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Re-grounding biopsychosocial back pain research- Introducing Grounded Theory Method

Patients’ and practitioners’ values, preferences and experiences are very much part of modern iterations of evidence-based practice (EBP), and developing a research-based knowledge of these constructs are crucial to the sensible and effective adoption of EBP by healthcare professionals [see seminal paper by Greenhalgh and colleagues here]. Its now widely accepted that evidence derived from qualitative research designs contribute a valuable perspective of practice and contribute to a rounded and robust evidence base for healthcare and musculoskeletal practice [see our recent editorial here].

Grounded theory method (GTM) is one of the most commonly used qualitative research approaches in healthcare research. It aims to develop theory (knowledge) from data to understand/explain key psychological and social processes which arise out of/occur in human (social) interaction. Examples in musculoskeletal care include clinical reasoning, how patients seek care, the construction of patients’/practitioners’ beliefs (e.g. pain beliefs, self-efficacy, beliefs of hurt/harm/frailty of the back), how conceptions of theory (eg patient-centred care, evidence-based practice, clinical guidelines) develop and are implemented, and how therapeutic roles and relationships are negotiated. Many of these psycho-social factors inform our behaviour with back pain (e.g. how we move, whether we exercise, spend time with friends/family/social events and whether we take time off work due to back pain; and these factors are now associated with successful clinical outcomes from back pain [for example see here here here here here]

Back in 2009, I approached my PhD off the back of an MSc is Exercise Rehabilitation [here], so was familiar mainly with quantitative statistical research methods and evidence. So it was a real challenge for me to ‘shift paradigms’ and employ a qualitative research methodology to understand osteopaths’ clinical reasoning and decision-making [key papers here and here]. As you will see in the paper, qualitative research adopts quite different positions with regards to the nature of truth, knowledge (epistemology) and reality (ontology), compared to quantitative research (e.g. randomised control trials, cross-sectional survey designs and other observational study designs). Getting my head around these differences and how they related to my research question, took hours of reading, hair pulling and gallons of strong coffee!

I managed to do it, and in this Masterclass paper [here] from 2014, used my doctoral research experience as an example of how to operationalise grounded theory method (GTM), and discusses the role and value of GTM for contemporary evidence-based biopsychosocially orientated osteopathy and manual therapy practice. It outlines the different theoretical/philosophical positions when using GTM, & the key methods of data analysis involved (eg coding, categorising, theoretical sampling, theoretical sensitivity and memo-writing).

I’ve since used GTM to explore and publish papers with some excellent co-researchers on: osteopaths’ and physiotherapists’ attitudes & beliefs of the biopsychosocial model [here and here], osteopaths’ attitudes towards clinical guidelines (under review), care-seeking behaviour of injured dancers [here], development of osteopathy students’ professional identities [here] and chronic low back pain patients’ interpretation of diagnostic language [here].

Those of you interested in learning more about qualitative research in healthcare, osteopathy and musculoskeletal practice, check out my other publications on the topic [here here and here].

In the meantime, get the coffee on…paradigm shift ahead…

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