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5. External Validity in Research on Rehabilitative Interventions: Issues for Knowledge Translation. FOCUS Technical Brief No. 33

Author

SEDL, National Center for the Dissemination of Disability Research (NCDDR) and Dijkers, Marcel P. J. M.

Abstract

This issue of "FOCUS" discusses external validity and what rehabilitation researchers can do to help practitioners answer the question "How far can we generalize this finding-- is it applicable to other clients/patients, with different characteristics, in dissimilar settings treated by other clinicians?," which clinicians and other practitioners ask whenever researchers publish evidence in support of a new or revised intervention. It is argued that there is no statistical basis for generalizing from the findings of a particular study, however well conducted, to a clinician's next patient/client or even to the groups a health care policy maker is responsible for. Generalizing is done by the decision maker based on the similarity of the case or cases to be treated to the people who were included in the research, and based on the resemblance of the clinicians and rehabilitative settings involved to the treater(s) and setting(s) in the research. Therefore, it is the responsibility of rehabilitation researchers to provide extensive information on their intervention study in their reports, well beyond issues impacting its internal validity. Only by reading such detailed reports on the characteristics of a study's patients/clients, treaters, treatments and outcomes, as well as on the wider health care and sociopolitical context of the study, can clinicians and their patients/clients begin to evaluate whether the same intervention might have a comparable feasibility and similar effect in their local situation. Unfortunately, reporting of issues relevant to external validity is much less common than of details relevant to internal validity, resulting in complaints by clinicians and other practitioners. This article provides and describes a checklist of 27 items that was designed to help rehabilitation researchers include more informative details in their research reports.

Published
2011

6. When the Best Is the Enemy of the Good: The Nature of Research Evidence Used in Systematic Reviews and Guidelines

Author

SEDL, National Center for the Dissemination of Disability Research (NCDDR) and Dijkers, Marcel P. J. M.

Abstract

Evidence-based practice, according to authoritative statements by the founders of this approach to health care, involves using the "best available" evidence in addition to clinical expertise and patient preferences to make decisions on the care of patients. However, many systematic reviewers interpret "best available" as "best possible" and exclude from their reviews any evidence produced by research of a grade less than the highest possible (e.g., the randomized clinical trial [RCT] for interventions), even if that means making no recommendations at all. Voltaire's comment that "the best is the enemy of the good" is applicable here. Rehabilitation would be disadvantaged especially, as it can boast few RCTs, because of its nature. The myopic focus on the "strongest" research designs may also steer researchers away from asking, "What is the best design to answer 'this' research question?" Lastly, rehabilitation and other clinicians need to know not just "which" interventions are effective, but also "how" these interventions need to be delivered; information relevant to this latter aspect of knowledge translation is typically produced using "weak" research designs.

Published
2009

28. Spinal Cord Injury-Functional Index: Item Banks to Measure Physical Functioning in Individuals With Spinal Cord Injury

Author

Tulsky, David S., Jette, Alan M., Kisala, Pamela A., Kalpakjian, Claire, Dijkers, Marcel P., Whiteneck, Gale, Ni, Pengsheng, Kirshblum, Steven, Charlifue, Susan, Heinemann, Allen W., Forchheimer, Martin, Slavin, Mary D., Houlihan, Bethlyn, Tate, Denise G., Dyson-Hudson, Trevor, Fyffe, Denise G., Williams, Steve, and Zanca, Jeanne

Published
2012
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35. What Determines the Quality of Rehabilitation Clinical Practice Guidelines?

Author

Dijkers, Marcel P., Ward, Irene, Annaswamy, Thiru, Dedrick, Devin, Hoffecker, Lilian, and Millis, Scott R.

Subjects
Review Literature as Topic, Practice Guideline [Publication Type], Quality Assurance, Health Care, Original Research Articles, Rehabilitation, Practice Guidelines as Topic, ComputingMethodologies_DOCUMENTANDTEXTPROCESSING, Humans, Guidelines as Topic, Physical and Rehabilitation Medicine, Review [Publication Type]
Abstract

Supplemental digital content is available in the text., Objective The aim of the study was to determine what factors determine the quality of rehabilitation clinical practice guidelines. Design Six databases were searched for articles that had applied the Appraisal of Guidelines for Research & Evaluation II quality assessment tool to rehabilitation clinical practice guidelines. The 573 deduplicated abstracts were independently screened by two authors, resulting in 81 articles, the full texts of which were independently screened by two authors for Appraisal of Guidelines for Research & Evaluation II application to rehabilitation clinical practice guidelines, resulting in a final selection of 40 reviews appraising 504 clinical practice guidelines. Data were extracted from these by one author and checked by a second. Data on each clinical practice guideline included the six Appraisal of Guidelines for Research & Evaluation II domain scores, as well as the two Appraisal of Guidelines for Research & Evaluation II global evaluations. Results All six Appraisal of Guidelines for Research & Evaluation II domain scores were statistically significant predictors of overall clinical practice guideline quality rating; D3 (rigor of development) was the strongest and D1 (scope and purpose) the weakest (overall model P < 0.001, R2 = 0.53). Five of the six domain scores were significant predictors of the clinical practice guideline use recommendation, with D3 the strongest predictor and D5 (applicability) the weakest (overall model P < 0.001, pseudo R2 = 0.53). Conclusions Quality of rehabilitation clinical practice guidelines may be improved by addressing key domains such as rigor of development.

Published
2020

42. Data Cleaning in Occupational Therapy Research.

Author

Dijkers, Marcel P. J. M. and Creighton, Cynthia L.

Abstract

Presents general principles for cleaning data sets. Suggests techniques: check for column shifts, data completeness, marginal frequencies, and selected cross-tabulations; examines a sample of cases. Gives strategies for preventing data processing errors. (SK)

Published
1994

49. Toward a rehabilitation treatment taxonomy: summary of work in progress

Author

Dijkers, Marcel P., Ferraro, Mary K., Hart, Tessa, Packel, Andrew, Whyte, John, and Zanca, Jeanne M.

Subjects
Rehabilitation -- Methods -- Standards, Health
Abstract

With funding from a cooperative agreement from the National Institute on Disability and Rehabilitation Research, we have worked for the past 5 years on the development of a rehabilitation treatment [...]

Published
2014
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