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Preface

Choosing to become an occupational therapist the chapters emphasize the usefulness of research
involves a commitment from each and every one in terms of building practitioners’ knowledge base
of us to ensure that the profession’s practice and and credibility within and outside of our field.
scholarship stand at the cutting edge of rehabili-
tation science and innovation. This responsibility
carries with it an effortful and disciplined practice Organization and Scope
of applying the theoretical underpinnings, infra-
structural requirements, scientific methods, and This book offers a comprehensive guide to con-
practical means of disseminating research find- ducting applied research in the field of occupa-
ings. Contributions represented within this second tional therapy from quantitative, qualitative, and
edition represent a collective effort on the part of mixed perspectives. It is organized in terms of six
many occupational therapy educators to make the sections. Given the breadth of material covered, the
process of learning and utilizing research in occu- content is targeted toward a student–practitioner
pational therapy one that is relevant to practice, audience, and most topics are covered at a foun-
unintimidating, and, most importantly, motivating. dational level. Each of the six sections and chap-
By definition, research represents a disciplined ters within each section may be read in isolation.
and systematic approach to the development, iden- However, readers will gain the most by reading the
tification, and verification of new knowledge. It sections and chapters in the order in which they
is governed by ethics and rules of conduct and is are presented.
structured and rational in nature. In the field of The first section, Research in Occupational
occupational therapy, research involves testing the- Therapy: Basic Elements for Enhancing Practice,
ories and theoretical concepts as they are reflected emphasizes every therapist’s professional respon-
in practice frameworks and in conceptual practice sibility to conduct practice that is informed by
models. Moreover, research involves using assess- research and stresses the importance of evidence-
ments and other approaches to data collection to based practice to advancing the field of occupa-
generate knowledge and to test innovative devices, tional therapy. Basic content on what to look for
technologies, and approaches to practice. when reading a published research study, including
The focus of this book is the concepts, methods, how to critically appraise research, is included.
and common practices that comprise the act of This section provides an overview of the aims and
conducting research in the field of occupational classifications of research and a discussion of the
therapy. Content in this text is balanced to ensure philosophical foundations of research. The impor-
equal coverage from both quantitative and qualita- tance of theory in the development of research and
tive perspectives. The two original themes binding testing of concepts, assessments, and interventions
the first edition were retained in this volume. First, is also emphasized.
the chapters illustrate how research is fueled by The second section, Laying the Groundwork
creativity, represented in the ongoing development for Evidence-Based Practice: The Steps of the
and discovery of new knowledge. The develop- Research Process, covers six broad components
ment of this knowledge and any associated skills of the research process: conducting a literature
or technologies contributes to the field’s mandate review, generating research questions and defin-
to approach practice using the most humane, ing specific aims and hypotheses, selecting the
inclusive, contemporary, rigorous, and engaging research method, writing the research proposal,
methods possible. Second, specific efforts were ensuring ethical review, and securing samples and
made to demonstrate how research is both essen- performance sites.
tial to and can support and improve occupational The third section, Qualitative Approaches: First
therapy practice. To this end, all of the examples Steps in Communicating With Language, describes
and cases contained in this book emanate directly design considerations, approaches to the collec-
from the field of occupational therapy. Additionally, tion of qualitative data, contemporary methods for

vii

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viii Preface

analyzing qualitative data, and approaches to inter- Conclusion


preting and reporting qualitative data.
The fourth section, Quantitative Approaches: Each contribution to this book not only represents
First Steps in Communicating With Statistics and a level of expertise within the relevant topic area,
Measures, focuses on the same topics, but from but more importantly envelops the passion and
a quantitative perspective. Chapters emphasize dedication required for the conduct of science
selection of the appropriate research design; mea- within the field of occupational therapy. The book
surement approaches; data collection; techniques was designed to offer a clear and comprehensive
for entering, storing, and managing data; statistical approach to conducting occupational therapy
analysis; and meta-analytic studies. research at any level that is directed at improving
The fifth section, Descriptive, Exploratory, and our practice. After having read this edition, it is
Pilot-Study Research, covers single-subject, and my sincere hope, and that of all of the contribu-
survey research. tors, that its contents will inspire a similar sense
The sixth section, Additional Topics for the of passion, commitment, and dedication to the
Developing Investigator, covers needs assessment continual improvement of our field through the
research, program evaluation research, participa- rigors involved in the application of science and
tory research approaches, the process for writing discovery.
a literature review and writing up one’s research
findings, approaches to obtaining grant funding for Renée R. Taylor
research, mixed-methods designs, and outcomes
research for evidence-based practice.

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Acknowledgments

I wish to thank Christa Fratantoro, Senior Acquisi- not have been possible. I also wish to thank three
tions Editor at F. A. Davis, who believed in my work former University of Illinois at Chicago (UIC)
enough to support my assuming the sole editorship occupational therapy students—Baily Zubel, Mary
of the second edition of this text. Additionally, I Pearson, and Phoebe Kinzie-Larson—for their edi-
wish to thank Roxanne Klaas, for her excellence torial contributions, including some of the photog-
and good sense in copy editing. I wish to thank all raphy and figures. Finally, I wish to thank Nancy
of the contributors to this second edition. Without Peterson, Dana Bataglia, and Laura Horowitz for
their experience and excellence, this book would assisting with the editorial production of this text.

ix

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4037_FM_i-xii.indd x 11/25/2016 10:34:26 AM
Contents

SECTION 1 SECTION 2
Research in Occupational Therapy: Laying the Groundwork
Basic Elements for Enhancing for Evidence-Based Practice:
Practice The Steps of the Research Process

1 Occupational Therapy 9 Steps in the Research Process


as an Evidence-Based Practice and Characteristics
Profession 1 of Sound Research 86
Renée R. Taylor, Gary Kielhofner, Renée R. Taylor, Gary Kielhofner,
Nancy A. Baker Hector W. H. Tsang, Marian Arbesman

2 Classifications and Aims 10 Conducting a Literature Review 99


of Research 11 M. G. Dieter, Gary Kielhofner,
Renée R. Taylor, Gary Kielhofner, Ellie Fossey Renée R. Taylor

3 Philosophical Foundations 11 Generating Research Questions


of Research 25 and Defining Specific Aims
and Hypotheses 114
Renée R. Taylor, Gary Kielhofner
Renée R. Taylor, Hector W. H. Tsang,
Marian Arbesman
4 Reading and Understanding
Published and Presented 12 Selecting the Research Method 119
Research 34
Renée R. Taylor, Ellie Fossey, Gary Kielhofner
Renée R. Taylor, Nancy A. Baker,
Pimjai Sudsawad
13 Writing the Research Proposal 135
Renée R. Taylor
5 Critically Appraising
and Classifying Published
and Presented Research 47 14 Ensuring Ethical Research 144
Renée R. Taylor Don E. Workman, Gary Kielhofner,
Renée R. Taylor

6 Managing Barriers
to Evidence-Based Practice:
15 Securing Samples
and Performance Sites 162
An International Imperative 59
Anne E. Dickerson
Annie McCluskey, Renée R. Taylor

7 Professional Responsibility SECTION 3


and Roles in Research 69
Anne Cusick, Gary Kielhofner, Qualitative Approaches: First Steps
Renée R. Taylor in Communicating With Language

8 The Role of Theory 16 Design Considerations


in Occupational Therapy 78 in Qualitative Research 180
Renée R. Taylor Mark R. Luborsky, Cathy Lysack

xi

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xii Contents

17 Collecting Qualitative Data 196 27 Survey Research 375


Cathy Lysack, Mark R. Luborsky, Kirsty Forsyth, Frederick J. Kviz
Heather Dillaway

SECTION 6
18 Contemporary Tools
for Managing and Analyzing Additional Topics for the
Qualitative Data 214 Developing Investigator
Nadine Peacock, Amy Paul-Ward
28 Needs Assessment Research 395
19 Qualitative Approaches Marcia Finlayson
to Interpreting
and Reporting Data 228 29 Program Evaluation Research 410
Heather Dillaway, Cathy Lysack, Brent Braveman, Yolanda Suarez-Balcazar,
Mark R. Luborsky Gary Kielhofner, Renée R. Taylor

SECTION 4 30 Participatory Research


Quantitative Approaches: Approaches 424
Renée R. Taylor, Yolanda Suarez-Balcazar,
First Steps in Communicating Kirsty Forsyth, Gary Kielhofner
With Statistics and Measures
31 Writing a Literature Review 437
20 Quantitative Research Designs: Renée R. Taylor, Gary Kielhofner, Ellie Fossey
Defining Variables and Their
Relationships With One Another 244
32 Disseminating Research:
David L. Nelson, Gary Kielhofner,
Presenting, Writing,
Renée R. Taylor
and Publishing 447
Gary Kielhofner, Ellie Fossey, Renée R. Taylor
21 Developing and Evaluating
Quantitative Data Collection
Instruments 274 33 Writing a Grant Proposal 460
Gary Kielhofner, Wendy J. Coster Renée R. Taylor, Yolanda Suarez-Balcazar,
Geneviève Pépin, Elizabeth White

22 Collecting Quantitative Data 296


34 Using Mixed-Methods Designs
Renée R. Taylor, Gary Kielhofner
to Study Therapy
and Its Outcomes 488
23 Entering, Storing, Mary A. Corcoran
and Managing Data 313
Marcia Finlayson, Toni Van Denend
35 Creating Outcomes Research
for Evidence-Based Practice 498
24 Deciding on an Approach Pimjai Sudsawad
to Data Analysis 330
Renée R. Taylor
Glossary 509
Index 531
25 Meta-Analysis 342
Kenneth J. Ottenbacher, Patricia Heyn,
Beatriz C. Abreu

SECTION 5
Descriptive, Exploratory,
and Pilot-Study Research

26 Single-Subject Research 360


Jean Crosetto Deitz

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S E C T I O N 1
Research in Occupational Therapy:
Basic Elements for Enhancing Practice

C H A P T E R 1

Occupational Therapy as an
Evidence-Based Practice Profession
Renée R. Taylor ● Gary Kielhofner ● Nancy A. Baker

Learning Outcomes • A means of growth through developing new


approaches to understanding and treating people
■ State why research is an obligation of the with impairments
profession. • Evidence that assures others (e.g., family mem-
■ Define the role of evidence-based practice in bers, employers, insurance companies, and other
occupational therapy. public institutions) about the impact of occupa-
■ Explain why evidence-based practice is tional therapy services, thus increasing public
necessary to the profession. credibility
■ Explain the importance of clinical expertise
in evidence-based practice. For greatest relevance to practice and to the
■ Identify major ways in which research profession, research should be conducted accord-
supports occupational therapy ing to a theoretical framework. Figure 1.1 sum-
practice. marizes the dynamic relationships among theory,
■ Describe the major types of research research, and practice. Each of these key elements
that provide evidence about the nature of the profession influences the other elements.
and outcomes of occupational Theory and research evidence guide practice. Prac-
therapy. tice raises problems and questions to be addressed
in theory and research. Research tests theory and
practice, providing information about their validity
and utility, respectively.
This chapter explores the role of research in
Introduction supporting the theories that form the basis of the
occupational therapy profession. You will learn
Why and to what extent is research important to a the importance of research to clinical reasoning
practice-based profession such as occupational and other types of decision-making in practice.
therapy? If you are like many of us, this is a ques- This involves defining evidence-based practice,
tion that you have asked yourself at some time explaining why it is necessary to the profes-
during the course of your development as a student sion, describing the predominant ways in which
or occupational therapist. research supports the profession, and emphasizing
The Case Example in this chapter provides just the importance of student and clinician involve-
one illustration of why research is important to the ment in and support of research-related activities.
occupational therapy field overall. Research pro-
vides insight into:
• The resolution of practice dilemmas
A Profession’s Research
• The means to test innovations that improve peo- Obligation
ple’s well-being and functioning in a wide range
of contexts Every health profession asks its clients and the
• Knowledge and guidelines that direct therapists public to have a level of confidence in the worth
in their everyday work of its services. To justify that confidence, the

