The second phase (Chapter 4) aimed to explore the ecological validity of TR in a resource-limited country like India. The main focus of the study was to investigate the effectiveness of an ecologically valid TR system for the assessment and primary management of neurogenic dysphagia in a resource-limited country.
Background for the study
- Neurogenic dysphagia due to cerebrovascular accident
- Role of SLP in the intervention of neurogenic dysphagia
- TR and its use for the intervention of dysphagia
- Ecological validity of the TR system in the intervention of neurogenic
- Effectiveness of the ecologically valid TR system in the intervention of
The use of TR in the management of dysphagia is still in its early stages. There is limited evidence to support the use of TR in the management of dysphagia (Sharma, Ward, Burn, Theodoros & Russell, 2011).
Problem statement
Considering the concept of effectiveness trials, it seems necessary to investigate the effectiveness of an ecologically valid TR for the assessment and primary management of neurogenic dysphagia in a country with limited resources. However, as much of our knowledge about TR and its ecological validity comes from studies conducted in developed countries such as Australia and the USA, the question arises as to whether TR can be used to obtain similar results in a resource-limited country.
Research question
There are legitimate concerns about how TR will be influenced by contextual, technological, cultural, social, infrastructural and patient-related factors specific to resource-limited countries. Therefore, before introducing a new service delivery system in such environments, it is necessary to understand its current status in a resource-constrained country like India.
Study aims and objectives
Phase One Literature Review (Manuscript One)
Phase Two Study One (Manuscript Two)
Phase Three Study Two (Manuscript Three)
Summary of overall methodology
By following this model, there was a need to answer smaller questions to achieve the main objective of the study. The use of both qualitative and quantitative data to meet the overall purpose of the study provided richness and rigor (Silverman & Marvasti, 2008).
Outline of the study
The results obtained from the first two phases helped with the quantitative and qualitative analysis of the results obtained in phase three (Chapter Five). In the synthesis and critique chapter (Chapter Six) the researcher links the results of the three phases to identify the 'finding' of the study.
Overview of the chapter
To identify the variables that influence the ecological validity of TR in India based on the practice of TR staff. To identify the variables that influence the ecological validity of TR in India based on the experience of TR staff. So it is mainly the mothers who want to learn and they want to be in charge of the therapy for their children.
Overall, the results obtained from the current study helped to identify the factors that influence the ecological validity of the TR. The study also provided a more detailed conceptualization of the various factors influencing the ecological validity of TR in rehabilitation services in India. The literature review therefore identified the main concepts of the study as ecological validity and effectiveness of TR.
The results provided a more detailed conceptualization of the various factors influencing the ecological validity of TR services in India.
Literature Review Manuscript One
Summary of the literature review
Thus, there is a question mark over the ecological validity of TR in the management of dysphagia. Therefore, the researcher identified that the literature review added to her idea that the ecological validity of TR needed to be identified and thus its effectiveness when implemented in resource-limited settings because patient, clinician, technology, and contextual factors play a role. big. . This literature review showed that the researcher's assumption on the ecological validity of TR and its effectiveness is valid.
Conceptual Framework
The effectiveness of TR is affected by conditions such as geographical, political, social and cultural factors in a country with limited resources. Legal issues such as developing policies and procedures governing the use of TR in a country with limited resources are critical to the effectiveness of TR. The constructivist paradigm requires that the ecological validity of TR should be determined before it is implemented in a real-world environment in a country with limited resources.
Summary of the chapter
Overview of the chapter
No studies have been reported from India on the use of TR in the treatment of dysphagia. To examine the current status of TR in India through an understanding of the knowledge and attitude of TR staff. To examine and explain the effect of variables affecting ecological validity; that is, to see the effect of patient, clinician, technology, and context-related variables on the effectiveness of TR in assessment and primary management.
- Study aim and objectives
- Study design
- Study method
- Data collection tool
- Study participants and sampling
- Study location
- Data collection process
- Data analysis
- Trustworthiness of the study
The open-ended questions of the semi-structured interview were developed based on the purpose of the research and the KAP model. Key subsections related to the purpose of the study were identified and questions for the semi-structured interview were formulated. Confirmability: This ensured that the findings represented the participants' own views and that the results were free from the researcher's biases (Shenton, 2004).
