The evidence based medical practice is a way of integrating personal clinical knowledge with the most appropriate peripheral clinical facts from methodical research.  Increased skill is reflected in diagnosis and identification and empathetic use of patient’s dilemmas, preference, and rights in making decisions related to their clinical care. The research described in the article can be termed as to be a relevant research from medical point of view. The study is patient centered medical research that is leading into accurate and precise diagnostic treatment. The research is focused into understanding the form of treatment that works best through discussion of the client`s perspective about the therapy, at the same time it is seeking to honor client by giving him/her a chance to determine their own course of treatment. The approach is giving room for clinical expertise basing it on similar case that is providing context knowledge of research.  The Evidence Based Practice approach has been used to improve the impact of medical field of community rehabilitation scheme. The approach has given much specific emphasis on the outcomes of research; the decisions which are made from these outcomes are delimited and very specific. The clarity, quality and the measure of treatment have specific completeness nature of collected data which is adequate in determination of the results. The questions that are framed, have allowed a critical view, which is ethically accepted to both the patient and the doctor. (Dey, 2003)   


There exist several limitations on the analysis that attract our attention. First and the foremost, though a comprehensive literature review was conducted, there are publications that seemed missing, in particular with the credential of the review materials, that depends more so on snowball methodology. There is to some extent, reliance on cited works within the reference materials to obtain a deeper understanding of the discourse related to the rigor in the qualitative research approach is inadequate. Although, the discussions are evident in the reference, they are also manifested during the hallway conversation, and at the conferences. Individual’s perspectives and comments are liable to amendment, at the same time participant’s relationship with the interviewers and other people participating on the same study have indicated to have some influence on respondent’s final idea. This influence is affecting not only the idea given, but also the way it is presented. From this paper it is not possible to elaborate on the effect of these influences of outside. Participant’s perspectives have a great effect on the final report. The interviewer’s education background and experience may assimilate different values into active participants for the study. The training of reviewers has shaped the beliefs of interviewee, making them to be aligned with interpretations. This background effects respondent way of observing the research, the views and the answer that is to be examined. (Carl Auerbach, 2003)

The participants seem to be in contact with a broad range of methodology and theoretical approaches for carrying out qualitative research, making them to incline to indentify the standard character to use in evaluation technique. There is a mixture of paradigms- realism, interpretivism and positivism in the nature of the analysis presented (Crabtree, 1992). The views on reality and knowledge have been taken lightly to some point it has been dichotomized. The use of this dichotomized paradigms in a simplified form have limited the amount of knowledge obtained from the research, though this may have been useful in the sense that it is an approach that is easily understood by the participants. It is also common to qualitative research; hence give a simplified analysis of the work. (Alan Bryman, 2002)   

From the analysis, it is evident that some areas of research have been negotiated in regard to determining the principles for rigorous research. The principles have been accepted widely such as conducting an ethical and important qualitative research and coming up with an appropriate and clear report on research. Appropriate and rigorous techniques have been applied in this research. Conflicting views were noted in the field regarding to the bias in research, reliability and validation. The three measures are highly influenced by experimental and qualitative approaches (Sndelowski, 2007). The implication of these influences, to our analysis shows a need of testing the ways in which the mentioned criteria are inserted in the belief concerning the information obtained and the reality. At the core of the interpretive paradigm-this is the background for various qualitative traditions, lays the hypothesis that realities are, co-constructed, multiple and fluid, similarly skill is assumed to a take between the participant and the observer. This framework yields evaluative criteria examining a study that sheds light to meanings that are subjective and articulating multiple perspectives of viewing the phenomenon of interest. The researcher has demonstrated substantial content, understood delineation of study, self reflection, evidence of immersion knowledge on specifically regarding to scope of the topic. These are essential and special features of a high rated qualitative research (Morse, 1992).  

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Contrary, essential to positive paradigm, which is accredited to form the core for the most qualitative researches, there is a hypothesis that there exist a solo objective realism and assumption that this realism is ever known. This paradigm is supported by assumption that knowledge on the topic of study is never perfect. Considering this paradigm, the framework has driven the goal of research to an uphill in attainment of credibility, truth to better the research. This rigorous research has demand for much engagement, thick description, persistent observation a null case analysis, to make it impressive the research should make use of  triangulation methods where member are checked so as to attain truth and validity in the process of seeking the facts behind the results (Polger, 2008).   

The realistic paradigm in this study is demonstrated where its ability of assimilating the beliefs, values and criterion for rigorous qualitative research is developed from the positive paradigm.  In a society that holds with esteem, the medical research as the one in the topic above, a random controlled testing for reference set should have a belief in reality objective, and should value study that is dependable. Dissimilar to interpretive, realistic approach is based on the scientific philosophy. Through maintenance of a principle in the objective fact and regarding truth to be an ideal observer have strived and have succeeded in putting the research that can yield valid, and a research that can be generalized, which is essential in importing equality to medical qualitative research (Melnyk, 2011).

Though from the above paper, qualitative research has emerged from realistic paradigm, which has led to assimilation into medical qualitative research society, it has happened at an extra cost. The qualitative research approach that may have been much compatible to traditional principles of a qualitative research would have been more accepted. A radical technique, that could have made better contributions in the research, would have been marginalized, since they may not have fitted to the evaluative standards that emerged from the topic of discussion. Conducting a rigorous research, as described under realistic approach, it involves utilization of various methods that would have furthered the availability of valid and reliable outcome (Green, 2004).

To assess the validity of a quantitative research differs significantly from the assessment of a qualitative research. The later is more driven towards demonstration of the reasons of bias, but not much on eliminating them. Therefore, it is good to include parts in a report on the reflexive stand of the observer, the perspective on which the study was carried out and the level of reliance that can obtained from the collected data (Hammel, 2004).    


The part of the observer

The observer should have put into consideration their part in the survey; for instance, as a participant, either an interviewer or interviewee. This is what is called to as ‘reflexibility’.  The position of the observer can be actually affecting the resulting data. To illustrate this, take an example, middle aged man and a teen boy are likely to receive different  responses based on the bias that results from respondent perspective towards them. Thus for a fair representation of the result of a qualitative research, it is always advisable to put this consideration into the model (Lavender, 2004).

It’s also of a great importance, when gauging how valid a qualitative research data to take into account of the data in a contextual meaning under which it was obtained. Observer should consider, if the data collected are realistic and plausible. To have an accurate test on the mentioned realistic, it would be of help, if the researcher would have feel for the setting of the research even, physical feeling determines the accuracy of the data obtained (Denzine, 1994).  

Analysis of qualitative data is different as compared to analysis of quantative data.  However, this does not imply that this analysis should not follow rigorous and systematic order. The systematisation and rigour demand have different assessment techniques. The key way of assessing this is in the terms of how clearly the preparation and presentation of the report is done. There must be in place a clear and precise technique for recording and decoding the data for analysis purposes. The most important of all is the rationale of conducting the research and the preparedness of the participants. (Matthew B. Miles, 1994)

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