Research and practise – relevant?


This week I want to focus on research.  A couple of events brought this up for me:

I spent some time with Margaret Morrell, professional supervisor and trainer in supervision on Friday.  She raised the thought with me that many practitioners (from any field) don’t routinely question what they do and why. Her view is that supervision provides a forum for this to happen – so that people can continue to develop as a professional, and to routinely bring criticism and questioning into their practice to be the very best they can be.  I was a bit stunned when she said this – I can’t remember a time when I didn’t routinely question what I do, how I do it, why I do it and want to be challenged, but it seems that there are those therapists who simply follow the ‘rules’ and act more as technicians than professionals.

This is a real problem for patients who don’t know the practice style of the health professional they are seeing – how do they know if the therapist they are seeing is simply doing what he or she has always done, or whether their practice is routinely informed by recent research developments?

The second event to raise this issue with me was via the SomaSimple forum where someone pointed out that there are people who question their profession over and again, and there are people who are satisfied with doing what they’ve always done.  There are people who can’t answer the question ‘why does it work’ – and worse than that – they don’t care.  And this means our therapy can’t move past holding onto ‘comforters’ or things that seem reassuring even when they may not stand up to the cold hard light of day.  I wrote about this recently when talking about occupational therapy and the ‘myth’ of ‘activity is good’.   It may be that the belief that activity is good is demonstrated empirically to be sound, but until then it’s simply a belief.

By coincidence, I received a contents list from the journal ‘Rehabilitation Psychology’ which has a complete issue on Methodological Advances and Issues in Rehabilitation Psychology.  While this issue is mainly about psychology in rehabilitation, it has so much application to rehabilitation in general, I think it’s worth exploring.
Here’s the abstract from the editorial from the journal:

Scientific research plays an important role in advancing the knowledge base of rehabilitation psychology. Research contributes to theory building and provides the foundation for empirically supported rehabilitation psychology practices, and model-based diversity-sensitive evidence-based interventions help persons with disabilities to become fully integrated into the society. Objective: In this article, the guest editors present their rationale for developing this special issue on methodological advances in rehabilitation psychology. Conclusions: They suggest that rehabilitation psychology research needs to be theory driven using rigorous research designs, strategies, and techniques and describe their selection of articles designed to highlight some exciting new developments in rehabilitation psychology research and to stimulate thinking and facilitate discussion about incorporating these new techniques in theory-driven research programs.

You know, that doesn’t sound so very different from arguments about using research in any field of human endeavour.  Perhaps it’s tainted a little by the drive to have a theory-driven approach, using rigorous research designs – I mean, where is the place for human judgement and expert opinion??!  (sly reference to this post where I reported that psychometric data predicts more accurately than clinician opinion…)

Is research relevant to practise?  Well yes, of course – if you ask me.  Sadly, some others in my field of pain management might say ‘yes, but’… .

I mean it does take time to read the literature.  It does mean holding a lot of information in your head and comparing your current practice with what the literature is coming up with.  It does mean critiquing research to establish whether it has application beyond its study scope.  It means working out irrelevant from relevant information, it means never taking something at face value, it means being prepared to change practice from what was learned as ‘truth’ all those years ago in training.  It can mean being unpopular when it becomes important to disagree with people who are vocal or ‘senior’ or happy to do what is palliative and doesn’t challenge patients.  It is such hard work!!

Ask yourself today: have I reviewed the treatment of a patient recently?  Have I checked in with the latest evidence for or against the model I use in my practice? Do I use a model, or do I ‘follow the rules’ as a technician might?

More on research and practise – and some practical stuff too – tomorrow!

2 comments

  1. Your points are excellent, and an example of why Occupational Therapy is necessarily moving toward becoming “Occupational Science”, for example.

    I also think you raise a good point for the management of healthcare providers. As a former Chief Learning Officer for a large healthcare system, I was surprised at how often the management of healthcare providers of all stripes was not informed by the evidence. But at the same time, I found it easy to make the case to senior executives, especially physician leaders that they should implement “Evidence-based Management” for the same reasons as they do with clinical practice. I have one whitepaper on this for helping to mitigate the recent financial disasters that can also happen in healthcare, it’s free and here if you’re interested http://scientificleader.wordpress.com/2008/11/05/free-whitepaper-three-stooges-of-operational-risk/

  2. Thanks scientificleader – I too am astounded that managers of healthcare often don’t use evidence-based reasoning for their funding and decision-making. It bothers me that opinion, cost-efficiency and popularity can direct where health care dollars are spent. I’m not agin ‘efficiency’ but I think it’s far more important to look at ‘effectiveness’. Why treat lots of people poorly, when you can treat fewer, but do it really effectively and make a difference?

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