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2 Section 1 Research in Occupational Therapy: Basic Elements for Enhancing Practice

Explains phenomena
Theory addressed in practice
and provides a rationale
for practice

Yields findings that Generates clinical


lead to theory and puzzles addressed by Practice
that examine and theory and research
refine existing theory

Generates evidence
Research about the effectiveness
of specific practices

Figure 1.1 The dynamic relationship among theory, research, and practice.

profession must enable its members to offer high- providers are used and reimbursed, those disci-
quality services that will benefit clients. Thus, plines with objective evidence of their effectiveness
when health-care professionals provide services and efficiency will have a competitive advantage”
to clients, the knowledge and skills they use (p. 197). He concludes that research is an eco-
should be “justified in terms of a systematic and nomic imperative for the profession.
shared body of professional knowledge” (Polgar Without the development of a research base to
& Thomas, 2000, p. 3). This knowledge includes refine and provide evidence about the value of its
the underlying theory that informs practice and practice, occupational therapy simply will not
the tools and procedures that are used in practice. survive, much less thrive, as a health profession
Research is the means by which the profession (Christiansen, 1983; Christiansen & Lou, 2001;
generates evidence to test and validate its theories Cusick, 2001).
and to examine and demonstrate the utility of its
practice tools and procedures. Therefore, our pro-
fession has an ongoing obligation to support occu-
pational therapy professionals who choose to
Evidence-Based Practice
undertake systematic and sustained research.
The obligation of the profession to conduct
research that refines and validates its knowledge
Research for Professional base is paralleled by an obligation of individual
therapists to engage in evidence-based practice
Recognition and Support (EBP) (Taylor, 2000). Evidence-based practice is
an approach to practice that assumes the active
The occupational therapy profession depends on application of current, methodologically sound
societal support. This support ranges from sub- research to inform practice decisions and treatment
sidizing educational programs that prepare occu- options in light of a client’s preferences, expecta-
pational therapists to reimbursing occupational tions, and values (Sackett, 2002).
therapists for their services. Societal support for The process of evidence-based practice begins
the health-care professions cannot be assumed; the with a clinical situation that poses a unique ques-
individuals who make public policy and decide tion or challenge for the practitioner (Sackett,
what health-care services are needed increasingly 2002). Using evidence-based practice, the prac-
rely on scientific evidence to determine where titioner engages in a highly deliberate, publicly
limited public and private resources should be transparent, and well-reasoned use of clinical
directed. As a result, research is increasingly nec- research findings to inform decision-making about
essary to ensure that resources will be available to an individual client in an actual practice situa-
support the profession. Christiansen (1983) notes, tion (Sackett, 2002). Those who approach clinical
“It seems clear that as administrators and policy- decision-making from an evidence-based perspec-
makers render decisions about how health care tive consider what clients value, prefer, and expect

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Chapter 1 Occupational Therapy as an Evidence-Based Practice Profession 3

CASE EXAMPLE

Dr. Kerstin Tham is an occupational therapist who specializes in the neurorehabilitation of


individuals who have had a cerebrovascular accident (CVA), or stroke (Fig. 1.2). After working
with a number of clients with many different kinds of impairments resulting from their CVAs,
Kerstin observed that unilateral neglect was one of the most difficult and frustrating impairments to
treat in occupational therapy.
Unilateral neglect is an impairment in which people no longer recognize half of their own bodies
or perceive half of the world around them. As a consequence, people neglect these regions of the
self and the world, for example, washing only one side of the body, eating only the food on
one-half of a plate, and bumping into objects that they do not perceive to be present.
For answers, Dr. Tham turned to the existing evidence base, which consisted of a number of
published journal articles citing research findings about various training approaches to treat people
with unilateral neglect. The common finding, however, was that these approaches had not been
shown to be very successful in improving the overall functioning of people with this problem.
Dr. Tham became convinced that the research describing unilateral neglect had one major flaw:
It always examined how neglect appeared from the outside, that is, how it appeared to clinicians
and researchers. The researchers never asked the individuals with CVA what it was like to
experience the impairment. So, she decided to undertake research that would describe neglect
phenomenologically, or from the point of view of the person who had it. Her goal was to provide
insights into how to improve service provision to individuals with the impairment.
In a qualitative study in which she observed and interviewed four women over an extended
period of time, Dr. Tham and her colleagues came to provide some startling insights into the nature
of unilateral neglect (Tham, Borell, & Gustavsson, 2000). For example, they found that people with
neglect felt that the neglected body parts were not their own or were not attached to their bodies.
Their research described a natural course of discovery in which individuals with neglect came to
understand that they had the impairment and were able to make sense of the strange and chaotic
experiences of their bodies and the world.
In a subsequent investigation, Dr. Tham and a colleague went on to examine how the behavior
of other people influenced the experiences and behaviors of a person with neglect (Tham &
Kielhofner, 2003). She is continuing this line of research, which is providing a new approach to
understanding and providing services to persons with unilateral neglect. Moreover, she and her
doctoral students have expanded these ideas and are now examining the experience of persons with
other types of perceptual and cognitive impairments following acquired brain injuries (Erikson,
Karlsson, Söderström, & Tham, 2004; Lampinen & Tham, 2003).

Figure 1.2 Kerstin Tham, OT, PhD, is an


occupational therapist and researcher.

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4 Section 1 Research in Occupational Therapy: Basic Elements for Enhancing Practice

from the health-care encounter, alongside their clinically relevant research findings in practice
own ever-growing clinical experience, practical (Dysart & Tomlin, 2002). Findings revealed that
skill sets, and educational backgrounds (Sackett, occupational therapy practitioners were using evi-
2002). Evidence may be used to shed light on: dence in practice to a modest degree; more than
one-half (57 percent) relied on one to five evi-
• The anticipated course and outcome of a particu-
dence-based treatment plans per year.
lar impairment, symptom, or diagnosis
In sum, evidence-based practice requires an
• The relevance and accuracy of a selected assess-
ongoing commitment from researchers to investi-
ment tool
gate problems and answer questions that emerge
• The nature, conduct, and expected outcome of a
out of practice. Equally, it requires an enduring
chosen intervention
commitment from practitioners to access, evaluate,
Accordingly, whenever possible, practitioners and use this research to inform their decision-
should select intervention strategies and tools that making in everyday practice. It also requires the
have been empirically demonstrated to be effective client’s perspective and involvement (Bennett &
(Eakin, 1997). This process requires practitioners Bennett, 2000). Evidence-based practitioners inte-
to remain up to date with new developments in grate their own expertise with the best available
their practice areas. It also requires practitioners to research evidence. The next section briefly exam-
develop the ability to conduct thoughtful and effi- ines some of the ways in which research provides
cient literature reviews and possess knowledge evidence for practice.
about how to evaluate published research in terms
of its quality and level of methodological rigor
(Sackett, 2002). Clinical Expertise
The Canadian Association of Occupational
Therapists’ position statement on evidence-based
and Evidence-Based Practice:
occupational therapy is available online (Canadian A Collaborative Approach
Association of Occupational Therapists, Associa-
tion of Canadian Occupational Therapy University Evidence-based practice integrates individual
Programs, Association of Canadian Occupational clinical expertise with the best available external
Therapy Regulatory Organizations, & the Pre- clinical evidence from systematic research
sidents’ Advisory Committee, 2009). It defines (Sackett, Rosenberg, Grey, Haynes, & Richardson,
evidence-based occupational therapy as the client- 1996). Clinical expertise refers to the proficiency
centered enablement of occupation, based on client and judgment that individual practitioners acquire
information and a critical review of relevant through experience. Best available external clini-
research, expert consensus, and experience. cal evidence refers to findings from highest avail-
Bennett and Bennett (2000) describe the process able quality, clinically applied, research studies
of how evidence-based practice informs clinical within the field’s scientific literature.
decision-making within occupational therapy. It is clear from this definition that evidence-
According to this approach, the clinical questions based practice relies on practitioners’ clinical
being considered must address the nature of spe- expertise when applying research evidence to prac-
cific clients and client groups, as well as their treat- tice. Sackett et al. (1996) state that neither clinical
ment contexts. This definition stresses that the expertise nor the best available external evidence
relationship between clinician and patient is cen- alone are enough for evidence-based practice;
trally important in clinical decision-making. external clinical evidence can inform but can never
After a clinical question is defined, the next step replace individual clinical expertise. Clinical
in the process involves conducting a literature expertise is what determines whether the external
review. During this review, practitioners must be evidence applies to the individual patient (i.e.,
cognizant of the quality and standards by which whether and how it matches the client’s clinical
the research has been conducted. Then, match the state, predicaments, and preferences).
evidence to each feature of the client’s context, Sackett, Straus, Richardson, Rosenberg, and
including the client as an individual, the client’s Haynes (2000) later described evidence-based
desired occupation, and the client’s environment. practice as the integration of best research evi-
Within this process, the client acts as an active and dence with clinical expertise and patient values.
engaged partner with the practitioner. With this updated definition, the patient’s values
In 2002, Dysart and Tomlin surveyed 209 are acknowledged as an equally important and nec-
practicing occupational therapists to determine essary ingredient in the practice of EBP as research
the extent to which they access, use, and apply evidence and clinical expertise (Fig. 1.3).

