Michelle Morton and Katie Benfield completed this research study while undergraduate students at East Carolina University. They graduated with a Bachelor of Science in Recreational Therapy in the Spring 2001. Dr. Groff is an Assistant Professor of Recreational Therapy and Recreational Therapy Degree Director in the Department of Recreation and Leisure Studies.

KEY WORDS: Aquatic therapy, arthritis, experiential education, recreational therapy, research methods, undergraduate education.

The link between competency based practice, efficacy research, and undergraduate education has been well established (Malkin, 1993). Consistent with the intent of applied research, Malkin (1993) proposed that developing the research base within the field of recreational therapy requires: “(a) training and retraining practitioners and educators in research and statistical methods, (b) requiring research competencies at the undergraduate level, (c) establishing working agreements between universities and clinical and community settings to conduct research, and (d) publishing materials that link research findings to practice” (p. 16). Each of these points is linked in some fashion to undergraduate education. Therefore, if the profession hopes to promote the use of research, consideration of the delivery of technical skills at the undergraduate level should be considered. Clearly, undergraduate recreation and leisure studies students, regardless of their specific focus, need to develop skills in research as well as the ability to apply research findings to practice (Witt, 1988).

This paper will provide a case study of one class assignment that resulted in undergraduate students enhanced understanding of the research process. In addition, the methodology and results of this research study are provided. Finally, this paper will highlight recommendations for future research, curriculum development, and professional practice. Ultimately, it is the hope of the authors that the reader is left with a clear example of how experiential class assignments can develop the research skills and competence of undergraduate students. The authors believe that the skills and confidence the students gained during this project will assist them in conducting research as practitioners.

Title, Purpose, Research Question(s), Variables & Hypothesis (Due on February 10)
The first assignment is to come up with a title, purpose, research question(s), variables, and hypotheses of your study. Your research needs to focus on some type of recreation or leisure issue. Make sure that your title is appropriate and relevant to the subject. Your research question should be to the point, succinct, and clearly describe what you are attempting to learn. The question(s) should clearly indicate the variables (i.e. independent and dependent) that you will be examining. Finally, identify your research hypotheses or what relationship you will be examining between variables. If you are doing a qualitative or mixed methods design see the professor to discuss how to modify this section accordingly.

Introduction, Literature Review, and Problem Statement (Due Feb 17)
Introduce the topic you are examining and provide a clear justification for why it merits examination. Your justification will be interwoven with the problem statement and review of the literature. Develop a clear problem statement that is consistent with your title and research question(s). You should provide a minimum of 10 citations that support the reasoning behind your hypothesis.

Data Collection Instrument & Description of Methods (Due Feb 29)
Identify or develop an instrument to collect data. This can be a survey, experimental, or qualitative instrument. The product you hand in should be an exact copy of what you plan to use. Describe in detail the sample you will use in your study, your reasons for choosing this sample, how you will collect your data, and how you plan to analyze the data once it is collected.

IRB form (Due March 9)
Complete the East Carolina University IRB form. You will receive an electronic copy of the Word document via e-mail

Results and Discussion (Due April 11)
Provide summaries of the data you collected. You must use an appropriate form of summation (i.e. tables, graphs, figures, etc). Briefly describe the characteristics of each variable that you examined. Discuss the results of your analysis in detail. What do your results mean. What do the results clearly indicate about the research question(s) What is significant/important about your findings. Relate this discussion to your problem statement and hypothesis. Make recommendations for professional practice and further research.

Presentations (Due April 20 – 27)
Present your research project and findings to the class (10 minutes).

a)  Provide an introduction to the research project. Give a brief summary of your research project including the title, purpose, research questions, and hypotheses. In addition clearly describe the problem literature that you reviewed regarding this topic.
b)  Describe the research methods. What procedures did you use to explore this research question including research design, sampling procedures, data collections instrument, and techniques to ensure reliability and validity.
c)  Describe the procedure that you used to analyze your data.
d)  Describe your results.
e)  Summarize you findings including the potential benefits of your study to the research participants or mankind.

