This assignment aims to identify a research question which is relevant to my area of practice in MSK outpatient physiotherapy and legitimise the reason for this. Relevant methodologies used to address the research question and the context of practice will be critically appraised. The impact of professional, ethical and practical factors which may affect the successful completion of this project too will be discussed.
Attitude of Indian physiotherapists towards pain neuroscience education (PNE) in private MSK physiotherapy practice in India.
Pain Neuroscience Education
PNE is an informative framework used by physiotherapists that spotlights on educating people experiencing pain more about the biological and physiological procedures associated with their experience of pain. Present best-evidence gives solid help to PNE to unequivocally affect pain assessments, dysfunctions, fear-avoidance, and pain catastrophisation, movement limitations, knowledge of pain and utilisation of healthcare (Louw, n.d.). The scope of PNE is widely recognised in countries with healthcare systems which follow evidenced based practice.
However, from writer’s experience of working as a physiotherapist and interacting with physiotherapists from various parts of India there is a common belief that pain and tissue health are inter related, customary educational model teaches people about pain comparatively engaged on anatomical, patho anatomical and biomechanical clarifications (Louw, n.d.) as a result from the experience of writer so far, PNE have not been given much importance in clinical settings across India.
Why is PNE important?
Pain neuroscience education plans to exchange information to interminable pain patients, in this manner enabling them to comprehend their pain and make versatile discernments and enhancing their capacity to adapt to their pain. PNE infers showing individuals about the fundamental instruments of pain, including how the brain produces pain. Much consideration is paid to the way that pain isn’t generally the outcome of harm and that, certainly if there should arise an occurrence of industrious pain, the pain is because of upgraded focal pain preparing as opposed to basic damage. Understanding pain along these lines, diminishes its danger esteem, prompting more successful pain adapting techniques. As per evidences PNE is proven to be powerful in changing pain convictions, enhancing health status and decreasing health care expenses for adult patients with different chronic pain conditions (Meeus & Nijs, 2016).
From writer’s experience so far as a physiotherapist working in India, writer have neither practiced nor experienced it being practiced by Physiotherapists writer knew. From writer’s experience, he is not sure about how PNE is perceived by physiotherapists in India, he is also not sure about few other key questions like are Indian physios knowledgeable about PNE, it’s importance, are they willing to practice it in their clinical contexts, the facilitators and barriers of practicing PNE in clinics and most importantly how receptive are Indian patients towards PNE as compared to the traditional anatomical and bio-mechanical approaches. So from the above introduction of the issue in writer’s clinical context, and from the realisation of its relevance in contemporary MSK physiotherapy practice, the research question the writer would like to develop and focus on is, “Attitude of Indian physiotherapists towards pain neuroscience education (PNE) in private MSK physiotherapy practice in India”
Relevance of PNE in Physiotherapy practice
The bio-psycho-social model for chronic pain management suggests that the experience of pain can best be comprehended as a blend of science (e.g., tissue harm, physiological procedures), psychology (e.g., state of mind, beliefs, thoughts and emotional well being) and social or relevant elements (e.g., culture, condition or assets). Hence, the bio-psycho-social model requires that physiotherapists include assessments and medications that mirror the between connectedness of organic, mental and social factors in the individual living with pain. This comprehension of pain likewise broadens the scope of treatment choices accessible (Physiotherapy Alberta, 2017). This can be achieved through PNE.
The fundamental focal point of Pain Neuroscience Education is around changing patients’ perceptions of pain in non specific chronic pain conditions and limiting further medical care by actuating knowledge into the patient’s complaints, enhanced adapting to complaints, enhanced self-control, and instigates peace of mind (Wijma, et al. 2018). The writer would like to throw some light on his experience of the management of low back pain in the Indian clinical settings with reference to evidence which underpins why PNE is important. According to (Synott, et al. 2015) Physiotherapists mostly perceived subjective, mental and social factors in individuals with LBP. Physiotherapists communicated an inclination for managing the more mechanical parts of LBP, and some demonized the practices suggestive of intellectual, mental and social commitments to LBP. Physiotherapists saw that neither their initial training, nor any further continuing professional development training, ingrained them with the imperative aptitudes and certainty to effectively address and treat the multidimensional pain features seen in LBP. Effectively incorporating PNE into clinical practiced would help physiotherapists overcoming these shortfalls.
