Design, Conduct, and Interpretation of Nonrandomized Orthopaedic Studies--A Practical Approach   |    
Qualitative Research: A Review of Methods with Use of Examples from the Total Knee Replacement Literature
Dorcas E. Beaton, BScOT, PhD1; Jocalyn P. Clark, MSc, PhD2
1 Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON M5B 1W8, Canada. E-mail address: beatond@smh.toronto.on.ca
2 Department of Medicine, University of Toronto, Suite RFE 3-805, 190 Elizabeth Street, Toronto, ON M5G 2C4, Canada
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Disclosure: In support of their research for or preparation of this work, one or more of the authors received, in any one year, outside funding or grants in excess of $10,000 from the Canadian Institute of Health Research (CIHR). Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity.

The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2009 May 01;91(Supplement 3):107-112. doi: 10.2106/JBJS.H.01631
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Qualitative research is a useful approach to explore perplexing or complicated clinical situations. Since 1996, at least fifteen qualitative studies in the area of total knee replacement alone were found. Qualitative studies overcome the limits of quantitative work because they can explicate deeper meaning and complexity associated with questions such as why patients decline joint replacement surgery, why they do not adhere to pain medication and exercise regimens, how they manage in the postoperative period, and why providers do not always provide evidence-based care. In this paper, we review the role of qualitative methods in orthopaedic research, using knee osteoarthritis as an illustrative example. Qualitative research questions tend to be inductive, and the stance of the investigator is relevant and explicitly acknowledged. Qualitative methodologies include grounded theory, phenomenology, and ethnography and involve gathering opinions and text from individuals or focus groups. The methods are rigorous and take training and time to apply. Analysis of the textual data typically proceeds with the identification, coding, and categorization of patterns in the data for the purpose of generating concepts from within the data. With use of analytic techniques, researchers strive to explain the findings; questions are asked to tease out different levels of meaning, identify new concepts and themes, and permit a deeper interpretation and understanding. Orthopaedic practitioners should consider the use of qualitative research as a tool for exploring the meaning and complexities behind some of the perplexing phenomena that they observe in research findings and clinical practice.

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