(Note) Although you may choose to conduct any type of established research methods that you want, it is recommended that you take a survey approach to complete this project. Keep your project relatively simple and focused. The more complicated your project is, the greater the chance that you will be spending your summer completing it. Please see me if you require any assistance.

Arthritis is defined as the inflammation of a joint and is one of the most prevalent problems associated with aging (Berkow, 1997; Eisdorfer, 1986). Arthritis is also a common reason people give for being inactive or engaging in limited physical activity. The pain and stiffness experienced by individuals with arthritis can make it difficult to be physically active. In turn, decreased physical activity may contribute to an increase in arthritic problems (Rheumatology, 1999).
Aquatic therapy may help to reduce perceptions of pain and allow individuals with arthritis to exercise more by minimizing the impact of exercise on the joints. The therapeutic environment created by the water may help to reduce individuals’ perceptions of pain because the “buoyancy diminishes the effects of gravity and as a result, there is less compression on the joints and less muscle activity required while supported by the water” (Eisdorfer, 1986; p. 197).

Of the 25 individuals asked to participate in the study, 13 completed and returned usable surveys. Twelve of the 13 participants had been enrolled in aquatic therapy class for more than six months. The remaining person had been enrolled in aquatic therapy for two-three months. The frequency of participation was as follows: two individuals participated in class two times a week, 10 individuals three times a week, and one individual four or more times a week.

Research Instrumentation
Participants completed two questionnaires during the study: The Arthritis Impact Measurement Scale and the Perceptions of Aquatic Therapy Questionnaire.

Arthritis Impact Measurement Scale 2. The Arthritis Impact Measurement Scale 2 (AIMS2) was used to assess participants’ perceptions of pain (Meenan, 1990). The AIMS2 is a 78-item questionnaire designed to assess the severity of arthritic pain and the extent to which arthritic pain impacts ones’ health. The AIMS2 uses 12 sub-scales comprised of 5 questions each to measure the degree to which arthritic pain has impacted each of these areas in the past month: mobility level, walking and bending, hand and finger function, arm function, self-care, household task, social activity, support from family, arthritis pain, work, level of tension, and mood. For each of the 12 areas of health individuals rate: a) the degree to which they are satisfied, b) the impact that arthritis has had, and c) where they would like to see improvements. Finally, individuals are asked to summarize their current, future, and overall perceptions of health and describe any existing medical problems that may impact their health.

The AIMS2 has been tested for reliability and validity. Meenan (1990) established that the instrument has an acceptable level of internal consistency for each of the 12 scales (r = 0.72-0.96). The test-retest reliability coefficients ranged from (r=0.78-0.94). According to a study designed to determine the validity of the AIMS2, patients who viewed certain areas as a problem, or gave that area a higher priority for improvement, had lower sub-scale scores. Lower scores for various sub-scales on the AIMS2 are indicative of an increased impact of arthritis.

One specific area of the AIMS2 was selected for use in this study. The rating scale section was chosen as a reflection of the 12 areas of health and how these areas had been affected by arthritis. This information was used to summarize how the participants perceived their arthritic pain. It is acknowledged that modifying the AIMS2 may impact the reliability and validity of the instrument.

 Perceptions of Aquatic Therapy Questionnaire. A six-item questionnaire was developed to determine the length of time an individual had participated in aquatic therapy and individuals’ perceptions of how aquatic therapy impacted arthritic pain. The response format included likert scale, checklist, and one open ended question.

Table 2

In addition to the questions associated with the AIMS2, participants were asked to respond to the following open-ended question, “In what ways has aquatic therapy affected your level of arthritic pain?” Analysis of the responses indicated that aquatic therapy has positively effected individuals’ perceptions of pain in four main areas: level of activity, severity of pain, level of mobility, and amount of stiffness in the joints.

