“Your double-blind RCT needs feminism”: an argument for engaging critical theory in quantitative rehabilitation research

Abstract

Purpose Rehabilitation science has, for years, endorsed a connection between quantitative research and the philosophical assumptions of positivism. These assumptions can limit the scope of rehabilitation research, particularly in relation to matters of equity, diversity, and inclusivity. As our field moves toward a greater focus on inclusivity in research design and patient-centred care, it is imperative that we reconsider the theoretical foundations of rehabilitation research and practice. Methods We provide an analysis of positivism on equity, diversity, and inclusivity within quantitative rehabilitation research, using the Participant Intervention Comparison Outcome (PICO) model to provide structure for the resultant discussion and recommendations. Results Our analysis reveals that there are significant limitations and ethical concerns to engaging in positivism as the primary paradigm for quantitative rehabilitation research. We argue that decoupling of positivism and quantitative research methods may be warranted. Conclusions Equitable and inclusive rehabilitation research requires the researcher to consider variables which are neglected in the positivist paradigm. We argue that critical theory can equip researchers with a lens to better address injustices within rehabilitation research. We provide a series of recommendations for researchers to engage critical theory at each stage of the PICO model of clinical trials. IMPLICATIONS FOR REHABILITATION Common assumptions in quantitative rehabilitation research (i.e., positivism) can limit the utility of research findings to rehabilitation patients. Equitable, diverse, and inclusive participant samples in research better reflect the diversity of real world rehabilitation patients, helping us better serve these populations. Critical theory can help researchers and clinicians identify and avoid interventions that may cause harm to rehabilitation patients. Research and practice that prioritize concepts of “normalcy” (i.e., “normal gait,” “normal behaviours”) may perpetuate negative concepts of disability and further marginalize the individuals that our interventions aim to serve.