PNE can modify a patient’s pain recognitions and wellbeing status, and is best when it is conveyed in the format of one-to-one. It ought to be custom-made to the individual, and introduced in blend with composed materials the patient can audit in the non-clinical environment. As a major aspect of the instructive procedure, patients are urged to talk about the use of PNE standards to day by day movement. PNE is progressing all through treatment. Ideally, it is first instructed in a way that empowers questions and progressing exchange (e.g., in view of the patient’s reactions to the Neurophysiology of Pain Questionnaire) and fortified all through generally treatment in advance talks with the patient, relating all treatment to the objectives of PNE (Physiotherapy Alberta, 2017).
PNE for patients with chronic pain tends to the physiology of pain, as opposed to the biomedical approach (in which instruction centres on anatomy and biomechanics). The objective for PNE is to push the patient to; Revise their comprehension of pain, to perceive and acknowledge that their pain encounter isn’t fixing to genuine or potential damage, enhance physical movement and capacity in view of that understanding, Promote self-care and goal setting (Physiotherapy Alberta, 2017).
From the above discussion and analysis the relevance of PNE is clearly understood and highlights the need for why it should be incorporated in clinical settings across India. Hence writer would like to explore the attitude of Indian physiotherapists towards the use of PNE within theirs and clinical settings across India.
Evaluation of Research Paradigms
A paradigm is a method for depicting a world view that is educated by philosophical suspicions about the idea of social reality (known as ontology – that is, the thing that do we accept about the idea of the real world?), methods for knowing (known as epistemology – that is, how would we recognise what we know?), and morals and esteem frameworks (known as axiology – that is, the thing that do we accept is valid?). A paradigm along these lines drives us to make certain inquiries and utilize suitable ways to deal with deliberate request (known as methodology– that is, by what means would it be advisable for us to examine the world?) (Chilisa ; Kawulich, 2015) .
Research methods are a broad term; with methods such as data collection and data analysis representing the core of research methods (Research methodology n.d.).
The information obtained are constantly numerical, and they are examined utilizing mathematical and statistical techniques. In the event that there are no numbers included, at that point it’s not quantitative research. They are probably not going to be extremely useful when you need to comprehend the nitty gritty purposes behind specific conduct inside and out. It is additionally conceivable that appointing numbers to genuinely digest builds, for example, individual opinion dangers making them deceptively precise (Skills you need, 2018). The most common forms of quantitative data collection are surveys, observations and secondary data.
Qualitative research does not include numbers or numerical information. It frequently includes words or language, however may likewise utilize pictures or photos and perceptions. Any marvel can be inspected qualitatively. Qualitative investigation results in rich information that gives a top to bottom picture and it is especially helpful for investigating how and why things have happened. Common strategies for gathering information incorporate, interviews, focus groups, post cards, secondary data and observations (Skills you need, 2018).
Online interviews empower data to be accumulated from a fascinating gathering of respondents that would have been hard to contact generally. The entire web based process of interviewing was advantageous for respondents who did not need to leave their homes and workplaces for the meetings. When all is said in done, respondents delighted in the web based laddering talking with understanding and specifically the loose and cordial air (Gruber, 2008).
Skype interviews can be considered as a form of online interview. According to (Lo Iacono et al. 2016) something of the rapport and wealth of the communication might be lost in skype interviews. It is without a doubt genuine that a portion of the compatibility might be lost as an eye to eye meeting would be. On the other hand, a few participants might be more disposed to open up while being met by means of Skype, since they can remain in their own particular picked environment. The way that the member is in a well-known environment might be, more helpful to participants who are timid or independent, enabling them to feel more happy with opening up before a screen’.
Another form of online interviewing is through sending email so as to meet timid individuals and the individuals who experience issues to generally communicate. It can conceivably be hard for a timid individual to consent to sit before a questioner for any period of time and to do as such, especially in the same-space nearness of somebody whom the volunteer sees as authoritative (Lo Iacono et al. 2016).
This type of data collection method can possibly gather both qualitative and quantitative information. Leading an online survey empowers access to vast and topographically distributed populations (Regmi et al. 2016). Online surveys are ending up progressively common and research contrasting electronic with postal overviews is beginning to affirm that electronic review content outcomes might be the same than postal study content outcomes, yet give solid points of interest of quick conveyance and response cycles .It is better than email studies in numerous viewpoints (Andrew et al. 2003).