Participants reported that participation in aquatic therapy had decreased their perceptions of pain and subsequently they have been able to increase their level of physical activity. Representative statements include, “I am a very active person due to my aquatics” and “I feel better and can do more things. I have worked in the yard some recently and I have not done that before in several years.” Participants also reported that the severity of pain they experience had decreased due to the combined effects of aquatic therapy and medication. While medication was noted as a contributing factor to reduced perceptions of pain, the majority of participants reported that they took less medication for pain after participating in aquatic therapy. One participant added that her pain had not lessened but her mobility and mental outlet had improved. Other participants stated that they experienced decreased pain and increased mobility. Finally, two of the 13 participants reported that they were less stiff since they began participating in aquatic therapy.

Students’ Perspectives
It has been effectively argued that a comprehensive education is one that combines intellectual study with applied class assignments (McKeachie, 1994). Experiential learning projects help students understand the cognitive material, as well as, develop a level of mastery and competence over the subject matter. It is the opinion of the first two authors that indeed they were able to learn more about research from this applied class assignment than they could have from reading a textbook. The students had an opportunity to discover how these 13 individuals credited aquatic therapy with decreasing their arthritic pain. They also achieved a more in-depth understanding of the research process. Although very anxious about conducting a research project on their own, the students learned that research was more than some obscure process that you read about in books and professional journals. Research is something that undergraduates, and future professionals, can do effectively. The remainder of this section will focus on the authors’ view that curricula designed to teach undergraduate students skills in research can assist them in developing competencies required to be effective practitioners.

Research is a necessary component of professional practice. Being able to guide the process in the direction of their choice, the students discovered that they were the ones to direct what they studied, how they studied, whom they studied, and when they studied an issue. This resulted in a sense of empowerment and lifted their level of confidence to complete the research process. Additionally, by being provided a protocol to follow when conducting research, and by being mentored through the process in a stepwise fashion, the students are less threatened by research and have an increased willingness to engage in the process. Most importantly, while conducting the review of the literature, the students came to understand how limited research is within the field of recreational therapy. This helped provide a comprehensive understanding of how the lack of applied research in recreational therapy casts doubts upon the contributions of the profession. The students realize that as future practitioners they need to do research in order to substantiate the profession.

In addition to developing an appreciation for research, there was an understanding that undergraduate students still have a great deal to learn about conducting evaluative studies. The students encountered some frustrating obstacles including the dependence upon others, the lack of available resources (e.g. literature and research instruments), and the pace of the research process. The dependence upon practitioners for access to subjects made students realize that the research process necessitated balancing the demands of research with the daily demands of practitioners.
The students also realized how difficult it was to find the resources that they needed to support their research. It was extremely frustrating that upon finding the limited studies that did support the use of aquatic therapy for individuals with arthritis, they were not readily available in the library or on-line. Additionally, the students could not find a research instrument that met their needs. Upon deciding to use a modified version of the AIMS 2, the students realized that this instrument provided very little decisive data. The survey that was developed by the students became a primary source of data, even though it did not have an acceptable level of validity and reliability.

Each of these previous obstacles affected the time frame in which the study was completed. Given that this project had to be completed within a 15-week time frame, the pace at which the process was conducted produced an extreme amount of anxiety. The students now realize that as practitioners they will face similar frustrations and obstacles. However, they have gained an appreciation for the need to substantiate the recreational therapy field and are determined to explore strategies to cope with these frustrations and obstacles.

The experiences of these two students can help to inform professional practice in two ways: (a) it further supports the effectiveness of aquatic therapy for the treatment of arthritic pain, and (b) it substantiates the need for educators to provide undergraduate students with applied learning opportunities.

By receiving an assignment that required them to learn and implement the research process step by step, the students have an advantage over other students who only learn through readings and class based assignments. Although the lectures supplied them with a great deal of information about research, it wasn’t until they were actively engaged in the process that they understood and appreciated its importance to the future of the profession. The independence that they were given forced them to make decisions about what they were going to do, and left the fine details in their hands.