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Chapter 1 Occupational Therapy as an Evidence-Based Practice Profession 5

available to occupational therapists (Zimolag,


French, & Paterson, 2002), including:
Clinical • Research evidence
expertise • Information provided by the client for determin-
ing occupational priorities and capacities
Best research • The knowledge that occupational therapists have
evidence EBP gained from past experience
Based on those definitions, the essence of EBP
may be summarized as follows:
• Evidence-based practice involves more than just
Patient values the use of research evidence.
and preferences • Clinical expertise is as important to evidence-
based practice as research evidence.
• Client input is vital to the decision-making
process in evidence-based practice.
Figure 1.3 Evidence-based practice is the
• Health-care decisions are also influenced by
integration of best research practice, clinical
expertise, and patient values and preferences.
available resources.
For example, a client has had several acute epi-
sodes of low back pain that he states have led to
The Role of Evidence- decreased participation in work, play, and home
Based Practice activities. After assessment, it is clear that the
client has low flexibility and endurance, and he
in Occupational Therapy reports high levels of pain. He has had several
courses of physical therapy but continues to have
Evidence-based practice evolved from the princi- problems. The client states that he would like to
ples of evidence-based medicine (EBM), a concept miss less work, improve his ability to play with his
that originated in the 1980s at McMaster Univer- children, and improve his overall fitness level. The
sity in Canada (Taylor, 1997). EBP emerged within practitioner working with the client believes that a
health care and health education in the 1990s. It is course of intensive work-related occupational
now widely known that research evidence must be therapy will benefit the client and provides him
used as a primary foundation for informing occu- with the following information to help him make
pational therapy practice (Stronge & Cahill, 2012). his decision: “Mr. Koifier, you have had chronic
Since the introduction of EBP in occupational low back pain for 1 year now. Your physical
therapy, there continues to be discussion about its therapy has helped some, but you continue to have
implementation. There is an increasing recognition trouble with home activities, and you feel that your
that the implementation of evidence-based practice overall fitness level is low. I would like to suggest
is a complex process that may need to be adapted a course of therapy in which you attend daily
to ensure its applicability to occupational therapy. therapy lasting 4 hours a day. The therapy is
To implement EBP in occupational therapy, the designed to improve your flexibility, endurance,
synthesis of the available evidence with clinical strength, and work ability. A recent study reported
expertise and judgment, as well as knowledge of that this type of therapy was superior to a three-
the values and preferences of the clients, is critical times-a-week physical therapy program in decreas-
(Graham, Robertson, & Anderson, 2013; Pighills, ing sick days, improving flexibility and endurance,
Plummer, Harvey, & Pain, 2013; Stronge & Cahill, and assisting people to getting back to leisure
2012). Authors have also argued that the direct and sports activities. For example, there was a
adoption of EBM and its established prescriptive 17 percent greater decrease in sick days for people
guidelines may not adequately reflect the philo- who received this type of therapy, a 29 percent
sophical beliefs and the highly contextualized and increase in endurance, and a 17 percent decrease
dynamic nature of occupational therapy (Graham in pain. In addition, one in five clients in this type
et al., 2013; Pighills et al., 2013; Stronge & Cahill, of intervention report the improved ability to par-
2012). ticipate in sports and leisure activities.”
Evidence-based occupational therapy is an off- This type of evidence-based statement provides
shoot of evidence-based practice that recognizes the client with information that will help him to
the range of sources and scope of evidence make a more informed decision as to whether the

4037_Chapter 1_0001-0010.indd 5 11/25/2016 10:32:41 AM


6 Section 1 Research in Occupational Therapy: Basic Elements for Enhancing Practice

additional time and effort required to attend the Needs assessment is particularly important in
more intensive program will be worth it. identifying the nature and consequences of new
types of disabilities and new circumstances that
affect persons with disabilities, and in identifying
How Research problems not previously recognized or understood.
Supports Practice For example, studies have indicated that HIV/
AIDS increasingly affects individuals from under-
Research supports practice in many different ways, served minority populations and individuals with
including: histories of mental illness, substance abuse,
poverty, limited education, and limited work expe-
• Generating foundational knowledge used by rience (Centers for Disease Control and Prevention
therapists [CDC], 2001; Karon, Fleming, Steketee, & De
• Proving the need for occupational therapy Cock, 2001; Kates, Sorian, Crowley, & Summers,
services 2002). Research has also shown that although
• Developing and testing the theories that underlie newer drug therapies have lowered AIDS mortal-
practice ity, the chronic and disabling aspects of the disease
• Generating findings about the process and out- and its numerous associated conditions continue to
comes of therapy pose challenges for those affected (CDC, 2001).
The following section examines each of these Many people with HIV/AIDS struggle to over-
ways in which research supports and advances come personal, financial, and social challenges that
practice. affect their desire to live independently and return
to the workforce (McReynolds & Garske, 2001).
Generating Foundational In addition to these general characteristics of the
AIDS population, a needs assessment study dem-
Knowledge onstrated that individuals’ perceptions of needs
Much of the background information that occupa- differed by race, ethnicity, and gender (Sankar &
tional therapists use on a daily basis stems from Luborsky, 2003).
research. Often, a long history of investigation is Together, these studies indicated that individu-
behind what has become common knowledge. als with HIV/AIDS would potentially benefit from
Knowledge of musculoskeletal anatomy, neuronal an individualized intervention designed to help
transmission, the milestones of child development, them achieve independent living and employment
the nature of personality, and the etiology and as they envisioned it. These studies provided a
prognoses of diseases has resulted from thousands foundation on which to propose a study of that type
of studies. of occupational therapy intervention (Paul-Ward,
Over decades, investigators examined these Braveman, Kielhofner, & Levin, 2005).
phenomena, providing analyses that were subse-
quently verified or corrected by others. In time, this
knowledge was accumulated and refined until it Developing and Testing
became part of the repository of knowledge that Occupational Therapy Theory
informs occupational therapy practice. This knowl-
edge is ordinarily generated by individuals who are Every profession makes use of theories that under-
not occupational therapists; however, their research lie and explain its practice. By definition, the
is important to occupational therapy practice. explanations offered by a theory are always tenta-
tive. By testing these explanations, research allows
Proving the Need theory to be corrected and refined so that it pro-
vides increasingly useful explanations for practice.
for Occupational Therapy Services
Ideas about how research refines and tests theory
Without clear identification of need, one can have evolved over the centuries, but research
neither decide what services to provide nor accu- remains the primary tool by which a theory can be
rately evaluate the value of any service. Needs improved.
assessment research determines what clients Practice theory research explains problems
require to achieve some basic standard of health or that therapists address and justifies approaches to
to improve their situation (Witkin & Altschuld, solving them that are used in therapy. Conse-
1995). It focuses on identifying gaps between quently, the testing and refinement of such theories
clients’ desires and their situations (Altschuld & through research contributes to advancing practice.
Witkin, 2000). Therapists should always judge and place their

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Chapter 1 Occupational Therapy as an Evidence-Based Practice Profession 7

confidence in the explanations provided by any tional therapy typically seek to explain problems
theory in relation to the extent to which that theory that therapists encounter in practice and how thera-
has been tested and developed by research. pists attempt to solve those problems, these types
The motor control model provides one example of studies directly inform practice.
of how research tests theory with implications for
practice. Occupational therapy practice for indi-
viduals with central nervous system damage has Providing Evidence
been guided by the motor control model, which About the Nature
is a theory of how people control movement. and Outcomes of Therapy
Toward the end of the 20th century, this model,
which previously saw the control of movement as Many types of studies examine the various aspects
being directed exclusively by the brain, began to of occupational therapy practice and its outcomes.
change. A new conceptualization (Mathiowetz & These are typically studies that:
Bass-Haugen, 1994, 2002) argued that movement • Are undertaken to develop and test assessments
is a result of the interaction of the human nervous used in practice
system, the musculoskeletal system, and the envi- • Examine the clinical reasoning of therapists
ronment. This theory emphasized the importance when they are making decisions about therapy
of the task being performed and the environment • Determine the outcomes that result from therapy
(e.g., the objects used) in influencing how a person • Examine the process of therapy (i.e., asking
moves. The implication of this theory was that what goes on in therapy)
the tasks chosen and the objects used in therapy • Use participatory methods to investigate and
would have an impact on recovery of coordinated improve services in a specific context
movement.
Occupational therapists conducted research Studies That Test Assessments
that illustrated clearly that the nature of the task Used in Therapy
being done and the environment do affect the
quality of movement (Lin, Wu, & Trombly, 1998; A number of interrelated forms of inquiry are used
Mathiowetz & Bass-Haugen, 1994; Wu, Trombly, to develop and test assessments used in the field;
& Lin, 1994). These and other studies (Ma & the aim of assessment research, sometimes
Trombly, 2002; Trombly & Ma, 2002) now provide referred to as psychometric research, is to ensure
evidence that tasks involving meaningful objects the dependability of those methods (Benson &
and goal-oriented activities positively influence Schell, 1997). Dependable assessments are reli-
performance and motor learning. able; that is, they yield consistent information in
A wide range of research can be used to test and different circumstances, at different times, with
develop theory. In fact, no single study can ever different clients, and when different therapists
test all aspects of a theory. The types of studies that administer them. A dependable information–
are typically used to examine and develop theory gathering method must also be valid, providing the
include: information it is intended to provide. Studies that
examine whether an assessment is valid are typi-
• Studies that aim to verify the accuracy of the cally those that:
concepts by asking whether there is evidence to
support the way a concept describes and/or • Ask experts whether the content of an assess-
explains certain phenomena ment is coherent and representative of what is
• Studies that ask whether there are relationships intended to be gathered
between phenomena as specified by the theory • Analyze the items that make up an assessment to
• Studies that compare different groups of partici- determine whether they coalesce to capture the
pants on concepts that the theory offers to trait they aim to measure
explain the differences between those groups • Ask whether the assessment correlates with mea-
• Studies that examine the potential of the theory sures of concepts that are expected to concur and
to predict what will happen whether it diverges from those with which no
relationship is expected
Over time, as the evidence accumulates from such
• Determine whether they can differentiate be-
studies, informed judgments can be made about the
tween different groups of people
accuracy and completeness of a theory. Findings
from such research typically lead to alterations in In addition to studies that examine the reliabil-
the theory that allow it to offer more accurate ity and validity of assessments, there are studies
explanations. Because the theories used in occupa- that examine their clinical utility. Such studies may