Online surveys offer advantageous and dependable management of data. By design, the format of online surveys secures against the loss of information and expedites transfer of data into a database for analysis. Additionally it is cost-effective as well as; it can save a lot of time of the researcher (Regmi et al. 2016). Online surveys not only have the upside of affordability and speedy dispersion. Moreover, online surveys give the capacity to exchange study responses straightforwardly into a database, erasing interpretation errors and avoiding survey change by the study respondent. At first specialised issues repressed the utilization of online surveys, however new programming and Internet related innovation give off an impression of being alleviating a significant number of the specialised constraints (Andrew et al. 2003).
As discussed above, online surveys offer many advantages as compared to other forms of surveys however there are some disadvantages as well. Key disadvantages include sampling and access issues
Numerous Internet communities pay for network tasks with publicizing. This can desensitize members to beneficial survey requests posted on the site. To put it plainly, there is an inclination of a few people to react to a challenge to take an interest in an online survey, while others overlook it, causing a systematic bias (Wright, 2006).
Difficulties can also be encountered around generating samples from virtual groups and organisations and from an online community as some virtual groups and organisations give participation email records that can enable researchers to build up a sampling outline. In any case, not all individuals from virtual groups and organisations permit their email delivers to be recorded, and some may not enable directors to give their email delivers to scientists. This makes precisely estimating an online populace troublesome (Wright, 2006).
A few researchers get to possible participants by presenting solicitations on partake in a survey on bulletin boards, discussion groups, and chat rooms. Be that as it may, individuals from online groups regularly discover this conduct discourteous or hostile or view this kind of posting as “spam”. A people group arbitrator may erase the undesirable post, or the analyst might be immersed with messages from angry individuals from the network. Specialists utilizing email solicitations to take an interest in a review may confront comparative dismissal. An undesirable email ad is frequently viewed as an attack of security. The welcome for the survey might be erased, or the analyst may get email from participants griping about it (Wright, 2006).
Online Focus groups
Online focus groups (OFG) can be directed in two different ways: synchronously or asynchronously, or utilizing a blend of both. In the synchronous mode, members are online at the same time at a prearranged time, and instantly respond to each other’s reactions as these are obtained. The asynchronous mode alludes to a progressing site where members are allowed to sign in amid a set period, read every others’ commitments and post a remark themselves during a period that is helpful for them, not really when any other person is participating. The most evident preferred standpoint of utilizing on the web centre gathering approach is that it empowers access to populaces that are difficult to incorporate utilizing standard research strategies and that it encourages exchange between members who may not generally have talked with each other (Tates et al. 2009)
Another noteworthy advantage of utilizing OFGs is giving participants a helpful and agreeable method for joining bunch discussions. Unconstrained by place and time, online participants can add to the group discussion at their recreation and individual places. In option to these favourable circumstances for participants, potential researcher benefits have been archived too. Preeminent among these favourable circumstances of OFGs, are expenses and time-savings because of the programmed and exact acquisition of the discussion data. Responses can be moved specifically in a database where they are promptly available for examination, without the requirement for translation or altering, upgrading the exactness of gathered data and wiping out transcriber bias. Extra advantages of OFGs incorporate lower enlistment costs in contrast to traditional face-to-face focus group and the nonappearance of calculated and travel costs (Tates et al. 2009).
However there are some limitations in conducting OFG surveys, which includes trouble in arranging and overseeing real-time groups, the requirement for inspired participants in asynchronous groups keeping in mind the end goal to keep up participation for more than a few days or weeks (Kite ; Phongsavan,2017). Another major concern related with online information gathering is selection bias, because of non-representativeness of the sample and self-determination of participants. Constrained PC access or PC ignorance may confine support, making an advanced gap between the ‘have nets’ and ‘those who lack wealth’, along these lines prompting age or financial status examining inclination. Self-determination of participants from a non-arbitrary pool of Internet clients may moreover diminish the external validity (Tates et al. 2009).
After the analysis of the above discussed potential methodologies writer is of the view that no single methodology could be considered appropriate for undertaking this research project in the clinical and cultural context of the writer. Perhaps a combination of all the above mentioned methodologies to gather the desired data would be deemed appropriate given the geographical and time factors, obtaining permission from relevant bodies and access to internet/ ease of access and so on needs to be considered with the target population.
