I often think that I was very lucky to have been given a classical physiotherapy training – with its focus on anatomy and physiology, biomechanics and kinesiology, objective testing and quantitative research. But this was enriched no end by being introduced to qualitative research early in the 1990s when it was really taking off in healthcare. Since then I’ve probably reviewed more than a hundred qualitative research articles and read thousands more. And in all that time I still come back to one simple test of whether qualitative research is any good or not.
Whenever I review qualitative research article I ask myself is the study is telling me anything I don’t know already. Notwithstanding all the discussions about whether qualitative research should be more or less rigorous, more methodologically sound or more creative and imaginative, it comes down to the simple question of whether our understanding of the phenomenon is increased as a result of the work that the researchers have done, or whether the research merely confirms what we knew already.
There is a beautiful example of this in a recent paper titled “The Magic Wand: A Case Study of Chronic Neck Pain” which follows a common trend in qualitative research these days, in that it uses interpretive or descriptive methods to analyse the phenomenon at hand. What this fundamentally means is that the research is often methodologically sound – following all the basic rules down in the myriad qualitative research textbooks – but it often lacks the kind of depth of insight that qualitative research ought to offer.
The principal weakness of all of this kind of research is that it makes no effort to engage deeply with philosophy. The point of using philosophy in healthcare research is to elevate the analysis beyond the ordinary; to draw out findings that could not have been anticipated from everyday practice experience; or to reveal understandings that may be counterintuitive, confusing, contradictory, and confounding for our current ways of thinking. In all my years of reviewing qualitative research, I can honestly say that I’ve never yet once come across an article that transformed the way I think about something that did not engage with philosophy.
So here we have an article about chronic neck pain that tells us that “pain pervades everything…Findings suggest that living with chronic pain is framed by both the experience of severe pain and the search for a cure. Fear, panic, and despair accompany ongoing pain.”
Go more deeply into the article and you will find a very well constructed piece of research that is almost entirely bloodless. It is the epitome of the kind of model qualitative research now promoted in graduate schools, that extracts everything that is unique and profoundly radical about qualitative research and turns it into nothing more than quantitative-lite. (For a really engaging and insightful commentary on the demise of qualitative research, read this).
Qualitative research of this sort has become increasingly common in physiotherapists, as clinicians, educators, researchers and students look for new ways to explore complex subjective phenomena that cannot be explained adequately by quantitative research. Pain, breathlessness and movement represent three important paradigms here, and each one has a growing share of extremely well constructed but virtually anaemic qualitative research emerging in the field.
Physiotherapists are naturally sceptical of philosophy because they are trained to ignore it: to think that their practice is natural and has no particular paradigmatic roots. And so talk of philosophically informed research can be scary. But unless we can engage more deeply with some of the grand ways in which philosophers have taught us to think differently about the world, the only thing we will ever be able to say about complex phenomena like pain is that it is aversive. And we know that already.