TIPO DE ESTUDIO

The RCT makes the positivist assumption that the active role of the participant in the experiment is a passive responder to stimuli which was the physiotherapy treatment. It does not give us the opportunity to understand how the intervention may have

changed the individuals’ behaviour or lifestyle (Jones et al., 2006). This empirico- analytical approach has been used previously by physiotherapists for evidence based practice because it generates repeatable and reliable results (Donaghy and Morss, 2000). The qualitative component of Stage 2 then explored what the intervention meant to the participants. This was taking an interpretivist perspective restricted to the understanding of subjective meaning whereby it is assumed that all individuals have their own unique interpretations of that world or in this case the group programme interventions (McEvoy and Richards, 2006; Morgan, 2007). Focus groups were used to explore patients’ views and satisfaction regarding their treatment. Patients were given the opportunity to rate and discuss the benefit of the programme to them. Patients discussed what the barriers of continuing with physical activity were and what might be their main reasons for continued participation in exercise or physical activity. This supplemental qualitative stage could identify a set of barriers that would predictably block the effectiveness of the back pain interventions. This could lead to identifying strategies for reducing these barriers and emphasizing facilitators which could lead to specific variations in future programmes. Any future versions of a group programme could be more effective by offering alternatives that would be more suitable by meeting specific requirements of specific client groups (Morgan, 2014). The aim was not to reach a consensus on the discussed issues but encourage a range of responses to provide a greater understanding of the attitudes, opinions or

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interview was used in preference to an individual interview as it encourages

interaction between other participants rather than with the moderator. Interaction is a key feature of the focus group interview as group processes assist participants to explore and clarify their point of view which may not be possible in an individual interview. Group interaction allows the researcher to experience different

communication forms which participants use in their everyday interaction. This may include joking, arguing or recalling past experiences. It may be much more difficult to reveal the true knowledge or attitudes of individuals by asking them to respond to direct questions from questionnaires. The focus group method allowed me as the researcher to follow-up comments in the session and cross-check with participants in a more interactive manner which a questionnaire or individual interview can’t offer. However, the disadvantage of focus group interviews is that some of the participants may not actively take part in the group discussions. Other participants with dominant personalities may have strong or opposing opinions and influence the group

discussion. Some participants may feel that they cannot disagree with these dominant personalities or present an alternative view to the group. The depth or intensity of discussion may not be sufficient to have a good understanding of the participants’ experiences that may be obtained in an individual interview (Halcomb et al., 2007).

There have been a small number of studies which have used qualitative designs such as semi-structured questionnaires or focus group interviews to investigate the views of patients with back pain and their experiences on the treatment that they received (Slade et al., 2009a; Sokunbi et al., 2010). These methods of data collection may also give the researcher the opportunity to understand how a physiotherapy intervention has changed individuals’ perspectives or behaviours. Focus group interviews have not

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been used widely to explore the issues surrounding the management of CLBP (Liddle et al., 2007). Sokunbi et al. (2010) used focus group interviews to explore subjective exercises of participants who had taken part in a spinal stabilisation programme as part of an RCT. They found that participants had indicated a positive behavioural change in managing their back pain and had achieved a greater self-confidence through participating in the exercise programme. Few participants had continued with their exercises post programme. Reasons given for non-adherence were unsuitable home environment, lack of supervision and equipment and the inability to adapt to daily routines. One of the limitations of using focus groups in this study was that only small sample sizes were interviewed which may reduce the generalisability of the findings to the population of CLBP patients. This is due to the time constraints as they are very time-consuming and small numbers may be willing or able to participate. This may also lead to a likely positivity bias and lack of ethnic diversity (Rajendran et al., 2012). Another limitation is the subjectivity of the researcher’s interpretation of the transcribed data (Liddle et al., 2007). A questionnaire using open questions was used by Underwood et al. (2006) to further explore patients’ experiences and views following their treatment for low back pain in the UK BEAM trial. This method had produced a large number of detailed narrative responses from participants which was very time consuming to analyse. This type of questionnaire did give the respondent more flexibility and the opportunity to provide extra information regarding their treatment.

The analysis of the qualitative phase in Stage 2 helped to explain or elaborate on the quantitative results obtained in the initial instance. Thus, the quantitative data and the subsequent analysis provided a general understanding of the effects of the group

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programmes. The qualitative data and its analysis attempted to explain the statistical results by exploring participants’ views in more depth. Arguably, such a process can be time consuming and dependent on the feasibility of resources to collect and

analyse both types of data (Ivankova et al., 2006). Priority in Stage 2 was given to the quantitative approach because quantitative data collection came first in the sequence and presented the major aspect of the mixed-methods data followed by the smaller qualitative component. The decision to follow the quantitative-qualitative data collection and analysis sequence in this design was based on the project’s purpose to evaluate an alternative group exercise programme. The smaller qualitative component aimed to seek a contextual practice-based explanation of the statistical results.

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