Professional, ethical and practical considerations
Research utilize is viewed as a vital part of Evidence Based Practice. The requirement for a more research-oriented physiotherapy practice was perceived decades ago. Supportive conditions for physiotherapists’ utilization of research exist at numerous associated levels, including the individual, working environment, and additional hierarchical levels. Research use in physiotherapy has all the earmarks of being an intuitive and interpretative social process that includes a lot of interaction with different individuals, including colleagues and patients (Dannapfel et al. 2013).
Availability of regulatory budgetary help, ability to surrender income delivering time, familiarity with the utilization of statistics, availability of outside funding , availability of equipment and facilities, familiarity with the research process, willingness to make research a higher priority, availability of a research consultant, availability of a reliable patient load, and a good administrative philosophical support are required for an effective conduct of a research (Ballin et al. 1980) and hence all these factors needed to be given ample consideration also therapists working in private clinical settings in contrast to therapists working in acute care, rehabilitation clinics expressed less of an enthusiasm for research, including an unwillingness to make research a higher priority (Ballin et al, 1980). This needs to be considered as well because the research project intended is to be conducted among physiotherapists working in private practice.
Following governance procedures and engaging in ethical review are required strides in guaranteeing the honesty and quality of a research venture. Focusing on whom the research is pertinent to show signs of greater response rate, keep data clear and brief demonstrating what responsibility is included, clearly outlining the advantages individuals will pick up by taking part. Also the security, respect and well-being of participants, researchers and others involved in the research ought to be ensured (CSP, 2018). Writer recognises these values and realise the importance of having a commitment to these values whilst undertaking his research.
A reasonable due date for research completion will be required keeping in mind the end goal to adhere to the time frame of the research. The researcher knows, that individuals might be willing to take part yet could not respond on time as expected by the researcher due to various factors (personal, professional, access to resource and so on) experienced by the participants. All these factors need to be given a good consideration whilst undertaking the research. Consequently an arrangement for conveying an update email should be considered in order to overcome these barriers.
Research is fundamental to discover which treatments work better for patients. It assumes an essential part in finding new medicines, and ensuring that we utilize existing treatments in the most ideal ways. Research can discover answers to things that are obscure, filling knowledge gap and changing the manner in which that health care professionals work (NHS, n.d.). The writer hopes give insight to the participants regarding the role of PNE in the management of chronic pain which is practiced in countries with health care systems following evidence based practice and transferring it into their respective clinical settings and hence improve the practice of physiotherapy profession in private clinical settings across India.
Andrews, D., Nonnecke, B., Preece, J. (2003) Electronic survey methodology: A case study in reaching hard to involve Internet Users. International Journal of Human-Computer Interaction. 16, 2, 185-210. Retrieved from https://www.researchgate.net/publication/228597952_Conducting_Research_on_the_Internet_Online_Survey_Design_Development_and_Implementation_Guidelines
Ballin, J.A., Breslin, H.W., Wierenga, S.A.K ., & Shepard,F.K. (1980). Research in Physical Therapy. Philosophy, Barriers to Involvement, and Use Among California Physical Therapists. Retrieved from http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.912.5836&rep=rep1&type=pdf
Chilisa, B., & Kawulich, B.(2015). Chapter 3, Selecting a research approach: paradigm, methodology and methods. Retrieved from https://www.researchgate.net/profile/Barbara_Kawulich/publication/257944787_Selecting_a_research_approach_Paradigm_methodology_and_methods/links/56166fc308ae37cfe40910fc/Selecting-a-research-approach-Paradigm-methodology-and-methods.pdf
CSP (2018). Ethics and governance. Retrieved from https://www.csp.org.uk/professional-clinical/research-and-evaluation/doing-research/ethics-and-governance
Dannapfel, P., Peolsson, A., & Nilsen, P. (2013). What supports physiotherapists’ use of research in clinical practice? A qualitative study in Sweden. Implementation Science?: IS, 8, 31. http://doi.org/10.1186/1748-5908-8-31
