Research And Evidence In Practice

Evidence & Research in Practice

The paper I have chosen for this assignment is 'Effects of locality based community hospital care on independence in older people needing rehabilitation: randomised controlled trial'. The authors are John Green, John Young, Anne Forster, Karen Mallinder, Sue Bogle, Karin Lowson and Neil Small - published in the British medical journal as BMJ,doi:10.1136/bmj. 38498.387569.8F (published 1 July 2005). Accessed on 3rd February 2008 via U.W.E. library facilities.

Introduction

I work in a district hospital as part of a social work team involved in arranging services to patients fit for assessment and discharge from the acute hospital. This process however can be complex, many patients are dis-empowered by hospitalisation and as a result can become anxious about their health and ability to manage their own needs and it is those who require rehabilitation following illness or surgery that a careful assessment by both medical and social care practitioners becomes important. Transfers to community hospitals can be traumatic for the patient - further disempowerment, isolation from friends and family, loss of familiar acquaintances both staff and other patients in an unfamiliar environment, and the unknown timescale of the hospitalisation/recovery period. Limited rehabilitation services are available in the busy environment of the acute hospital and input from physiotherapists and occupational therapists can be sporadic.

It is to this end that I have chosen a research paper which evaluates rehabilitation in the acute hospital compared to community hospitals, adding to my knowledge of effective discharge procedures and (hopefully) enabling patients to consider their own safety and well-being in this process.

My search was through the UWE library electronic database system. I searched through a variety of database resources including OVID, The Campbell Collaboration, and Social Care online resources that would be likely to provide a social care and health link. During my search I found Social Care Online as the most appropriate. Using the terms 'research' and 'older people' in the intermediate search facility I used the advance search option using the same terms and adding 'hospital' and selecting 'full text only'. This brought a wide range of research papers and I chose my article from pages 41-80 because it was relevant to my practice and was a Randomised Controlled Trial, which interested me as this is described within the research fraternity as the 'gold standard' (McLaughlin 2007). It is generally acknowledged that this method is not one for which social research would be used because of its impracticability and disregard for human nature (Payne & Payne 2004; McLaughlin 2007; Thompson 2000).

Evaluation

Authoritiveness

The research article is published in The British Medical Journal, in a standardised format which, it can be assumed, will have been subjected to 'peer review' by medical research contemporaries before acceptance for publication (McLaughlin 2007:21).

The seven collective authors of the work identify their qualification to produce the research and the entire research team members' individual roles in this process are identified on page 6 of the article.

Funding is from the 'Health Foundation' and although by definition this is linked to desirable health service outcomes, the funding was via an application from the research team and, given that the funding followed the hypothesis, it is unlikely that any bias exists from this funding source. Both Green and Young (principle contributors) are explicit in stating that they have both worked in the community hospital used to collect data. Their familiarisation within the hospital setting should not have any bias provided the quantitative tools used to collect data are objective and specific in design (Payne & Payne 2004:30).

Design & Methods

The hypothesis is unambiguous in the title of the paper and remains in focus throughout the work - it is objective, 'relevant to the knowledge base' and 'verifiable' by further research (Grinnell et.al.2005:71) Green et.al. study the clinical outcomes for patients and test the theoretical assumption that patients recover independence more effectively when rehabilitation services are given in the community hospital compared to those patients who remain in the acute hospital. Green et.al's theoretical stance has been generated by observations of existing literature researching community hospital usage, whether community hospitals are beneficial to the patients recovery and that the clinical outcome is 'superior' to other rehabilitation options.

To evaluate the outcomes of one group compared to another, a Randomised Controlled Trial ( RCT) is an appropriate experimental method of quantitative research that would give opportunities for the collection of facts and permit statistical analysis of data collected. This positivist approach is a scientific technique that ignores human responses such as emotions (McLaughlin 2007:25), focussing on the measurable and observable facts of the experiment (Grinnell et.al. 2005:64; Thompson 2000:44). Quantitative methods also provide opportunities to generalise the results to a much wider population (Payne & Payne 2004:210) which would validate the results of the research project, and the experimental design is considered to be at the "...highest level of the knowledge continuum..." (Grinnell et.al. 2005:208) . The use of 'intervention' and 'control' groups is a familiar one to medical practitioners as it eliminates bias by both practitioners and the subjects themselves (McLaughlin 2007:33), allowing outcome characteristics to be measured consistently for each group thereby increasing the reliability of the research results (Payne & Payne 2004:234).

There is limited referral to previous literature and research regarding the hypothesis, which the researchers acknowledge. The consequence of this however, is the reduced capacity to compare the design and results to other data collected elsewhere thereby inhibiting opportunities for replication and validation (Grinnell et.al. 2005:298). The research of this paper is based on only two hospitals in Bradford, which limits the option for generalisation.

The term 'older people' in the title will be misleading for some readers in other geographical areas, within this research the subjects are aged over 76, whereas medical and social