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8 Section 1 Research in Occupational Therapy: Basic Elements for Enhancing Practice

ask therapists and/or clients whether they find the enhanced school performance. A well-known
assessments informative and useful for identifying example of this type of research is a study by Clark
problems and making decisions about theory. The and colleagues (1997), which documented the
development of any assessment ordinarily involves positive outcomes of an occupational therapy
a series of studies that contribute to the ongoing program for well elderly individuals. Finally,
improvement of the assessment over time. studies that examine the effect of interdisciplinary
services can also document the impact of the occu-
Studies of Clinical Reasoning pational therapy component of such services.
Occupational therapists work with clients to iden-
tify their problems and choose a course of action Inquiry Into the Processes
so clients may manage their problems and improve of Therapy: Mechanisms of Change
their functioning through engaging in occupations.
Research that examines how occupational thera- It is important not only to understand whether
pists identify problems and make treatment deci- interventions work but also why they work or do
sions is referred to as clinical reasoning research not work. This approach is often referred to as
(Christiansen & Lou, 2001; Rogers, 1983; Schon, process research or formative research. This
1983). Investigations that examine clinical rea- approach involves understanding the mechanisms
soning constitute an important area of research in of change, that is, the processes by which an inter-
occupational therapy. vention creates change in a client. Studies that
One of the most influential studies of clinical examine the effect of interventions are increas-
reasoning, by Mattingly and Flemming (1994), ingly focusing on identifying the underlying mech-
identified different types of reasoning that charac- anisms of change (Gitlin et al., 2000). Often,
terized occupational therapy practice. Their an important prelude to designing intervention
research has served as a framework for under- outcome studies is to examine what goes into
standing how occupational therapists make sense therapy in order to improve upon services before
of and take action with reference to their clients’ they are more formally tested.
problems and challenges in therapy. An example is a study by Helfrich and
Kielhofner (1994) that examined how clients’
Outcomes Research occupational narratives influenced the meaning
they assigned to occupational therapy. This study
Outcomes research is concerned with the results showed how the meanings of therapy intended by
of occupational therapy. Investigations that therapists were often not received by or in concert
examine the outcomes of occupational therapy ser- with clients’ meanings. The study findings under-
vices include: scored the importance of therapists having knowl-
• Investigations of specific intervention strategies edge of their clients’ narratives and organizing
or techniques therapy as a series of events that enter into those
• Studies of comprehensive occupational therapy narratives. Such studies of the process of therapy
programs provide important information about how therapy
• Inquiries that examine the occupational therapy can be improved to better meet clients’ needs.
contribution to an interdisciplinary program
of services (Kielhofner, Hammel, Helfrich, Participatory Research
Finlayson, & Taylor, 2004)
A new and rapidly growing approach to investiga-
The study of occupational therapy techniques and tion is participatory research. This approach
approaches helps refine the understanding of these involves researchers, therapists, and clients doing
discrete elements of practice. This type of research research together to develop and test occupational
examines outcomes specific to an intended inter- therapy services. Participatory research reverses
vention. Such studies may also seek to determine the traditional role in which the occupational thera-
the relative impact of different techniques or pist decides on what research questions to answer
approaches, such as comparisons between indi- and what procedures to use. Instead, it relies on the
vidual versus group interventions. client to drive, or heavily influence, these deci-
Studies of comprehensive occupational therapy sions. Participatory research embraces the idea of
programs ask whether an entire package of ser- partnership in which all the constituents work
vices produces a desired outcome. Such studies together and share power and responsibility to
typically examine the impact of services on such investigate, improve, and determine the outcomes
outcomes as independent living, employment, and of service. It also involves innovation in which

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Chapter 1 Occupational Therapy as an Evidence-Based Practice Profession 9

new services are created to respond to problems 2. What are some likely consequences if research is
that are mutually identified by researchers, thera- not conducted or used to enhance occupational
pists, and clients. therapy practice?
3. How did evidence-based practice origninate?
This type of research is especially useful for
What is the difference between evidence-based
contributing knowledge that practitioners can medicine and evidence-based practice in
readily use and that consumers will find relevant occupational therapy?
to their needs. An example of this kind of study 4. Compare and contrast participatory research and
involved developing and evaluating a consumer- outcomes research in occupational therapy,
driven self-management program for individuals describing the utility of each in context.
with fatigue and other impairments associated with 5. How does needs assessment research differ from
chronic fatigue syndrome. This program provided practice theory research? Describe two different
clients an opportunity to learn self-advocacy skills, practice situations in which each of these
energy conservation, and other ways to improve approches would be appropriate, and explain
why they would be appropriate.
their quality of life, functional capacity, coping
skills, and resource acquisition (Taylor, 2004).
REFERENCES
Summary Altschuld, J. W., & Witkin, B. R. (2000). From needs assess-
ment to action: Transforming needs into solution strate-
This chapter introduces the necessity of research gies. Thousands Oak, CA: Sage Publications.
for the occupational therapy profession and empha- Bennett, S., & Bennett, J. W. (2000). The process of
sizes that research gives clients and the public evidence-based practice in occupational therapy:
reason to have confidence in occupational therapy Informing clinical decisions. Australian Occupational
Therapy Journal, 47, 171–180.
services and outcomes. Research also provides the Benson J., & Schell, B. A. (1997). Measurement theory:
rationale for administrators and policymakers to Application to occupational and physical therapy. In
support occupational therapy services. J. Van Deusen & D. Brunt (Eds.), Assessment in occu-
The chapter also examines the evolution of evi- pational therapy and physical therapy (pp. 3–24). Phila-
delphia, PA: W.B. Saunders.
dence-based practice and its applications in occu- Canadian Association of Occupational Therapists, Associa-
pational therapy. Additionally, this chapter covers tion of Canadian Occupational Therapy University Pro-
the types of research most often conducted by occu- grams, Association of Canadian Occupational Therapy
pational therapists, ranging from needs assessment Regulatory Organizations, & the Presidents’ Advisory
to theory development, to psychometric research, Committee. (2009). Joint position statement on evi-
dence-based occupational therapy. Canadian Journal of
to clinical outcomes studies and participatory Occupational Therapy, 66, 267–269.
research. Each of the key elements of the profes- Centers for Disease Control and Prevention (CDC). (2001).
sion (research, theory, and practice) influences the HIV/AIDS surveillance supplemental report (Vol. 7,
others. Theory and research evidence guide prac- No. 1). Atlanta, GA : Author.
Christiansen, C. (1983). An economic imperative. Occupa-
tice. Practice raises problems and questions to be tional Therapy Journal of Research, 3(1), 195–198.
addressed in theory and research. Research tests Christiansen, C., & Lou, J. (2001). Evidence-based practice
theory and practice, providing information about forum. Ethical considerations related to evidence-based
their validity and utility, respectively. practice. American Journal of Occupational Therapy,
Other chapters in this text explain the nature, 55(3), 345–349.
Clark, F., Azen, S. P., Zemke, R., Jackson, J., Carlson, M.,
scope, design, methods, and processes of research Mandel, D., . . . Lipson, L. (1997). Occupational therapy
and illustrate the wide range of tools that research- for independent-living older adults: A randomized con-
ers use for their inquiries. Throughout the text, as trolled trial. Journal of the American Medical Associa-
you encounter multiple discussions of how research tion, 278(16), 1321–1326.
Cusick, A. (2001). The experience of clinician-researchers
is performed, it is important not to lose sight of in occupational therapy. American Journal of Occupa-
why it is done. Remember Yerxa’s (1987) observa- tional Therapy, 55(1), 9–18.
tion that “Research is essential to achieving our Dysart, A. M., & Tomlin, G. S. (2002). Factors related
aspirations for our patients and our hopes and to evidence-based practice among U.S. practitioners.
dreams for our profession” (p. 415). American Journal of Occupational Therapy, 56,
275–284.
Eakin, P. (1997). The Casson Memorial Lecture 1997:
Shifting the balance—evidence based practice. British
Review Questions Journal of Occupational Therapy, 60(7), 290–294.
Erikson, A., Karlsson, G., Söderström, M., & Tham, K.
(2004). A training apartment with electronic aids to daily
1. Describe three approaches to occupational living: Lived experiences of persons with brain damage.
therapy practice that have been informed by American Journal of Occupational Therapy, 58(3),
research. Provide specific examples. 261–271.

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10 Section 1 Research in Occupational Therapy: Basic Elements for Enhancing Practice

Gitlin, L. N., Corcoran, M., Martindale-Adams, J., Malone, of reseach experience. Australian Occupational Therapy
M. A., Stevens, A., & Winter, L. (2000). Identifying Journal, 60, 241–251.
mechanisms of action: Why and how does intervention Polgar, S., & Thomas, S. A. (2000). Introduction to research
work? In R. Schulz (Ed.), Handbook of dementia care in the health sciences. Edinburgh, UK: Churchill
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Graham, F., Robertson, L., & Anderson, J. (2013). New 1983; Clinical reasoning: The ethics, science, and art.
Zealand occupational therapists’ views on evidence- American Journal of Occupational Therapy, 37(9),
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dence, and behaviors. Australian Occupational Therapy Sackett, D. L. (2002). Evidence-based medicine: How to
Journal, 60, 120–128. practice and teach EBM (2nd ed.). Edinburgh, UK:
Helfrich, C., & Kielhofner, G. (1994). Volitional narratives Churchill Livingstone.
and the meaning of therapy. American Journal of Occu- Sackett, D. L., Rosenberg, W. M., Grey, J. A., Haynes,
pational Therapy, 48(4), 319–326. R. B., & Richardson, W. S. (1996). Evidence-based
Karon, J. M., Fleming, P. L., Steketee, R. W., & De Cock, medicine: What it is and what it isn’t. British Medical
K. M. (2001). HIV in the United States at the turn of the Journal, 312(7023), 71–72.
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Public Health, 91(7), 1060–1068. W., & Haynes, R.B. (2000). Evidence-based Medicine:
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(2002). Critical policy challenges in the third decade of London: Churchill Livingstone.
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Health, 92(7), 1060–1063. nity-based definition of needs for persons living with
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Taylor, R. R. (2004). Documenting outcomes of occupa- Schon, D. (1983). The reflective practitioner: How profes-
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education. American Journal of Occupational Therapy, Stronge, M., & Cahill, M. (2012). Self-reported knowledge,
58, 15–23. attitudes, and behaviour towards evidence-based prac-
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ical environment in everyday occupation after stroke: pational Therapy International, 19, 7–16.
A phenomenological study of visuospatial agnosia. Taylor, M. C. (1997). What is evidence-based practice?
Scandinavian Journal of Occupational Therapy, 10(4), British Journal of Occupational Therapy, 60, 470–474.
147–156. Taylor, M. C. (2000). Evidence-based practice for occupa-
Lin, K. C., Wu, C. Y., & Trombly, C. A. (1998). Effects of tional therapists. Oxford, UK: Blackwell Science Ltd.
task goal on movement kinematics and line bisection Taylor, R. (2004). Quality of life and symptom severity in
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Ma, H., & Trombly, C. A. (2002). A synthesis of the effects Occupational Therapy, 58(1), 35–43.
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Remediation of impairments. American Journal of ery of disability: A phenomenological study of unilateral
Occupational Therapy, 56(3), 260–274. neglect. American Journal of Occupational Therapy,
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Mathiowetz, V., & Bass-Haugen, J. (2002). Assessing abili- Journal of Occupational Therapy, 57(4), 403–412.
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Mattingly, C., & Flemming, M. (1994). Clinical reasoning: Witkin, B. R., & Altschuld, J. W. (1995). Planning and
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McReynolds C. J., & Garske, G. G. (2001). Current issues Wu, C. Y., Trombly, C. A., & Lin, K. C. (1994). The relation-
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C H A P T E R 2

Classifications and Aims of Research


Renée R. Taylor • Gary Kielhofner • Ellie Fossey

Learning Outcomes understand the aims of the different approaches.


