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Relación entre la valoración radiológica y la evaluación funcional entre pacientes con gonartrosis

According to Laughlin, “all empirical research is partial and incomplete and that

theoretical and methodological choices are inevitably made whether appreciated or not” (1995: 65). He also argues that “looking for universally accepted ‘facts’ is impossible”

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(2004: 264). Middle range thinking (MRT hereafter) focuses on the continua of theory, methodology and change for which the choice for a mid-point38 has to be made. These choices are influenced by research philosophical assumptions such as ontology (what constitute reality), epistemology (what constitute knowledge) and human nature

(researcher’s influence in the research process). MRT maintains hybridized ontological and epistemological assumptions of interpretive and positivist schools of thought. Ontologically, it recognises the existence of reality distinct from our interpretations and one biased by our perceptual biases, which also influences what counts as knowledge (epistemology). MRT provides a deliberate instrumental choice process which

encourages the researcher to have some understanding of the underlying methodological assumptions of the positivist and interpretive schools of thought and combine their features as may be useful to extend our understanding. Laughlin’s argument for such hybridization is that:

The way to engage with this empirical reality cannot either be left to some seemingly abstracted methodological approach, which is intended to be operated with minimal intrusion of subjectivity … or should it be left to an inevitably variable and sometimes very individualistic set of subjective processes … Middle range thinking sets up

structures around the subjective processes which recognise and accept the subject in the discovery process yet also set some limits on how that subjectivity can be

operationalised (2004: 268).

Laughlin (1995; 2004) discusses the three areas where middle range choices have to be made such as theory, methodology and change. With respect to theory, Laughlin argues that “[t]here are ‘skeletal’ rather than ‘full’ or ‘no’ theories which can explain … any empirical phenomena” (2004: 268). MRT allows theories to be used in a ‘skeletal’ manner to be later fleshed with empirical details from data. Theory, in relation to MRT,

38 This is one of the criticisms of the middle range thinking (see Lowe, 2004). How exact is the middle point to be in may not be easy to determine. Laughlin recognising this difficulty and complexity states that the “descriptors “high”, “medium” and “low” are not precise, definable or measurable” (1995: 68). However, what is useful about the middle range assumption is the recognition of extreme schools of thought and locating one’s work away from such extremes to a middle point which may not necessarily be a fixed mid-point which might only precisely be attained if the two extreme points are reducible to numeric values. Although Laughlin positions the German Critical Theory within its middle point of theory, methodological and change choices (another criticism by Lowe), he appears to clarify the possibility of other Theories or schools of thought fitting into the middle point. For example, Laughlin states by way of annotation in his reply to Lowe’s (2004) criticism that: “Whilst ‘middle range thinking’ has been inextricably linked to German Critical Thinking … it doesn’t have to be so. I am trying to argue for characteristics of an approach (‘middle range thinking’) but this does not mean that it is only this set of ideas that possess these characteristics” (2004: 269). Laughlin (2004: 274) equally argues that “[a]n assumption on structured subjectivity could lead to a number of alternative methodological

frameworks. Yet in the spirit of trying to maintain consistency with the original framework–which positions German Critical Theory in the mid-point—‘critical discursive analysis’ is highlighted.”

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does not follow positivist or hypothetico-deductive orientation (Chua, 1986), but serves as a skeleton upon which the empirical flesh from data will be fitted. This thesis

employs two principal theoretical lenses (“‘skeletal’ theories”, to borrow Laughlin’s term): those of accountability and sense-making and these theories have been explored in Chapter three. Theory, as used in this thesis, is a framework upon which the

empirical data is fleshed. As Laughlin contends:

[W]here the empirical details do not fit the theoretical ‘skeleton’, the empirical data provides a basis for extending and/or reforming this framework. In this sense the ‘skeletal’ theory guides the discovery process but in such a way that can be reactive to the ‘fit’ of the detailed ‘flesh’ that is being added (2004: 268).

In MRT, ‘skeletal’ theories only guide the process of discovery rather than being immersed in prior theories to falsify or confirm them (Laughlin, 2004). This is necessary because theories and empirical investigation can only help us gain partial understanding of phenomena as it is practically difficult to make claim of absolute truth (Laughlin, 1995, 2004). Laughlin also suggests that the claim that theory cannot help our understanding of phenomena is not absolutely correct. What is necessary is balancing the role that theory plays in our understanding reality.

In respect of methodology, the MRT permits the design of a “methodology which sets “skeletal” rules for processes of discovery which still allows for variety and diversity in observational practice” (1995:82). Such methodological design derives from

epistemology and observer’s role Laughlin (2004) refers to as ‘structured’ subjectivity. According to Laughlin, “‘Structured’… specifies in more precise and abstracted terms what is involved in this engagement process whilst, at the same time, not trying to squeeze out the intuitive, imaginative properties of individual observers” (2004: 274). The nature of the structured subjectivity could lead to alternative methodological frameworks (2004: 274) and thus having implications for the data narratives and data collection methods39.

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Although Laughlin places data narratives and collection methods within what he called ‘qualitative 2’, it is not apparent that quantitative data cannot be used within the middle range thinking methodology. In his response to Lowe’s (2004) criticism, Laughlin (2004: 269) admitted to have placed the German Critical Thinking within the middle point for illustration, which does not foreclose the possibility of other schools of thought sitting in the middle point. When such possibilities hold, both qualitative and

quantitative data might derive from the ‘structured’ subjectivity assumption of MRT. In my informal conversation with Professor Laughlin, he states that MRT does not foreclose the use of questionnaire even though it was not part of the research instruments his articles identified with the MRT.

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In terms of change choice, MRT is open to both maintaining the status quo and requiring change (Laughlin, 1995: 84). Laughlin (1995; 2004) recognises the

complexity associated with change and argues that change can meaningfully be pursued in respect of a particular phenomenon when that phenomenon is understood. He equally argues:

[W]e cannot say that our understanding must inevitably lead to change in the

phenomena being investigated—adopting this position means that everything is ‘wrong’ and in need of development. The arguments for a ‘middle position’ is that there needs to be mechanisms to judge when change should be pursued (2004: 269).

Researchers may not necessarily seek to make change because they may not have the enabling resources to do so (1995: 67-68). Whilst it is possible for the understanding gained from this thesis to promote change, it is however not the immediate concern of this thesis. Although change might be incidental to the output of this study, it is not pursued as to stand in the way of this thesis as I do not have the ‘resources’ to pursue such cause. Essentially, this thesis is primarily concerned with enriching our

understanding of accountability: its conceptions, manifestations, and underlying logic in order to further understand the extent accountability is discharged. This is achieved through an articulated research design that clearly defines the cases, respondents and research instruments useful for answering the relevant research questions. The following sections deal with these issues.