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J Sim

Publications and source records attributed to J Sim.

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A critical appraisal of the role of triangulation in nursing research.

Triangulation is a research strategy that has received considerable practical and theoretical interest in nursing research. However, despite its popularity, triangulation raises a number of problematic methodological and philosophical issues. Four such issues are discussed in this paper. First, it is argued that triangulation is not always a necessary ingredient of a research project, as some questions, framed in fairly specific terms, may be adequately answered with the use of a single method. Second, triangulation is often advanced as a means of securing the validity of data; however, this claim often makes unwarranted assumptions as to the criterial status of one method in relation to others. To the extent that triangulation does secure validity, this is likely to be in respect of content validity (i.e. the scope of findings) rather than, as is often suggested, criterion-related validity (i.e. the 'accuracy' of findings). Third, the bringing together of quantitative and qualitative methods in triangulation tends to ignore fundamental questions as to whether data generated by methods that come from divergent epistemological frameworks can meaningfully be combined. Finally, the use of different theoretical frameworks, in theory triangulation, mistakes the true nature of a theory and overlooks the distinctness and incommensurability of different theoretical perspectives. In conclusion, nurse researchers should approach triangulation in a cautious and critical way, with due regard to the rather dubious assumptions upon which it frequently rests.

Bias↗

Comparison of physical treatments versus a brief pain-management programme for back pain in primary care: a randomised clinical trial in physiotherapy practice.

BACKGROUND: Recommendations for the management of low back pain in primary care emphasise the importance of recognising and addressing psychosocial factors at an early stage. We compared the effectiveness of a brief pain-management programme with physiotherapy incorporating manual therapy for the reduction of disability at 12 months in patients consulting primary care with subacute low back pain. METHODS: For this pragmatic, multicentre, randomised clinical trial, eligible participants consulted primary care with non-specific low back pain of less than 12 weeks' duration. They were randomly assigned either a programme of pain management (n=201) or manual therapy (n=201). The primary outcome was change in the score on the Roland and Morris disability questionnaire at 12 months. Analysis was by intention to treat. FINDINGS: Of 544 patients assessed for eligibility, 402 were recruited (mean age 40.6 years) and 329 (82%) reached 12-month follow-up. Mean disability scores were 13.8 (SD 4.8) for the pain-management group and 13.3 (4.9) for the manual-therapy group. The mean decreases in disability scores were 8.8 (6.4) and 8.8 (6.1) at 12 months (difference 0 [95% CI -1.3 to 1.4], p=0.99), and median numbers of physiotherapy visits per patient were three (IQR one to five) and four (two to five), respectively (p=0.001). One adverse reaction (an exacerbation of pain after the initial assessment) was recorded. INTERPRETATION: Brief pain management techniques delivered by appropriately trained clinicians offer an alternative to physiotherapy incorporating manual therapy and could provide a more efficient first-line approach for management of non-specific subacute low back pain in primary care.

Acute Disease↗