Gruber, T. (2008). Emerald Insight. Designing and conducting online interviews to investigate interesting consumer phenomena. Retrieved from https://www.emeraldinsight.com/doi/abs/10.1108/13522750810879002
Kite, J., ; Phongsavan, P. (2017). Insights for conducting real-time focus groups online using a web conferencing service. F1000Research, 6, 122. http://doi.org/10.12688/f1000research.10427.1
Lo Iacono, V., Symonds, P., and Brown, D H.K. (2016). ‘Skype as a Tool for Qualitative Research Interviews’. Sociological Research Online 21(2)12. Retrieved from https://warwick.ac.uk/fac/soc/al/people/mann/interviews/paul_symonds_-_skype-research-method.pdf
Meeus, M. ; Nijs, J. (2016) Pain in motion. Five Requirements for Effective Pain Neuroscience Education in physiotherapy practice. Retrieved from http://www.paininmotion.be/blog/detail/five-requirements-effective-pain-neuroscience-education-physiotherapy-practice
NHS (n.d.). The Penine Acute Hospitals. Why is Research Important? Retrieved from http://www.pat.nhs.uk/education-and-research/why-is-research-important.htm
Louw, A. (n.d.) Pain Neuroscience Education. Retrieved from https://www.ispinstitute.com/wp-content/uploads/sites/4/2017/08/Pain-Neuroscience-Education.pdf
Physiotherapy Alberta (2017).Chronic Pain Management: A Toolkit for Physiotherapists. Retrieved from https://www.physiotherapyalberta.ca/files/chronic_pain_toolkit.pdf
Regmi, P. R., Waithaka, E., Paudyal, A., Simkhada, P., ; van Teijlingen, E. (2016). Guide to the design and application of online questionnaire surveys . Nepal Journal of Epidemiology, 6(4), 640–644. http://doi.org/10.3126/nje.v6i4.17258
Research methodology (n.d.) Retrieved from https://research-methodology.net/research-methods/
Skills you need (2018). Quantitative and Qualitative
Research Methods. Retrieved from https://www.skillsyouneed.com/learn/quantitative-and-qualitative.html
Synnott, A., O’Keefe, M., Bunzli, S., Dankaerts, W., O’Sullivan, P., ; O’Sullivan, K. (2015). Physiotherapists may stigmatise or feel unprepared to treat people with low back pain and psychosocial factors that influence recovery: a systematic review Journal of Physiotherapy, 61: 2, 68-76. Retrieved from https://www.sciencedirect.com/science/article/pii/S183695531500017X
Tates, K., Zwaanswijk, M., Otten, R., van Dulmen, S., Hoogerbrugge, P. M., Kamps, W. A., & Bensing, J. M. (2009). Online focus groups as a tool to collect data in hard-to-include populations: examples from paediatric oncology. BMC Medical Research Methodology, 9, 15. http://doi.org/10.1186/1471-2288-9-15
Wijma, J.A., Speksnijder, M.C., Crom-Ottens, F.A., Knulst-Verlaan, C.M.J., Keizer, D., Nijs, J., & van Wilgen, P.C. (2018) What is important in transdisciplinary pain neuroscience education? A qualitative study, Disability and Rehabilitation, 40:18, 2181-2191, DOI: 10.1080/09638288.2017.1327990
Wright, B.K. (2006) Researching Internet?Based Populations: Advantages and Disadvantages of Online Survey Research, Online Questionnaire Authoring Software Packages, and Web Survey Services. Retrieved from https://doi.org/10.1111/j.1083-6101.2005.tb00259.x
1) Develop online surveys knowledge and skills
Action • Sign up on www.surveylegend.com
• Engaging with their learning guides and seek further support as required.
• Conduct a trial survey with friends acting as participants.
Resources • Internet access
• Availability of friends.
Achieve by December 2018
2) Developing required interview skills ensuring the questions asked during the interview are related to the topic and also ensuring the fluency of language for the smooth conduct of the interview.
Action • Improving subject knowledge by reading relevant articles and journals.
• Watch videos and listen to audios of medical interviews, if possible interviews related to the research topic.
• Improving vocabulary, fluency of the language and body language.
• Conducting numerous mock interviews with friends who will act as participants
• Audio/ Video record mock interviews. Compare and analyse them to measure the quality and progress made after each interviews.
Resources • Internet access.
• Availability of friends to conduct mock interviews.
• Audio/video recording equipment.
• Attending soft skills training sessions to develop interview skills and body language.
Achieve by March 2019
3) Recruiting a sizeable participant population for the conduction of research
Action • Identify suitable participants (former colleagues and friends working in private MSK physiotherapy practice) and obtaining their confirmation to engage with the research.
• Seek help from colleagues to canvas their friends who could be potential participants
• Giving them choices about their preferred mode of participation.
Resources • Internet and telephone access.
• Pamphlets providing explanation about the purpose and nature of the research.
Achieve by March 2019