Nursing Research Methods and Design Cohort

Research on the most effective and cost-effective methods of physiotherapy training for improving chronic lower back pain outcomes can use a multitude of different designs. During the course of my search for evidence, I expect to find several meta-analyses of the literature as well as a variety of qualitative and quantitative designs. Because I am exploring treatment/intervention efficacy as well as cost-effectiveness, designs will range from experimental and quasi-experimental to cohort and case study designs.
A meta-analysis of the literature on interventions would help to illuminate specific issues like the cost effectiveness of target interventions, as well as measurable patient outcomes. The meta-analyses will be systematic, taking into account published studies using a range of different variables. However, ultimately a cohort design would be optimal for gathering initial data. Cohort designs are likely to be ubiquitous in the literature on the treatment efficacy of specific physiological interventions for lower back pain. As Song & Chung (2011) point out, cohort designs are frequently used in medical research because “a well-designed cohort study can provide powerful results,” (p. 2235). The methods used generally entail studying a disease-free population sample (in this case, a sample without back pain) over time, to determine the effectiveness of the intervention from a non-disease state onwards. This way, the same population can be evaluated to determine treatment efficacy. Unfortunately, the cohort design will be less effective at addressing the financial outcomes of the target interventions.
Case study designs and descriptive research might be located when examining the questions related to cost-effectiveness and other administrative concerns relative to implementing specific types of physiotherapy training programs. For example, if I focus on white board usage and physiotherapy training, I would search for studies that use these specific interventions. Case studies on individual institutions implementing the target intervention could be used to highlight problems or challenges for healthcare administrators. Also, case studies might help to illuminate the effectiveness of the actual back pain intervention on specific patient cohorts.
Several of the studies I locate may use a convenience sample, including those relying on self-selection methods. For example, the patient population in the study might have already enrolled in a lower back pain physiotherapy program and the researchers are testing the efficacy of that program versus a control group of sufferers. Although far from being the gold standard of random selection and random assignment, convenience samples offer several advantages when studying a specific healthcare issue like lower back pain. One advantage to the convenience sample is that the researchers would be gathering data from populations that are already enrolled in specific back pain care programs like physiotherapies. Pragmatic advantages for using convenience samples include cost and speed, as well as program efficacy within a specific geographic region or community. It is easy to gain access to a patient population via a convenience sample, as in this case, we need patient populations who either receive or who want to receive treatment for chronic lower back pain.
Using a convenience sample might alter the way I interpret and use the findings of any given research. Convenience samples hinder the generalizability of the results of the research, and also impact the perceived validity and reliability of the research in general. Therefore, it is important to remember why convenience samples are not ideal. Convenience samples would also inhibit the validity of studies examining the cost-effectiveness or perceived effectiveness of programs from the administrative standpoint. I would interpret any findings that used a convenience sample carefully, taking into account other elements of the research design and methodology.



References

Song, J.W. & Chung, K.C. (2011). Observational studies. Plastic and Reconstructive Surgeries 126(6): 2234-2242.