Article type
Year
Abstract
Introduction/Objective: To highlight the methodological problems associated with trials data which, whilst failing to produce any quantifiable evidence of effectiveness, yield qualitative findings which are theoretically significant. The aim of the presentation (or poster presentation) is to promote exploration and debate on ways in which qualitative evidence might be more usefully used in systematic reviews supported by the Cochrane Collaboration
Methods: Data derived from a Cochrane Collaboration (Cochrane Dementia and Cognitive Impairment Group) review of interventions designed to support informal carers of Alzheimer's disease will be used as an examplar of the problems associated with this significant 'gap' in the science of systematic reviewing. Examples of trials which have only limited quantitative usefulness but which yield qualitative data of potentially great clinical significance will be used to highlight the methodological problematic.
Results: The review used as the examplar was severely limited in its power (and probable impact) by the lack of convention with regard to incorporating qualitative data in the synthesis of results, and therefore the implications for practice and further research. It was clear that many of the 'traditional', quantitative, approaches to 'measuring' concepts such as burden or anxiety failed to reflect the unique context of both the interventions evaluated, and the experience of caring for a dependent rather than receiving healthcare 'treatment'. For example, one study found no quantifiable evidence for the introduction of a special computer network designed as a supportive resource for carers. Yet the same study also found that one of the reasons for drop out from the trial was that the use of technology in the carer's home was reported (qualitatively) by some respondents as frightening. However, this important piece of information was treated as both statistically and theoretically insignificant within the study.
Discussion: Qualitative data is a potentially valuable offshoot of many trials, particularly as the scope of Cochrane increases in the near future to include nursing as well as predominantly medical sources of evidence. Ways need to be found to incorporate such evidence in reviews of these trials and better aid the isolation (and validity) of implications for future research and practice.
Methods: Data derived from a Cochrane Collaboration (Cochrane Dementia and Cognitive Impairment Group) review of interventions designed to support informal carers of Alzheimer's disease will be used as an examplar of the problems associated with this significant 'gap' in the science of systematic reviewing. Examples of trials which have only limited quantitative usefulness but which yield qualitative data of potentially great clinical significance will be used to highlight the methodological problematic.
Results: The review used as the examplar was severely limited in its power (and probable impact) by the lack of convention with regard to incorporating qualitative data in the synthesis of results, and therefore the implications for practice and further research. It was clear that many of the 'traditional', quantitative, approaches to 'measuring' concepts such as burden or anxiety failed to reflect the unique context of both the interventions evaluated, and the experience of caring for a dependent rather than receiving healthcare 'treatment'. For example, one study found no quantifiable evidence for the introduction of a special computer network designed as a supportive resource for carers. Yet the same study also found that one of the reasons for drop out from the trial was that the use of technology in the carer's home was reported (qualitatively) by some respondents as frightening. However, this important piece of information was treated as both statistically and theoretically insignificant within the study.
Discussion: Qualitative data is a potentially valuable offshoot of many trials, particularly as the scope of Cochrane increases in the near future to include nursing as well as predominantly medical sources of evidence. Ways need to be found to incorporate such evidence in reviews of these trials and better aid the isolation (and validity) of implications for future research and practice.