Not just numbers: qualitative research and the clinical neurosciences.

nerve decompression, and then living with the consequences – good or bad – of the surgery. Qualitative inquiry is not a monolith. It is an umbrella term that encompasses numerous approaches to health research. 3 Khu and colleagues have chosen an exploratory descriptive design using semi-structured interviews to better understand patient satisfaction with entrapment neuropathy surgery. Other data collection and analytic approaches for exploring issues relevant to such disorders and their treatments could also be employed. For example, grounded theory – a sociological methodology to understand social processes – could use face-to-face interviews and focus groups to understand the process of adapting to a condition such as CTS. Phenomenology – a philosophically-based methodology to better understand human experience – using in-depth interviewing could explore the everyday experience of living with a disability. Ethnography – an anthropological methodology to investigate socio-cultural phenomena – using participant observation could be employed to understand how our socio-cultural values and practices influence the provision of services for disabled members of our society. Qualitative approaches can also be used in other complex areas of neurological health care. Kaptchuk and colleagues, 4 for example, use a qualitative methodology to demonstrate how conventional theories of placebo inadequately attend to the myriad factors (physiological, embodied, social and cultural) that co-mingle to create what we call, in shorthand, the 'placebo effect'. Similarly, Thorne and colleagues 5 demonstrate with interpretive description the intricacies of good communication between health care providers and MS patients, and the iatrogenic effects of poor communication. Critiques of qualitative inquiry as an approach to health research are often located in a debate about objective versus subjective engagement with data. In qualitative inquiry, the researchers themselves are the tools for the collection of data, given that they are embedded in the research contexts where they talk to and observe patients, health care providers and even policy makers. While subjectivity is indeed an important element of quality inquiry, this should not be taken to mean a lack of a rigorous research process. On the contrary, standards of rigor and critical appraisal are essential to qualitative inquiry, ensuring that research is conducted with the sophistication and precision one would expect from expert quantitative sciences. 6 The careful development of the Cochrane Qualitative Research Methods Group, for example, is a case in point. Furthermore, quantitative and epidemiological research is not immune to subjectivity; Shrier and colleagues, for example, demonstrate how the …