Research may be classified in terms of major meth-
■ Compare and contrast the three ways of odological approach, design, and the underlying
classifying research: major methodological purpose for the research.
approach, research design, and research Another important aspect of the diversity of
purposes. research is the value system and worldview that
■ Describe the basic characteristics of underlies the selection of a particular approach.
quantitative research and the relevance of This underlying value system drives decisions
this approach to occupational therapy about whether an approach to a particular research
research and practice. question is useful and valid. For example, is a
■ Delineate the key aspects of qualitative study more valid if the researcher is blinded to the
research and explain their role in experiences of the subjects? Or is it more valid if
occupational therapy and practice. the researcher personally identifies with the sub-
■ Explicate the utility and benefits of the jects’ experiences? Depending on whom you ask,
following research designs, including their the answers to these questions are bound to be
limitations: quasi-experimental studies, vastly different. These differences are deeply
single-subject studies, field studies and rooted in the underlying beliefs and traditions of
naturalistic observation, survey studies, and knowledge discovery to which each researcher
psychometric studies. adheres. The belief system that underlies a
■ Differentiate among basic research, applied researcher’s data collection approach, measure-
research, and transformative research. ment instruments, and orientation to analysis is
often referred to as the philosophical foundation of
research.
Introduction This chapter examines the three different
ways to define and classify research: (1) by major
Research studies are almost as varied as they are methodological approach, (2) by design, and
numerous. Even within a specific field such as (3) by aim, or purpose, of the research.
occupational therapy, there is considerable diver-
sity in terms of the different topics and approaches
to investigation. For example, studies may differ Defining and Classifying
along such dimensions as: Research
• The sample size, or number of study participants
(from one to hundreds or thousands) The three major ways in which to define and clas-
• What participants are asked to do (being observed sify research are (Table 2.1):
versus undergoing complex interventions) • Major methodological approach
• How information is gathered (following partici- • Research design
pants in their ordinary activities and context • Research purposes
versus taking measurements in a laboratory
setting)
• How the data are analyzed (identifying underly- Major Methodological
ing narrative themes versus computing statistical Approach
analyses)
One of the broadest ways to classify research is
One way to appreciate the diversity of research is to examine it in terms of the two major method-
to examine the different ways it is classified and to ological approaches: qualitative and quantitative

11

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12 Section 1 Research in Occupational Therapy: Basic Elements for Enhancing Practice

CASE EXAMPLE

Kate is an entry-level student enrolled in a research methods course at a large, research-intensive


university. She is working on an assignment in which she must explain the major types of research
in occupational therapy and their aims. Then, she will choose one approach to research and explain
the philosophical foundation that underlies that particular approach.
Kate visits the university library and retrieves various journal articles containing studies with
vastly different experimental designs and approaches to data collection. In some studies, the
researchers have made every effort to restrict the amount of information that both they and subjects
have about the research process, so that there is no chance that the effects of any treatment that is
given are influenced by advanced knowledge or expectations about the outcome.
In other studies that Kate encounters, researchers and subjects not only know the type of
treatment that the subjects are receiving, but they are collaborators in producing the treatment. One
example is a chronic illness self-management program in which participants helped develop a
treatment protocol in order to manage their own chronic illnesses and symptoms. Still another study
reveals how a researcher with a particular disability joins a focus group that includes other
individuals with the same disability to detail and plan a persuasive way to document their
experiences with environmental barriers within their communities.
After reading through the different studies and their approaches, Kate realized that some
researchers designed their studies in such a way that subjectivity and personal bias were minimized
by strict standardization procedures and careful distancing of themselves from the subjects. By
contrast, others immersed themselves in the lives of those they studied and detailed how their
personal histories and subjective experiences shaped and informed their investigations. Still other
investigators invited study participants to be equal partners in the research enterprise. Previously
Kate had stereotyped research as a dry and rather boring topic of study, but she immediately
became enthused to learn more about the various ways to approach science within the field of
occupational therapy. Her plan was to learn about the different classifications and purposes
of research and then to examine her own thoughts and feelings about how these underlying
worldviews and belief systems might correspond philosophically with the various approaches.

research methods. The terminology suggests these


Table 2.1 Ways to Define methods differ by the presence or absence of quan-
and Classify Research tification. However, it is important to note that
Classifications Examples these two broad categories of research are also
distinguished by important philosophical differ-
Major Qualitative methods ences (Crotty, 1998). The following discussion
methodological Quantitative methods describes the origins of these research methods and
approach
their differing assumptions, approaches to rigor,
Research design Experimental and quasi-
and research foci, as well as examines how
experimental studies
researchers using these approaches gather, analyze,
Single-subject designs
and interpret data.
Field studies and
naturalistic observation
Quantitative Research
Survey studies
Psychometric studies Quantitative research is an approach to
Research purposes Basic research research that is characterized by objectivity.
Applied research Researchers create and test theories using stan-
Transformative research dardized and predetermined designs, measures,
sampling approaches, and procedures. Quantita-
tive approaches test one hypothesis (a structured
statement of anticipated results of the study) or
more and translate reports and observations into
numerical data that are analyzed using statistical

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Chapter 2 Classifications and Aims of Research 13

approaches. The aim of quantitative methods is to lower when wearing the weighted cuffs. This
discover the rules or laws underlying the objec- author concluded that the addition of the cuff
tive world as a basis for scientific prediction and slowed the speed of movement, negatively
control (Guba & Lincoln, 1994). Quantitative affecting coordination.
researchers make every effort to enforce rigor by
The characteristics of these two studies—
limiting the influence of subjective bias and other
quantification of the variables under study through
actions and events that interfere with an accurate
use of standardized measures, use of experimental
interpretation of the data. It is helpful to consider
conditions in the second study, and statistical anal-
historical and contemporary examples of quantita-
yses (descriptive in the first study; inferential in the
tive research in occupational therapy.
second study)—are hallmarks of quantitative
Historical Examples. Research in the occupa- research. Since these studies were conducted, the
tional therapy field began to develop in earnest in use of more complex experimental designs, includ-
the mid-20th century. At that time, occupational ing pre- and postintervention testing, randomiza-
therapy practice was dominated by an approach tion of study participants, and test development,
that emulated medicine’s emphasis on scientific has developed in occupational therapy. Neverthe-
methods developed in the physical and life sci- less, the underlying logic of the research designs
ences, such as chemistry and biology (Kielhofner, used in these two historical studies is similar to that
2009). Not surprisingly, the research that began to of contemporary quantitative research in occupa-
appear around this time was quantitative in nature. tional therapy.
The following two examples of research, reported
Contemporary Example. Let’s examine a con-
in the American Journal of Occupational Therapy,
temporary example of a quantitative research
are characteristic of the period:
study. The study is a randomized clinical trial
• Drussell (1959) reported a descriptive study to involving clients with trigger finger, a painful con-
investigate whether the industrial work perfor- dition affecting the flexor tendon of a digit in
mance of adults with cerebral palsy was related which the digit locks or catches, as if a finger were
to their manual dexterity, as measured by the wrapped around the trigger of a gun. A particular
Minnesota Rate of Manipulation Test (MRM). splinting approach is being tested on an experi-
The MRM is a standardized measure of manual mental group, and a placebo splint is given to a
dexterity originally used for testing workers’ control group. This is considered a randomized
ability to perform semiskilled factory operations. clinical trial because subjects are assigned to either
Work performance was measured with a widely the experimental or control group without knowing
used industrial measure, the Service Descriptive the condition to which they are assigned. When a
Rating Scale. In this study, both tests were researcher is not allowed to know which kind of
administered to 32 adults with cerebral palsy splint has been given to a particular subject, it is
who were enrolled in an adult vocational training often referred to as blinding. When subjects are
program. The results of the study indicated that not allowed to know the kind of treatment they are
the two measures were positively correlated. receiving, it is also called blinding. When both
This finding was interpreted as indicating that researchers and subjects are not permitted to know
the MRM could be a valuable tool in assessing which treatment a particular subject is receiving, it
vocational potential for this population. is referred to as a double-blind study. The hypoth-
• Cooke (1958) reported results of an experimen- esis of this study is that subjects receiving the
tal study that investigated whether adding a experimental splint will demonstrate a decreased
weight to the dominant upper extremity of frequency of trigger finger compared with controls
patients with multiple sclerosis would improve within a 1-year period.
their coordination. The rationale was that the
addition of weight would mitigate patients’
Qualitative Research
intention tremors and thus increase coordination.
In this study of 39 patients in a physical reha- Qualitative research is an approach that aims to
bilitation program, the subjects were tested with describe and explain individuals’ subjective expe-
and without a weighted cuff using the MRM riences, actions, interactions, and social contexts
(used in this study as the measure of coordina- through various approaches involving interview-
tion). The results of the study failed to support ing, note-taking of events and actions, examin-
the hypothesis that the addition of a weight ing written and visual documents, and making
would improve coordination. In fact, the oppo- audio and video recordings. Qualitative research
site was observed; subjects scored significantly is an umbrella term for a range of methodologies

4037_Chapter 2_0011-0024.indd 13 11/25/2016 10:33:14 AM


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— Vaan sinäpä et nukkunut, pyssynlaukaukset sinut herättivät.

— Sinä luulet siis, että teidän pyssynne pitävät semmoista melua?


Isäni tussari pamahtaa paljon kovemmin.

— Vieköön sinut saakeli, senkin kirottu vetelys! Että sinä olet


nähnyt Gianetton, siitä olen varma. Kenties olet hänet kätkenytkin.
Hoi, kumppalit, käykää tupaan ja katsokaa, eikö junkkarimme ole
siellä. Hän nilkutti enää vain yhdellä käpälällä, ja se lurjus on liian
viisas lähteäkseen sillä tavoin palolle asti pyrkimään. Sitäpaitsi
loppuvat verijäljetkin tähän.

— Vaan mitäs isä sanoo, kysyi Fortunato ilkamoiden, jos saa


tietää, että te olette hänen poissa ollessaan tunkeutuneet tupaan?

— Kuules, junkkari, sanoi ajutantti Gamba nipistäen poikaa


korvasta, tiedätkös sinä, että minä voin helposti saada sinut toista
virttä veisaamaan? Ehkäpä sinä vielä sanotkin, jos saat parisen
kymmentä lyöntiä sapelin lappeella.

Fortunato vain naureskeli pilkallisesti.

— Isäni nimi on Mateo Falcone! sanoi hän juhlallisesti.

— Tiedätkös sinä, pikku veijari, että minä voin viedä sinut joko
Corteen tai Bastiaan. Panen sinut vankeuteen, raudat jaloissa
olkivuoteelle makaamaan, ja mestautan sinut, jos et sano missä
Gianetto
Sanpiero piileksii.

Poika remahti suureen nauruun kuullessaan tämän lystikkään


uhkauksen.
Hän vain toisti:
— Isäni nimi on Mateo Falcone.

— Ajutantti, sanoi aivan hiljaa eräs jääkäreistä, älkäämme


riitaantuko
Mateon kanssa.

Gamba näytti todellakin joutuneen ymmälle.

Hän puheli kuiskaten sotamiesten kanssa, jotka olivat tarkastaneet


koko talon, toimitus, joka muuten ei kauan kestänytkään, sillä
korsikkalaisen asuntoon ei kuulu muuta kuin yksi neliskulmainen
tupa. Huonekaluja on pöytä, penkkejä, kirstuja ja metsästys- sekä
talouskapineita. Sillä aikaa pikku Fortunato hyväili kissaansa ja näytti
ilkamoiden nauttivan jääkärien ja sukulaisensa hämmennystilasta.