Phase Three Effectiveness of an ecologically valid TR for neurogenic dysphagia
- Study aim and objectives
- Study design
- Study method
- Data collection tool
- Study participants and sampling
- Study location
- Data collection process
- Data analysis
- Reliability and validity
The FTF-SLP was present in the room with the SP in India and performed the CSE independently of the TR-SLP to determine the concurrent feasibility of the TR assessment compared to the standard clinical assessment environment. However, to avoid bias, the training of the SP to depict a case of neurogenic dysphagia was conducted by an external SLP who had experience in the treatment of dysphagia. TR-SLP and FTF-SLP only received information about age, gender and a brief medical history for SP.
Overview of the chapter
Although telemedicine has been used in resource-limited countries for more than a decade, not much literature is available on the use of TR in such settings. Therefore, this phase aimed to investigate the ecological validity of TR in a resource-constrained country like India.
Manuscript Two
There should also be an understanding about the factors influencing the ecological validity, implementation and range of practice of TR in India. The few specialties using TR in India are reported to be radiology, psychiatry and surgery. As unanimously agreed by the participants, there is a shortage of doctors in government sector hospitals and speech language pathologists in India in general.
Summary of the chapter
Considering all these factors, considering a resource-constrained country like India, the ecological validity of TR assumes greater importance. In addition, the importance of real-life settings for the ecological validity of TR needs to be analyzed. Given that no study has been published to date on the use of TR in a resource-constrained country, the researcher must be aware of and be prepared for the impact of such extraneous factors on the effectiveness of TR when implemented in a real-life setting. .
Overview of the chapter
To meet the objective of this phase, a mixed methodology was adopted, using a quantitative interrater reliability method to investigate the effectiveness of TR and a qualitative descriptive analysis to describe the effects of variables on effectiveness. Inter-rater reliability had to be calculated to overcome the degree of subjectivity that may arise from the researcher's interpretation of the construct. Therefore, based on the results of similar studies, it can be assumed that the use of SP will not negatively affect the ecological validity of the strategy under investigation, given that the researcher defined ecological validity as the implementation of a new intervention method, such as TR, in an outpatient setting in a real-world setting. life.
Manuscript Three
Comparison of the results will help determine the effectiveness of TR in the assessment and primary treatment of neurogenic dysphagia. The FTF-SP who was in the room with the patient and performed the proforma Clinical Swallowing Examination (CSE) independently of the TR-SLP. The obtained results showed that the greater the severity of neurogenic dysphagia, the lower the scores on the CSE, as seen in cases C and D.
Summary of the chapter
Descriptive analysis of the obtained results could explain the reason for the variation of results for certain CSE parameters in each case in relation to the factors affecting the ecological validity. Thus, compared to previous studies that conducted a dysphagia intervention using TR in controlled settings in economically developed countries, there was little variation in inter-rater reliability, which may be attributed to factors affecting ecological validity and thus efficacy. Although there may be differences in results on the CSE, the TR is still effective in the evaluation and primary treatment of neurogenic dysphagia in a country with a shortage of dysphagia experienced by SLP.
Introduction
Summary of findings of the phases
Epistemologically, the reality had to be interpreted to identify the underlying understanding of the factors influencing the ecological validity and effectiveness of TR (Guba & Lincoln, 1982), which formulated the theoretical and methodological perspective of the further stages of the study (Scoci, 2012). . Thus, the researcher determined the need to first explore the use of TR in a country with limited resources, which helped to identify factors that affect the ecological validity and effectiveness of TR. Factors affecting the ecological validity and hence the effectiveness of TR need to be addressed when it is implemented in India.
The current study
The researcher admits that these factors are indeed affecting the effectiveness of the service provided. The researcher identified that the factors explained by Mosadeghrad (2014) fall under the subjectivity factors explained by Princeton. The social world of health care identifies that the knowledge we gain is through the interpretation of the interaction between the patient and the health care provider.
Limitations and future recommendations
From chapter four it was identified that the acceptance of TR other professionals was mixed. In a country with limited resources like India, where the health care providers are burdened with their own clinical work and thus come back to perform TR. However, there is no denying that the results provide valuable preliminary information for future research of TR in resource-limited country.
Conclusions
The impact of telemedicine in the postoperative care of the neurosurgical patient in an outpatient clinic: a unique perspective of this valuable resource in the developing world - an experience of more than 3000 teleconsultations. Efficacy and effectiveness trials (and other phases of research) in the development of health promotion programs. An application of hierarchical kappa-type statistics in the assessment of majority agreement between multiple observers.
Biomedical Research Ethics Committee Approval for the study
Ethics approval for the study from NIMHANS
Study One interview schedule
Study One Information Sheet and Consent form
Study Two Clinical Swallow Evaluation Proforma
Study Two Information sheet and Consent form for simulated patient
Study Two Information sheet and Consent form for speech language pathologist
