|LETTER TO EDITOR
|Year : 2014 | Volume
| Issue : 3 | Page : 182-183
Qualitative methodological randomized control trials: A need for evidence-based learning and practice in physiotherapy
Department of Physical Therapy, College of Applied Medical Science, Majmaah University, Al Majmaah, Saudi Arabia
|Date of Web Publication||7-Oct-2014|
Department of Physical Therapy, College of Applied Medical Science, Majmaah University, Al Majmaah
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Ateef M. Qualitative methodological randomized control trials: A need for evidence-based learning and practice in physiotherapy. Saudi J Health Sci 2014;3:182-3
There is a growing awareness of evidence-based physical therapy among students and practitioners worldwide, and it should be made mandatory in curricula. Today research journals are mushrooming worldwide and millions of articles and their replications are diluting the scientific rigor, creating a status of confusion among practitioners which content is to be chosen for qualitative evidenced articles for clinical decision-making.
Evidence-based physical therapy was first initiated at World Confederation of Physical Therapy's (WCPT) Expert Meeting on Evidence-Based Practice in London in 2001. Evidence-based physiotherapy is most important for patients because it implies that, within the available current knowledge the safest and most effective interventions will be offered for the best possible clinical outcomes. 
There are numerous reasons for poor qualitative studies (which means poorer methodology would have been adapted to justify the research articles), some among those are improper designing of the study (for example randomization bias), lack of proper researchers and guidance, unavailability of research settings, inadequate funds, lack of constructive research methodology in physiotherapy education and last but not the least inadequacy of available quality literature in physiotherapy (where sufficient qualitative clinical trials have been missing to synthesize systematic reviews).
It has been well-established that for better results, good 'effect size' is necessary for implication of the outcomes of a research design. Best outcomes can be obtained only when constructive internal validity/qualitative methodology are used in the research designs.
Randomized clinical trials are supposed to be effective among research designs used to obtain the effects of interventions proposed for specific diseases than pre- and post-treatment/interventional comparisons. More effective implications for patients would be obtained through systematic reviews when qualitative and quantitative methodologically randomized control trials are available. High-quality research would be possible through constructive internal validity/qualitative methodology used in the research design. Systematic reviews and meta-analysis can be possible when sufficient quality clinical trials are available.
It is a known fact that randomized control trials and systematic reviews must be used for evidence-based practice and well-evidenced articles should be used to synthesize literature for future research designs including randomized control trials and systematic reviews.
Evidence-based learning during student life would be difficult along with regular curricula design. Teachers must initiate problem-based teaching, which should be incorporated with evidenced literature review (Randomized Clinical Trials) discussing about the measures of variability leading to 'effect size' calculations for patient's symptom-based interventions. ,,.
Student community must habituate to learn throughout their curriculum about problem-based learning, under the supervision of their teachers. 
Since physiotherapy research has been a developing domain, substantial priority should be given to internal validity/qualitative methodology of clinical trials.
There is only one center for evidence-based research in physiotherapy in Australia named as PEDro, which is currently offering a constructive qualitative methodological research scale, which means when an article meets the criteria, it would be productive in terms of good 'effect size' for clinical implications. PEDro stands for Physiotherapy Evidence Database providing qualitative articles for the researchers and practitioners. Its main aim is to evaluate internal validity/believability of clinical trials. ,,,
One can use www.PEDro.org.in by following the following steps/criteria in clinical trials, and implications beneficial to patients can be expected.
- Resource and criteria
- Concealed randomization
- Baseline comparability
- Subject blinding
- Therapist blinding
- Assessor blinding
- Adequate follow up
- Intention to treat analysis
- Between group comparability
- Point estimate and measures of variability.
Measure of variability is necessary in clinical trials to obtain an unbiased size of treatment effects (effect size).  One can bring around major changes in his or her clinical studies by following unbiased approach through a systematic and constructive methodology.
A study conducted in India showed that effective educational strategy is useful to implement Evidence Based Practice (EBP).  Clinical instructors are acting as role models to incorporate EBP into practice for the students.  A study concluded by Bridges et al. stated that the department managers need to derive benefits and develop strategies to foster the adoption of EBP  and transformation of knowledge and updating skills within the workplace. Rotor and Gorgon have also adapted different education models to teach EBP and to implement in practice.  Karner et al. have demonstrated improved patient outcomes in a randomized control trial on coronary heart disease using problem-based learning.  In all, 64% of medical students in three different universities were reasonably more satisfied in another study conducted by Gurpinar et al. with problem-based learning in the year 2013. 
In conclusion, qualitative randomized clinical trials are therefore pillars for evidence-based physical therapy learning and practice.
| References|| |
|1.||Bø K, Bary Berghmans B, Mørkved S, Van Kampen M. Evidence-based physical therapy for the pelvic floor. Bridging science and clinical practice. Churchill Livingstone, 2007. Available from: http://www.sciencedirect.com/science/book/9780443101465 [Last accessed on 2014 Apr 18]. |
|2.||Koh GC, Khoo HE, Wong ML, Koh D. The effects of problem based learning during medical school on physician competency: A systematic review. CMAJ 2008;178:34-41. |
|3.||Neville AJ. Problem based learning and medical education forty years on. A review of its effects on knowledge and clinical performance. Med Princ Pract 2009;18:1-9. |
|4.||Barrett T. Handbook of enquiry and problem based learning. In: Barrett T, Labhrainn IM, Fallon H, editor. Galway: CELT; Understanding problem based learning; 2005. p. 13-25. |
|5.||Schmidt HG, Rotgans JI, Yew EH. The process of problem based learning: What works and why. Med Educ 2011;45:792-806. |
|6.||Available from: WWW.PEDro.org.in [Last accessed on 2014 Apr 25]. |
|7.||Maher CG, Sherrington C, Herbert RD, Moseley AM, Elkins M. Reliability of the PEDro scale for rating quality of randomized controlled trials. Phys Ther 2003;83:713-21. |
|8.||de Morton NA. The PEDro scale is a valid measure of the methodological quality of clinical trials: A demographic study. Aust J Physiother 2009;55:129-33. |
|9.||Bhogal SK, Teasell RW, Foley NC, Speechley MR. The PEDro scale provides a more comprehensive measure of methodological quality than the Jadad scale in stroke rehabilitation literature. J Clin Epidemiol 2005;58:668-73. |
|10.||Agarwal R, Kalita J, Misra UK. Barriers to evidence-based medicine practice in South Asia and possible solutions. Neurol Asia 2008;13:87-94. |
|11.||Olsen NR, Bradley P, Lomborg K, Nortvedt MW. Evidence based practice in clinical physiotherapy education: A qualitative interpretive description. BMC Med Educ 2013;13:52. |
|12.||Bridges PH, Bierema LL, Valentine T. The propensity to adopt evidence-based practice among physical therapists. BMC Health Serv Res 2007;7:103. |
|13.||Rotor ER, Gorgon EJ. Teaching evidence-based practice: Preliminary outcomes of students′ EBP-related attitudes and skills. Philippine J Occup Ther 2011;4:15-24. |
|14.||Karner A, Nilsson S, Jaarsma T, Andersson A, Wirehn AB, Wodlin P, et al. The effect of problem-based learning in patient education after an event of coronary heart disease--a randomized study in primary health care: Design and methodology of the COR-PRIM study. BMC Fam Pract 2012;13:110. |
|15.||Gurpinar E, Kulac E, Tetik C, Akdogan I, Mamakli S. Do learning approaches of medical students affect their satisfaction with problem-based learning? Adv Physiol Educ 2013;37:85-8. |