Eräs sotamiehistä lähestyi heinäsuovaa. Hän huomasi emäkissan


ja sohaisi pistimellä huolettomasti heinäsuovaan kohauttaen
olkapäitään merkiksi, että tämä teko tuntui hänestä naurettavalta.
Suovassa ei mikään liikahtanut, eivätkä pojan kasvotkaan ilmaisseet
vähintäkään mielenliikutusta.

Ajutantti ja hänen joukkonsa miettivät heittää hiiteen koko


toimituksen ja katselivat jo totisina nummelle päin ikäänkuin aikoen
palata takaisin samaa tietä, jota olivat tulleetkin, kun päällikkö,
vakuutettuna siitä, etteivät uhkaukset vaikuttaneet mitään Mateo
Falconen poikaan, päätti tehdä vielä viimeisen ponnistuksen ja
koettaa hyväilyjen ja lahjojen mahtia.

— Kuules, pikku serkkuni, sanoi hän, sinä näyt olevan hyvin


kasvatettu viikari ja tulet varmaankin vielä menemään pitkälle. Mutta
nyt sinä lasket minusta ilkeää leikkiä, ja ellen minä pelkäisi
suututtavani sukulaistani Mateo Falconea, niin piru vieköön
ottaisinkin sinut mukaani.

— Hui-hai!

— Vaan kun sukulaiseni tulee kotiin, niin kerron koko jutun


hänelle, ja silloin saat valheistasi verisen selkäsaunan.

— Jokohan?

— Saat nähdä… Vaan kuuleppa… ole nyt siivo poika, niin minä
annan sinulle jotain.

— Ja minä annan sinulle, serkku, erään neuvon: että jos te vielä


viivyttelette, niin Gianetto ehtii jo palolle, ja silloin täytyy olla
useampia sinunlaisiasi uskalikkoja, jos mieli häntä sieltä etsiä.

Ajutantti otti taskustaan hopeakellon, joka maksoi ainakin


kolmekymmentä frangia, ja huomatessaan, että pikku Fortunaton
silmät säteilivät sitä katsellessa, hän riiputti sitä teräksisten vitjojen
nenästä sanoen:

— Sinä veijari tahtoisit kai mielelläsi tämmöisen kellon kaulaasi ja


astuskelisit Porto-Vecchion katuja ylpeänä kuin riikinkukko; ja ihmiset
kyselisivät sinulta: »paljonko kello on?» ja sinä vastaisit: »katsokaa
kelloani».

— Kun tulen isoksi, niin korpraali-enoni kyllä antaa minulle kellon.

— Antaa jos antaa, vaan enosi pojallapa on jo kello… ei sentään


niin kaunis kuin tämä… Ja hän on kuitenkin sinua nuorempi.

Poikanen huokasi.
— No, tahdotkos tämän kellon, pikku serkku?

Fortunato näytti syrjäsilmällä kelloa katsellessaan kissalta, jolle


tarjotaan kokonainen kananpoika. Tuntien itseään vain härnättävän
ei se uskalla iskeä siihen kynsiänsä, vaan kääntää tuontuostakin
silmänsä poispäin, ettei houkutus kävisi liian suureksi; kuitenkin se
nuoleksii myötäänsä suupieliänsä ja näyttää tahtovan sanoa
isännälleen: »Teidän leikkinne on liian julmaa!»

Ajutantti Gamba tuntui sentään todenteolla tarjottelevan kelloansa.


Fortunato ei ojentanut kättänsä, vaan sanoi happamesti hymyillen:

— Mitä te minua suotta pilkkaatte?

— En, jumal’avita, pilkkaakaan. Sano vain missä Gianetto on, niin


on kellokin sinun.

Fortunaton huulille ilmestyi epäilyksen hymy, ja katsoen mustilla


silmillänsä ajutantin silmiin koetti hän niistä lukea, minkä verran
tämän sanoihin oli luottamista.

— Vietäköön minulta olkaliput, huudahti ajutantti, jollen anna


sinulle kelloa sillä ehdolla! Kumppalini tässä ovat todistajina, enkä
minä saata lupaustani rikkoa.

Tätä sanoessaan hän vei kelloa yhä lähemmäksi, kunnes se


melkein kosketti pojan kalpeata poskea. Tämän kasvoilla kuvastui
selvästi sisällinen sieluntaistelu pyyteen ja vierasvaraisuuden
kunnioittamisen välillä. Paljas rinta kohoili kiihkeästi, ja hän näytti
olevan tukehtumaisillaan.

Sillä välin kello heilui ja kääntelihe koskettaen toisinaan hänen


nenänsä päätä. Vähitellen alkoi vihdoin pojan oikea käsi kohota
kelloa kohti: sormen päät jo koskettivat sitä, ja pian se lepäsi
kokonaan hänen kädessään, vaikka ajutantti yhä piteli sitä vitjojen
toisesta päästä… Numerotaulu oli taivaansininen… kuori vasta
kiillotettu… päivänpaisteessa se tulena välähteli… Houkutus oli liian
suuri.

Fortunatolla nousi jo vasen käsikin, ja olkansa yli hän viittasi


peukalollaan heinäsuovaa, jota vastaan hän nojasi. Ajutantti
ymmärsi hänet heti. Hän päästi vitjat kädestään, ja Fortunato tunsi
olevansa kellon ainoa omistaja. Hän hypähti pystyyn vikkelästi kuin
metsäpeura ja poistui kymmenen askeleen päähän heinäsuovasta,
jota jääkärit heti kävivät penkomaan.

Pian nähtiinkin heinäsuovan liikahtelevan: sieltä ilmestyi verissään


oleva mies, puukko kädessä; mutta koettaessaan nousta seisoalleen
ei hän hyytyneeltä haavaltaan jaksanutkaan pysyä pystyssä, vaan
suistui maahan. Ajutantti syöksyi heti hänen kimppuunsa ja väänsi
tikarin hänen kädestään. Samassa hänet lujasti köytettiin
vastustuksestaan huolimatta.

Maaten kentällä pitkällään, sidottuna kuin mikäkin lyhde, Gianetto


käänsi päänsä lähestynyttä Fortunatoa kohti.

— Senkin… sikiö! sanoi hän tälle enemmän ylenkatseellisesti kuin


vihaisesti.

Poika heitti hänelle saamansa hopearahan takaisin tuntien, ettei


sitä enää ansainnut; mutta vangittu ei näyttänyt huomaavankaan tätä
liikettä. Vallan kylmäverisesti hän sanoi ajutantille:

— Kuulkaas, hyvä Gamba, minä en jaksa kävellä, teidän täytyy


kantaa minut kaupunkiin.
— Äsken sinä kuitenkin juoksit kuin vuorikauris, vastasi julma
voittaja; mutta olehan huoletta: minä olen niin hyvilläni siitä, että
sinut vihdoinkin sain kiinni, jotta vaikka selässäni kantaisin sinua
penikulman väsymystä ensinkään tuntematta. Muuten aiomme
valmistaa sinulle paarit oksista ja päällystakistasi; ja Crespolin
vuokratalolla on meillä hevosetkin.

— Hyvä, sanoi vangittu; kai te panette hiukan olkia paareille, jotta


minun on mukavampi olla.

Sillä välin kuin muutamat jääkäreistä puuhailivat valmistellen


jonkinlaisia kantopaareja kastanjan oksista ja toiset sitoivat
Gianetton haavaa, ilmestyi Mateo Falcone vaimoineen äkkiä erään
palolle vievän polun käänteestä. Vaimo asteli hyvin kumarassa
kantaen tavattoman suurta kastanjasäkkiä, sillä aikaa kuin hänen
miehensä kulki herrana edellä, ainoastaan pyssy kädessä ja toinen
kantohihnassa; miehen arvo ei näet salli hänen kantaa muita
taakkoja kuin aseensa.

Nähdessään sotamiehet arveli Mateo heti, että ne olivat tulleet


häntä vangitsemaan. Mutta mistä tämä ajatus? Oliko Mateolla
mitään oikeuden kanssa tekemistä? Ei. Hänhän oli päinvastoin
hyvässä maineessa. Hän oli, kuten sanotaan, hyvämaineinen ja
itsenäinen mies; mutta hän oli korsikkalainen ja vuoristolainen, eikä
Korsikan vuoristolaisten joukossa ole monta, joka ei tarkoin
muistellessaan löytäisi menneisyytensä ansioluettelosta jotakin pikku
rikosta, sellaista kuin pyssynlaukausta, tikarinpistoa tai jotakin muuta
vähäpätöisyyttä. Mateolla oli parempi omatunto kuin ehkä
kenelläkään muulla, sillä ainakaan kymmeneen vuoteen ei hän ollut
tähdännyt pyssyänsä ihmistä kohti; mutta siitä huolimatta hän oli
varovainen ja varustausi ankaraan itsepuolustukseen, jos tarvis
sellaista vaati.

— Vaimo, sanoi hän Giuseppalle, heitä maahan säkkisi ja ole


varuillasi.

Tämä tottelikin silmänräpäyksessä. Mateo antoi hänelle pyssyn,


joka oli ollut kantohihnassa ja joka ehkä olisi ollut vain vastuksena.
Sitten hän latasi kädessään olevan tuliputken ja astui verkalleen
taloansa kohti pujotteleiden tien varrella kasvavien puiden välitse ja
ollen valmiina pienimmänkin vihamielisyyden huomatessaan
viskautumaan paksuimman puunrungon taakse, mistä saattoi
turvassa ollen itse ampua. Vaimo astui hänen jälkiään kantaen
varapyssyä ja patruunalaukkua. Hyvän aviovaimon velvollisuus on
näet taistelun tullessa ladata miehensä ampuma-aseet.

Ajutantille taas tuli aika hätä, kun näki Mateon lähestyvän näin
verkkaisin askelin, pyssy tanassa ja sormi liipasimella.

— Jos Mateo, ajatteli hän, sattuisi olemaan Gianetton sukulainen


tai ystävä ja tahtoisi häntä puolustaa, niin tulisivat luodit hänen
molemmista pyssyistään kahteen meistä yhtä varmasti kuin kirjeet
postissa; ja jos hän tähtää minuun, sukulaisuudesta huolimatta…

Tällaisessa hämmennystilassa hän teki sangen rohkean


päätöksen: hän astui näet yksin Mateota kohti kertoakseen hänelle
koko tapauksen ja lähestyi häntä kuin ainakin vanhaa tuttavaa; mutta
tuo pieni välimatka, joka erotti hänet Mateosta, tuntui hänestä
hirveän pitkältä.

— Hei, kuules, vanha toveri, huusi hän, — mitäs sinulle kuuluu,


hyvä ystävä? Tunnetko sinä minua, Gamba serkkuasi?
Sanaakaan vastaamatta Mateo pysähtyi, ja sillä aikaa kuin toinen
puheli, nosti hän verkalleen pyssyänsä, niin että sen suu oli taivasta
kohti ajutantin likelle saapuessa.

— Hyvää päivää, veliseni [Buon giorno, fratello, korsikkalaisten


tavallinen tervehdys], sanoi ajutantti ojentaen hänelle kätensä. Onpa
siitä aikoja, kun olen sinua nähnyt.

— Päivää, veli.

