for data analysis. Results: Participants expressed a range of interpretations in response to the language used when discussing their LBP. The use of medical words, metaphors and analogies, reassurance and the patient practitioner relationship were identified as factors influencing the level to which participants engaged, taking an active role in their care. Conclusions: The language used by student osteopaths' influences patient beliefs about LBP in a variety of ways. The current study furthers understanding of how language contributes to these beliefs, identifying ways through which communication can contribute to improved healthcare through enhancing patient engagement. Keywords: Low back pain, Osteopathy, Language, Engagemen

'It's a Form of Freedom': The experiences of people with disabilities within equestrian sport

This paper explores the embodied, gendered experiences of disabled horse‐riders. Drawing on data from five in‐depth interviews with paradressage riders, the ways in which their involvement in elite disability sport impacts upon their sense of identity and confidence are explored, as well as the considerable health and social benefits that this involvement brings. Social models of disability are employed and the shortcomings of such models, when applied to disability sport, are highlighted. The data presented here demonstrates the necessity of seeing disability sport as an embodied experience and acknowledging the importance of impairment to the experiences of disabled athletes. Living within an impaired body is also a gendered experience and the implications of this when applied to elite disability sport are considered

Clinical reasoning in osteopathy: more than just principles?

Clinical reasoning is an integral part of clinical practice, and importantly for osteopaths, encompasses more than just the formulation of a diagnosis. With the advent of evidence-based practice health professionals are required to make explicit the strategies behind their clinical decisions. With many other health professions taking a critical view of their models of practice, there is an equal requirement for the osteopathic profession to reflect on and improve the transparency of clinical practice models used in osteopathy. This paper discusses the role of clinical reasoning in professional practice and the existing research in a number of health professions. It considers the need of such research in the osteopathic profession, and goes on to outline the methods by which clinical reasoning can be made visible through research. © 2010 Elsevier Ltd

Reconsidering the patient-centeredness of osteopathy

The widespread use of the biopsychosocial model amongst various health professions, all of which claim to take a patient-centred approach to their practise, challenges what has been considered a unique and defining feature of osteopathy. This paper discusses the complexity of what is meant by patient-centeredness, and how it is practised and researched by other health professions. The assumption that osteopathy has always taken a patient-centred approach is questioned, and directions for further research are highlighted so that the profession can have a comprehensive working knowledge of its practise, thereby helping to define itself within the broad and competitive healthcare environment. © 2012 Elsevier Ltd

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

The manual therapy professions have almost exclusively focused on the use of quantitative research to help inform their practices. This paper argues that a greater use of qualitative research will help develop a more robust and comprehensive knowledge base in manual therapy. The types of knowledge used in practice and generated from the two research paradigms are explored. It is hoped that an understanding of the philosophical and theoretical underpinnings of qualitative research may encourage more manual therapists to value and use this approach to help further inform their practice; for some, this may involve a paradigm shift in thinking. © 2012 Elsevier Ltd

Diagnostic reasoning in osteopathy – a qualitative study

Background: The clinical reasoning processes which result in the formation of a diagnosis, are fundamental for safe, effective and efficient clinical practice and are central to professional autonomy and accountability. While research has identified the diagnostic reasoning approaches taken by a range of healthcare professions, there is limited understanding of how osteopaths formulate diagnoses in clinical practice.Objectives: The aim of this research was to explore the diagnostic reasoning of experienced osteopaths in the UK.Methods: A qualitative constructivist grounded theory approach was taken in this study, which was situated in the interpretive research paradigm. A total of seventeen face-to-face semi-structured interviews were conducted with twelve experienced osteopaths. Participants were purposefully and theoretically sampled to take part in this study. Data collection methods involved semi-structured interviews with participants and observation and video-recording of clinical appointments, which were followed by video-prompted reflective interviews. The constant comparative method of analysis was used to code and analyse data.Results: The findings suggest that when formulating a diagnosis practitioners adopted two diagnostic reasoning approaches, namely hypothetico-deductive reasoning and pattern recognition. In this study, there was interplay of these reasoning approaches as a result of the perceived level of complexity and degree of familiarity of the patient presentation.Conclusions: Experienced osteopaths adopted diagnostic reasoning approaches which are akin to other healthcare professions including medicine and physiotherapy. Metacognitive and reflexivity skills were central for safe and effective diagnostic reasoning. Further work is required to explore the transferability of these findings with practitioners of different levels of clinical experience and who work in different clinical settings. © 2013 Elsevier Ltd

Osteopaths' professional views, identities and conceptions – a qualitative grounded theory study

Background: The professional status of osteopathy calls for the critical evaluation of the beliefs, knowledge and conceptions which underlie practitioners' clinical practice. Objectives: To explore experienced osteopaths' professional identities, views and overall conceptions of osteopathy in the UK. Methods: This qualitative study employed constructivist grounded theory set in the interpretive research paradigm. The constant comparative method of analysis was used to analyse and code interview data. A total of seventeen semi-structured interviews were conducted with twelve UK registered osteopaths. Data collection methods involved semi-structured interviews with participants and observation and video-recording of clinical appointments, which were followed by video-prompted reflective interviews. Results: There was diversity in how osteopaths viewed different aspects of their professional practice. Views were constructed into the major categories of: professional identity, traditional osteopathic theories and principles, health and disease and practice skills. Together these views formed three qualitatively different overall conceptions of osteopathy, termed: practitioner-centred osteopathy, collaborative osteopathy, and osteopathy as empowerment. Conclusions: Osteopaths in this study held differing views, identities and conceptions in relation to their practise of osteopathy. This diversity in professional identities and conceptions may help to explain the variation of individual osteopaths' clinical decision-making and clinical approaches, thereby contributing to an epistemology of osteopathy. These findings may be helpful to educators when planning curricula and clinically tutoring osteopathy students. Further research is required to explore how these views and conceptions develop and evolve during undergraduate education and on-going professional development

Clinical decision-making and therapeutic approaches in osteopathy - a qualitative grounded theory study

There is limited understanding of how osteopaths make decisions in relation to clinical practice. The aim of this research was to construct an explanatory theory of the clinical decision-making and therapeutic approaches of experienced osteopaths in the UK. Twelve UK registered osteopaths participated in this constructivist grounded theory qualitative study. Purposive and theoretical sampling was used to select participants. Data was collected using semi-structured interviews which were audio-recorded and transcribed. As the study approached theoretical sufficiency, participants were observed and video-recorded during a patient appointment, which was followed by a video-prompted interview. Constant comparative analysis was used to analyse and code data. Data analysis resulted in the construction of three qualitatively different therapeutic approaches which characterised participants and their clinical practice, termed; Treater, Communicator and Educator. Participants' therapeutic approach influenced their approach to clinical decision-making, the level of patient involvement, their interaction with patients, and therapeutic goals. Participants' overall conception of practice lay on a continuum ranging from technical rationality to professional artistry, and contributed to their therapeutic approach. A range of factors were identified which influenced participants' conception of practice. The findings indicate that there is variation in osteopaths' therapeutic approaches to practice and clinical decision-making, which are influenced by their overall conception of practice. This study provides the first explanatory theory of the clinical decision-making and therapeutic approaches of osteopaths