Sophisticated Research Design in Chiropractic and Manipulative Therapy: Part 2

Sophisticated Research Design in Chiropractic and Manipulative Therapy;
“What You Learn Depends on How You Ask.”  
Part B.   Qualitative Research;   Quality vs. Quantity

The Chiro.Org Blog

SOURCE:   Chiropractic Journal of Australia 2016; 44 (2): 1–14

Lyndon G. Amorin-Woods, BAppSci(Chiropractic), MPH

Senior Clinical Supervisor;
Murdoch University Chiropractic Clinic
School of Health Professions,
Discipline of Chiropractic
Murdoch University South Street campus,
90 South Street, Murdoch,
Western Australia 6150

The plethora of quantitative evidence in chiropractic science stands in contrast to the relative dearth of qualitative studies. This phenomenon exists in spite of the intuitive impression that chiropractic is indeed suitable for investigation with a variety of qualitative methodologies. There is a long tradition of qualitative investigation in the social sciences, which focuses on gathering rich experiential data, recognising both that health research deals with ‘real’ people, and that people are not predictable or pre-determined. Qualitative chiropractic research can examine various aspects of a “package” of care and the participants “care journey” and the interplay between verbal and nonverbal, including tactile interactions, which may be diagnostic or therapeutic. Research in chiropractic ideally integrates experience, neurobiology and nonlinear dynamic thinking. Many chiropractic scientists are used to only working with linear models, consequently they may be reluctant to adopt the nonlinear framework of complexity theory and recognise that the analysis of lived experience including subjective phenomena can be an integral part of studies in the chiropractic space.

Keywords Evidence-Based Practice; Qualitative Research; Research Design

INTRODUCTION

This paper examines the application of qualitative methodology in the chiropractic sector. Philosophers of science have long observed that the positivist paradigm that underpins quantitative research can itself easily become a dogma, they recognise that science can never ‘prove itself’ and many would no doubt agree with Dupre that it may indeed become a form of ‘scientific imperialism’. [1-3] There is thus an increasing recognition that devotion to a purely quantitative methodology in the health sciences is at best, ‘unbalanced’. [1] This paper will lead the reader through a preliminary description of qualitative research methodologies while providing an overview of the major paradigms on which qualitative research is based, along with selected chiropractic examples.

Importance of Qualitative Research to Chiropractic Health Research

In general, “qualitative research,” refers to social research in which the researcher relies on textual data [preferably gathered by personal contact], rather than by conversion to numbers. The aim is to understand the meaning of human action by asking open questions about phenomena as they occur in context rather than setting out to test predetermined hypotheses. [2, 3] Adams presented a lucid framework for a qualitative research agenda that could be used to examine the ways in which chiropractic has been (and is currently) represented in a range of written forums including social policy, mainstream media, and clinical practice guidelines. [4] Latterly the formation of a formal practice-based network (PBRN) will facilitate this process. [5] Qualitative research has much to offer but may be unfamiliar to researchers with a biomedical or natural science background; health research deals with real people, and people are individuals, not predictable or pre-determined. Acknowledgement of social science does much more than consider people as numbers, thus the opportunity arises to consider what might constitute the best way to answer the research question posed, and that may not be quantitatively. Adams notes such analysis potentially has much to tell about the political, cultural, and social location and positioning of chiropractic. Increasingly qualitative methods are also an element in the development of RCT’s – particularly those of complex interventions where the conduct of the intervention is mediated by human behaviour, but, are also often used alongside a clinical trial to provide evidence to intervene if necessary – including to discontinue the trial. [6, 7] These are so-called ‘mixedmethods’ studies and can take a number of forms, which will be examined in greater detail in Part C of this series.

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