— Tulin ohikulkiessani sanomaan sinulle ja serkku Pepalle


hyvänpäivän. Olemme tänään olleet pitkällä matkalla, vaan ei sovi
valitella vaivojaan, kun on saanut sellaisen saaliin kuin me. Saimme
näet juuri kiinni Gianetto Sanpieron.

— Jumalan kiitos! huudahti Giuseppa. Viime viikolla hän varasti


meiltä lypsyvuohen.

Gambaa nämä sanat ilahuttivat.

— Kurja raukka, sanoi Mateo, hän oli nälissään.

— Se veijari puolustihe kuin jalopeura, jatkoi ajutantti hiukan


nolostuneena, — hän tappoi minulta yhden jääkärin eikä tyytynyt
vielä siihenkään, vaan katkaisi korpraali Chardonilta käsivarren… no,
vahinko ei ollut suuri, olihan tämä vain ranskalainen… Sitten hän oli
piiloutunut niin viisaasti, ettei lempokaan olisi häntä keksinyt. Ilman
pikku Fortunatoa en olisi häntä ikinä löytänyt.

— Fortunatoa! huudahti Mateo.

— Fortunatoa? toisti Giuseppa.


— Niin, Gianetto oli kätkeytynyt tuohon heinäsuovaan, mutta pikku
serkkunipa ilmaisi viekkauden. Minä aionkin sanoa hänen enolleen,
korpraalille, että lähettää Fortunatolle kauniin lahjan palkinnoksi. Ja
hänen sekä sinun nimesi tulevat raporttiin, jonka lähetän yleiselle
syyttäjälle.

— Kirous! mutisi hiljaa Mateo.

He olivat saapuneet jääkärijoukon luo. Gianetto lepäsi jo


paareillaan valmiina lähtöön. Nähdessään Mateon tulevan Gamban
seurassa hän hymyili omituisesti, käänsihe talon ovelle päin ja
sylkäisi kynnykselle sanoen:

— Kavaltajan asunto!

Täytyi olla valmis kuolemaan sen, joka uskalsi käyttää kavaltajan


nimeä Falconesta. Tarkka tikarinpisto, jota ei tarvitse uusia, olisi
tavallisissa oloissa loukkauksen heti kostanut. Mateo ei nyt
kuitenkaan tehnyt muuta liikettä kuin nosti murtuneen näköisenä
kätensä otsalleen.

Nähdessään isänsä tulevan oli Fortunato vetäytynyt tupaan. Sieltä


hän ennen pitkää palasi tuoden maitotuopin, jonka hän katse
maahan luotuna tarjosi Gianettolle.

— Pysy loitolla minusta! ärjäisi vangittu jyrkästi.

Kääntyen sitten erään jääkärin puoleen hän virkkoi: — Toveri


hyvä, annas minulle juotavaa!

Sotamies antoi litteän juomapullonsa hänelle käteen, ja rosvo joi


sen miehen antamaa vettä, jonka kanssa äsken oli laukauksia
vaihtanut. Sitten hän pyysi, että kätensä, jotka olivat köytetyt selän
taakse, sidottaisiin ristiin rinnalle.

— Lepään mieluummin mukavasti, sanoi hän.

Pyyntö täytettiin oitis; sitten antoi ajutantti lähtömerkin, lausui


jäähyväiset Mateolle mitään vastausta tältä saamatta, ja niin
lähdettiin kiireisin askelin nummelle päin.

Kului lähes kymmenen minuuttia, ennenkuin Mateo suunsa avasi.


Poikanen katseli levotonna vuoroin äitiänsä, vuoroin isäänsä, joka
pyssyynsä nojaten tuijotti häneen tuimasti.

— Sinä alottelet hyvin, sinä! sanoi Mateo vihdoin tyynellä äänellä,


joka kuitenkin värisytti sitä, ken miehen tunsi.

— Isä! huudahti poika lähestyen kyyneleet silmissä ikäänkuin


aikoen heittäytyä hänen jalkojensa juureen.

Mutta Mateo ärjäisi hänelle:

— Pois minusta!

Poika pysähtyi ja seisoi nyyhkyttäen liikkumattomana muutaman


askeleen päässä isästään.

Giuseppa tuli lähemmäksi. Hän oli huomannut kellonvitjat, joiden


pää pisti Fortunaton paidan aukeamasta esille.

— Kuka sinulle tämän kellon antoi? kysyi hän ankarasti.

— Serkkuni, ajutantti.
Falcone tempasi kellon ja lennätti sen sellaisella voimalla vasten
kiveä, että se pirstausi tuhanneksi muruksi.

— Vaimo, sanoi hän, onko tuo poika minun tekemäni?

Giuseppan ruskeat posket lensivät tulipunaisiksi.

— Mitä sinä sanotkin, Mateo, ja muistatko kenelle puhut!

— No niin, tuo poika on siis heimonsa ensimäinen kavaltaja.

Fortunaton nyyhkytykset kävivät kahta vertaa äänekkäämmiksi, ja


Falcone tuijotti häneen yhäti ilveksensilmillään. Vihdoin hän löi
pyssynsä perällä kerran maahan, heitti sen sitten olalleen ja lähti
astumaan palolle päin huutaen Fortunatoa tulemaan perästä. Poika
totteli.

Giuseppa juoksi Mateon jälkeen ja tarttui häntä käsivarteen.

— Hän on sentään sinun poikasi, sanoi hän vapisevalla äänellä ja


katsoi mustilla silmillään miestänsä silmiin nähdäksensä mitä hänen
mielessään liikkui.

— Laske irti minut! vastasi Mateo. Minä olen hänen isänsä.

Giuseppa syleili poikaansa ja meni itkien tupaan. Siellä hän


heittäysi polvilleen pyhän Neitsyen kuvan eteen ja rukoili kiihkeästi.
Sillä välin astui Falcone pari sataa askelta polkua myöten eikä
pysähtynyt ennen kuin tuli erään laakson luo, jonne laskeusi. Siinä
hän tutki maaperää pyssynsä perällä ja huomasi sen olevan
pehmeän ja helpon kaivaa. Paikka tuntui hänestä tarkoitukseen
soveliaalta.
— Fortunato, mene tuon suuren kiven luo.

Poika teki niinkuin käskettiin ja laskeusi sitten polvilleen.

— Lue rukouksesi.

— Isä, isä, älkää tappako minua.

— Lue rukouksesi! toisti Mateo hirvittävällä äänellä.

Supattaen ja nyyhkyttäen poikanen luki Isämeidän ja


uskontunnustuksen.
Isä vastasi kovalla äänellä: Amen! kummankin rukouksen jälkeen.

— Siinäkö ovat kaikki rukoukset, mitä osaat?

— Isä, osaan minä vielä Ave Marian ja sen, jonka täti minulle
opetti.

— Se on kovin pitkä, mutta menköön.

Poika luki rukouksensa sammuvalla äänellä.

— Oletko lopettanut?

— Voi, isä hyvä, armahtakaa! Antakaa anteeksi! En minä koskaan


enää semmoista tee! Ja minä rukoilen niin kauan korpraali-enoa,
että hän armahtaa Gianettoa!

Hän puhui vielä, kun Mateo jo oli virittänyt pyssynsä ja painoi


perän poskelleen lausuen:

— Jumala antakoon sinulle anteeksi!


Poika teki epätoivoisen yrityksen noustakseen isänsä polvia
syleilemään, mutta hänellä ei ollut siihen aikaa. Mateo laukaisi, ja
Fortunato kaatui kuolleena paikalle.

Luomatta silmäystäkään ruumiiseen lähti Mateo talollensa päin


hakemaan lapiota haudatakseen poikansa. Tuskin oli hän ehtinyt
astua muutamia askeleita, kun tapasi Giuseppan, joka laukauksesta
säikähtyneenä juoksi murhapaikalle.

— Mitä sinä olet tehnyt? huusi hän.

— Oikeutta.

— Ja missä hän on?

— Laaksossa. Aion juuri haudata hänet. Hän kuoli kristittynä, ja


minä luetan hänelle messun. Käy sano vävylleni Tiodoro Bianchille,
että hän muuttaa meille asumaan.

Etuvarustuksen valloitus.

Eräs ystäväni, upseeri, joka joitakuita vuosia sitten kuoli


kuumetautiin Kreikassa, kertoi minulle muutamana päivänä
ensimäisestä ottelusta, jossa hän oli ollut mukana. Hänen
kertomuksensa vaikutti minuun niin voimakkaasti, että heti
lomahetken saatuani kirjoitin sen muististani paperille. Tässä se nyt
on:

Saavuin rykmenttiin syyskuun 4:nnen päivän iltana. Everstin


tapasin leirikentällä. Ensin hän otti minut jotenkin tylysti vastaan;
mutta kenraali B:n antaman suosituskirjeeni luettuansa hän muutti
käytöstänsä ja lausui muutamia kohteliaita sanoja.

Hän esitti minut kapteenilleni, joka juuri palasi eräältä


partioretkeltä. Tämä kapteeni, jota minulla tuskin oli aikaa tarkastaa
tunteakseni, oli kookas, tummaverinen ja ulkomuodoltaan ankaran ja
tylyn näköinen mies. Tavallisena sotamiehenä hän oli alkanut uransa
ja voittanut sekä olkalippunsa että kunniamerkkinsä
taistelutantereella. Hänen äänensä oli käheä ja heikko ollen
omituisesti vastakkainen hänen melkein jättiläismäiselle vartalolleen.
Syynä tähän outoon äänenkäheyteen sanottiin olevan erään luodin,
joka oli kerrassaan lävistänyt hänet Jenan tappelussa.

Kuultuaan, että minä olin juuri päässyt Fontainebleaun


sotakoulusta, hän väänsi kasvonsa irvistykseen sanoen:

— Luutnanttini kaatui eilen…

Minä ymmärsin hänen tällä tahtovan sanoa: »Teidän pitäisi muka


täyttää hänen sijansa, mutta siihen ette kykene.» Huulillani pyöri jo
pisteliäs vastaus, mutta minä hillitsin itseni.

Kuu nousi Cheverinon etuvarustuksen takaa, joka sijaitsi kahden


kanuunanhan tämän päässä leirituliltamme. Suuri ja punainen se oli,
kuten tavallisesti noustessaan. Mutta tuona iltana se näytti
tavallistaan suuremmalta. Hetken ajan häämötti koko varustus vallan
synkkänä kuun heleässä hohteessa. Se muistutti purkautumaisillaan
olevan tulivuoren kartiomaista huippua.

Vierelläni oleva vanha sotamieskin huomasi kuun värin.


— Onpa se punainen, sanoi hän. Se merkitsee, että tuon
kuuluisan varustuksen valloitus käy meille kalliiksi!

Minä olen aina ollut taikauskoinen, ja varsinkin tällä hetkellä teki


tuo ennustus minuun syvän vaikutuksen. Laskeusin levolle, mutta en
saanut unta. Nousin makuulta ja kävelin jonkun aikaa katsellen
tavatonta tulijuovaa, joka kultasi Cheverinon kylän takaiset kukkulat.