These students have taken one small step in demonstrating that individuals’ perceptions of arthritic pain are reduced after participating in aquatic therapy. However, their one small step is not an ending point. Current and future practitioners will have to research and share the results of their studies. If two undergraduate students can complete a study in a 15-week period of time, they offer a challenge to other practitioners to engage in the research process as well.

Instructor’s Perspective
Applied learning projects are often praised for their ability to provide students an opportunity to synthesize book knowledge with hands-on skill development. The development of skills required to engage in the research process seem particularly important for recreational therapy students given the extent to which the field needs to continually engage in applied research. Yet, as a professor, it is often difficult to determine how to best facilitate the development of students’ skills in research methods when the time in which students have to conduct a study is so limited. Additionally, the quality of the projects and experiences students will have if they are forced to rush through the research process is a concern. Is it better to have students develop a greater theoretical knowledge of quality research methods or to develop hands-on skills using potentially inferior research methods? Was it possible within a 15-week period of time to teach undergraduate students the knowledge and skills needed to independently engage in the research process? Certainly the answers to these questions were not fully realized by this one research class and assignment. However, it was clear that when pushed, students have the capability to surpass their own, and the instructor’s, expectations of their capabilities.

With regard to the question of developing applied skill in conducting research it was clear that all of the students preferred the opportunity to practice what they were learning as opposed to simply developing a theoretical understanding of research methods. The students demonstrated their appreciation for this opportunity by appearing to be more focused during class. Given that the class lectures slightly preceded or coincided with what students were being asked to do (i.e., develop a research questions and hypothesis, conduct a review of literature, find or develop a reliable and valid instrument, select a sample, determine research methods, collect data, analyze data, and report results), students would associate the information presented in class with their projects. Students often asked informed questions that demonstrated that they had synthesized what they were doing with the material that was being covered in class.

In addition to being somewhat more focused during class, students expressed a sense of pride and, in some cases, wonderment at having actually completed a study. Students were particularly proud when they found out that the results of their study were statistically significant. The students who did not find statistically significant results were anxious regarding the process but ultimately came to understand, along with their classmates, that research is one endeavor where individuals may learn as much from studies that do not have statistically significant results as those that do.

One component of the research project that may have helped to make this assignment manageable for students was structuring the project so that students received extensive and consistent feedback, and were afforded the opportunity to correct their mistakes. Each week students were required to turn in a section of their research project. Upon receiving feedback, students would correct their mistakes and then the following week turn in the new material with the revised section of work. By the end of the semester students essentially had all but the results section of their final report completed. The extensive feedback and numerous opportunities students had to correct their work before being graded on the final project helped to ease some of the students’ concerns regarding the magnitude of the project. By breaking the project down into logical and sequenced steps, students hopefully came away with the sense that research is manageable if structured accordingly.

The quality of the survey or correlational research conducted by these students was admirable given the time constraints. As demonstrated in this one case study, the students completed all of the necessary steps required of research in a very short period of time. More importantly, where weaknesses in the research designs were present, the students were largely able to identify areas of weakness and the steps that they would take to correct the situation. The one area that students were not adequately trained in, nor comfortable with, was the selection of and rationale behind using the various statistical tests used to demonstrate significant differences. As an instructor it would have been helpful to have more time in which to adequately cover this material and answer students’ questions regarding the selection and use of statistical methods. This concern was partially addressed by encouraging students to either take additional statistics courses, or to collaborate with a statistician when and if they decided to conduct research as practitioners.

Overall, it is the hope of this professor that by providing students an opportunity to develop knowledge and skill in research methods they will leave this undergraduate institution with a sense of competence and courage to independently engage in the research process once employed in the field. If this sense of capability can be mirrored in all undergraduate institutions, then perhaps research can take on a more prominent role in everyday recreational therapy practice. These students have demonstrated to their instructor that they are capable of overcoming the intimidation often associated with research. Hopefully, they have also proven to themselves that they possess the knowledge and skill required to demonstrate the efficacy of recreational therapy services. Perhaps most importantly, they have taken the initiative and demonstrated the courage to challenge themselves, and current practitioners, to value and engage in research. 

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