Kun arvelin yön raittiin ja virkistävän ilman tarpeeksi vilvoittaneen


veriäni, palasin nuotiolle; kietoutuen huolellisesti päällystakkiini suljin
silmäni toivossa, etten avaisi niitä ennen päivän nousua. Mutta uni
vain ei tullut. Tahtomattani kävivät ajatukseni surullisiksi. Tuumin
itsekseni, ettei minulla noiden kentällä makaavien sadantuhannen
miehen joukossa ollut ainoatakaan ystävää. Jos haavoittuisin, niin
joutuisin sairashuoneeseen, missä tietämättömät välskärit minua
armotta kohtelisivat. Mieleeni johtui kaikki, mitä olin kirurgisista
leikkauksista kuullut. Ankarasti tykytti sydämeni, ja koneellisesti minä
asettelin nenäliinan ja lompakon rinnalleni jonkinlaiseksi panssariksi.
Väsymys valtasi minut, nukahdin aina hetkeksi, mutta samassa sai
joku surullisempi ajatus suuremman voiman, niin että hytkähtäen
heräsin. Väsymys voitti kuitenkin vihdoin, ja kun herätysrumpu soi,
nukuin minä makeinta untani. Asetuimme rintamaan, aamuhuuto
tapahtui, sitten pantiin aseet takaisin ristikoilleen ja kaikki näytti siltä,
kuin olisi meillä ollut aikomus viettää päivä aivan levollisesti.

Noin kolmen aikaan saapui ajutantti tuoden käskyn. Meidät


kutsuttiin uudelleen aseihin, jääkärimme hajoitettiin ympäri kenttää,
me seurasimme heitä verkalleen, ja kahdenkymmenen minuutin
kuluttua näimme venäläisten etuvartijoiden järjestäytyvän ja
palaavan varustukseen takaisin.
Eräs tykkipatteri asettui oikealle, toinen vasemmalle meistä, mutta
molemmat jotenkin kauas edellemme. Ne alkoivat sangen kiivaan
tulen vihollista kohti, joka yhtä tuimasti vastasi, ja pian peittyi
Cheverinon varustus paksuihin savupilviin.

Eräs ylänkö melkein suojasi rykmenttimme venäläisten tulelta.


Kuulat, joita meitä kohti ei monta tullutkaan (vihollinen kun
etupäässä ahdisti tykkiväkeämme), lensivät ylitsemme tai viskelivät
meitä vastaan multaa ja pieniä kiviä.

Niin pian kuin käsky marssia eteenpäin oli annettu, katsoi kapteeni
minuun niin tutkivasti, että minun täytyi pyyhkäistä pari kertaa nuoria
viiksiäni näyttääkseni niin huolettomalta kuin mahdollista. Muuten ei
minua pelottanutkaan, ja ainoa huoleni oli se, että muut ehkä luulivat
minun pelkäävän. Nuo vaarattomat kuulat vaikuttivat nekin siihen,
että pysyin sankarillisen kylmäverisenä. Itserakkauteni taas toisti,
että todellakin olin vaarassa, koskapa kuitenkin olin patteritulen alla.
Tunsin itseni vallan iloiseksi hyvinvoinnistani ja mietiskelin, kuinka
hauskaa on kertoa Cheverinon varustuksen valloituksesta rouva B:n
salongissa Provencen-kadun varrella.

Eversti kulki juuri komppaniamme ohitse virkahtaen minulle: »Kas


nyt te saatte jo alkajaisiksenne totuuden tuntea.»

Minä hymyilin kuin sodan jumala ja pyyhkäisin hihaltani pois


multaa, jota eräs kolmenkymmenen askeleen päähän pudonnut
kanuunankuula oli viskannut päälleni.

Venäläiset näyttivät huomaavan luotiensa huonon menestyksen,


sillä he rupesivat nyt ampumaan räjähdyskuulilla, jotka paremmin
yllättivät meidät notkelmassamme. Eräs suurehko kranaatinsirpale
pyyhkäisi lakin päästäni ja tappoi miehen sivultani.
— Onnittelen teitä, sanoi kapteeni minulle, juuri kun olin saanut
lakkini maasta; kas nyt te olette turvattuna täksi päiväksi.

Minä olen usein huomannut tämän taikauskon sotamiehissä, jotka


uskovat, että selviö non bis in idem pitää paikkansa yhtä hyvin
taistelutantereella kuin oikeussalissa. Panin ylpeästi lakin jälleen
päähäni.

— Kas sepä oli suora tapa tervehtiä ihmisiä, sanoin niin iloisesti
kuin voin. Oloihin nähden pidettiin tätä huonoa sukkeluutta vallan
mainiona.

— Onnittelen teitä, toisti kapteeni vielä, muuta vahinkoa ei teille


tule tapahtumaan, ja vielä tänä iltana on teillä komppania
komennettavana, sillä kovin minun korviani tänään kuumennetaan.
Joka kerta kun olen haavoittunut, on vierelläni seisova upseeri
saanut kuolettavan luodin ja — lisäsi hän hiljempää ja melkein
häpeissään — heidän nimensä ovat aina alkaneet P:llä.

Tekeysin urhoolliseksi, ja useat olisivat kai tehneet minun tavallani;


moneen olisivat nämä ennustavat sanat vaikuttaneet niinkuin
minuunkin. Ensikertalaisena minä tunsin, etten voinut uskoa
ajatuksiani kenellekään, vaan että minun aina tuli näyttää
kylmäveriseltä ja urhoolliselta.

Puolen tunnin kuluttua venäläisten tuli hiljeni tuntuvasti; silloin


astuimme mekin esille suojapaikastamme marssiaksemme
varustusta kohti.

Rykmenttiimme kuului kolme pataljoonaa. Toinen pataljoona sai


tehtäväkseen käydä varustuksen kimppuun kiertämällä laakson
puolelta; molemmat toiset määrättiin rynnäkköä varten. Minä olin
kolmannessa pataljoonassa.

Tultuamme ulos rintavarustusten takaa, missä olimme olleet


suojattuina, kohtasi meitä moneen kertaan jalkaväen linjatuli
voimatta kuitenkaan suuria aukkoja riveihimme tuottaa. Kuulain
vinkuminen oudostutti minua: usein käänsin päätäni sinnepäin
saaden vain leikkisanoja vastaani tähän ääneen tottuneemmilta
tovereiltani.

— Tappelu ei lopulta olekaan niin hirvittävä asia, arvelin itsekseni.

Rientoaskelin astuimme eteenpäin, jääkärit etunenässä; yhtäkkiä


venäläiset kiljaisivat kolme hurraata, kolme eri kertaa, pysyen sitten
vallan hiljaa ja ampumatta.

— En pidä tuosta hiljaisuudesta, sanoi kapteeni, se ei ennusta


hyvää.

Mielestäni meikäläiset melusivat liian kovasti, enkä voinut olla


sisässäni vertaamatta heidän rähiseviä huutojansa vihollisen
juhlalliseen äänettömyyteen.

Jouduimme pian varustuksen juurelle, vallisuojukset olivat


kuulamme rikkoneet ja mullistelleet. Sotamiehet ryntäsivät näille
uusille raunioille huutaen eläköön keisari! kovemmin kuin olisi voinut
odottaakaan ihmisiltä, jotka jo olivat niin paljon kirkuneet.

Loin katseeni ylöspäin enkä ikinä unohda silloista näkyä. Enin osa
savua oli kohonnut ilmaan ja riippui kuin telttakatos noin
kahdenkymmenen jalan korkealla varustuksen yllä. Sinertävän
usvan läpi näkyivät puoleksi hajonneen rintasuojuksensa takana
venäläiset krenatöörit, jotka seisoivat pyssyt koholla ja
liikkumattomina kuin patsaat. Olen vieläkin näkevinäni jokaisen
sotamiehen, vasen silmä meihin luotuna ja oikea kohotetun pyssyn
peitossa. Eräässä ampumareiässä muutamia askeleita meistä seisoi
mies tulisoihtu kädessä kanuunansa vieressä.

Minua värisytti, ja luulin jo viimeisen hetkeni tulleen.

— Kas nyt alkaa tanssi, pojat, huusi kapteeni. Hyvästi!

Ne olivat viimeiset sanat, mitkä kuulin hänen lausuvan.

Rummunpärinää kuului varustuksesta. Näin kaikkien pyssyjen


laskeutuvan. Ummistin silmäni ja kuulin hirmuisen paukkeen, jota
seurasi huudot ja voihkaukset. Avasin jälleen silmäni kummastellen,
että vielä olin hengissä. Varustus oli taas savun peitossa. Ympärilläni
haavoitettuja ja kuolleita. Kapteenini makasi jaloissani: hänen
päänsä oli eräs kuula murskannut, ja hänen aivojansa sekä vertansa
oli hulmahtanut vaatteilleni. Koko komppaniastani ei ollut pystyssä
enää kuin kuusi sotamiestä ja minä.

Tämän verisaunan saatuamme olimme hetken aikaa kuin


ällistyksissä. Asettaen lakkinsa miekkansa kärkeen kapusi eversti
ensimäisenä rintasuojukselle huutaen: eläköön keisari! ja hänen
jäljessään heti kaikki muut eloon jääneet. En paljon muista mitä
sitten seurasi. Me jouduimme varustuksen sisään, en tiedä millä
tavoin. Taisteltiin käsikähmässä niin paksussa savussa, ettei voitu
nähdä toisiaan. Luulen lyöneenikin, koskapahan sapelini oli vallan
verinen. Vihdoin kuulin huudettavan: »voitto on meidän!» ja savun
hälvetessä näin koko varustuksen kentän verta ja kuolleita täynnä.
Varsinkin kanuunat olivat vallan haudattuina ruumiskasojen alle.
Noin kaksisataa miestä ranskalaisissa univormuissa seisoi ryhmässä
ilman järjestystä, toiset ladaten pyssyjänsä, toiset puhdistaen
pistimiänsä. Yksitoista venäläistä vankia oli heidän keskessään.

Eversti lepäsi vallan verisenä särkyneiden vaunujen päällä linnan


portin suulla. Muutamia sotamiehiä tunkeili hänen ympärillään;
minäkin lähestyin häntä.

— Missä on vanhin kapteeni? kysyi hän eräältä kersantilta.

Kersantti kohautti olkapäitään sangen merkitsevällä tavalla.

— Entä vanhin luutnantti?

— Tämä eilen saapunut herra tässä, sanoi kersantti vallan tyynellä


äänellä.

Eversti hymyili happamesti.

— No niin, hyvä herra, te siis komennatte päällikkönä; varustakaa


heti linnoituksen portti näillä muonavaunuilla, sillä vihollinen on vielä
voimakas, mutta kenraali C… tulee avuksenne.

— Eversti, sanoin minä, te olette kai pahoin haavoittunut?

— Yks'kaikki, ystäväni, mutta varustus on valloitettu!

Arpapeli.

Liikkumattomina riippuivat purjeet mastoja vasten; meren pinta oli


kirkas kuin peili, ilma tukahuttavan kuuma ja tyven vallan toivoton.

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