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6113_FM_i-xxiv 05/12/19 1:31 pm Page i

Leslie G. Portney, DPT, PhD, FAPTA

Dean Emerita
MGH Institute of Health Professions
School of Health and Rehabilitation Sciences
Boston, Massachusetts
6113_FM_i-xxiv 05/12/19 1:31 pm Page ii

F. A. Davis Company
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Copyright © 2020 by F. A. Davis Company

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Library of Congress Cataloging-in-Publication Data

Names: Portney, Leslie Gross, author.
Title: Foundations of clinical research : applications to evidence-based
practice / Leslie G. Portney.
Description: Fourth edition. | Philadelphia : F.A. Davis, [2020] | Includes
bibliographical references and index. | Summary: “The text of this
fourth edition has maintained its dual perspectives. It is designed for
those who do research to generate new knowledge and examine theories and
for those who want to be critical consumers of evidence to inform
clinical decision-making. All of us need to be able to critically
evaluate research reports to inform practice and further study. The
scope of the text allows it to fulfill different needs at different
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incorporates several important contemporary themes, including the
application of evidence-based practice (EBP) for clinical
decision-making, the imperative of interprofessional collaboration, the
implications of translational research, and the focus of healthcare on
quality of life, meaningful outcomes, and patient values. These
directions and priorities continue to define research philosophies that
guide the conduct of clinical inquiry, the types of questions that are
deemed important, and how they influence advances in measurement and
analysis techniques”— Provided by publisher.
Identifiers: LCCN 2019044025 (print) | LCCN 2019044026 (ebook) | ISBN
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Subjects: MESH: Biomedical Research—methods | Evidence-Based
Practice—methods | Clinical Decision-Making—methods | Statistics as
Topic—methods | Research Design
Classification: LCC R853.C55 (print) | LCC R853.C55 (ebook) | NLM W 20.5
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6113_FM_i-xxiv 05/12/19 1:31 pm Page iii

To Hazel
. . . and joyful running hugs
6113_FM_i-xxiv 05/12/19 1:31 pm Page iv
6113_FM_i-xxiv 05/12/19 1:31 pm Page v

Preface
It is now more than 25 years since this text was first The popular features of the book have not changed,
published in 1993. It has become a classic reference, such as its accessible tone, use of extensive clinical exam-
cited extensively in literature from researchers around ples to illustrate applications of design and statistics, and
the globe. It is gratifying to see its sustained and wide- careful logic in explanation of complex concepts. It re-
spread use by clinicians, faculty, students, and re- mains a comprehensive text, meant to fulfill different
searchers in a variety of fields including rehabilitation, needs at different times, serving as both an introduction
medicine, public health, nursing, public policy, epi- and a reference as readers grow in their knowledge and
demiology, exercise physiology, and other disciplines experience. However, this fourth edition does represent
concerned with healthcare. This edition will continue a significant update in format, focus, and organization.
to serve this wide audience.
As I have approached each revision, I have been struck
by how much the framework for research continues to
evolve over time, and this edition is no different. It in-
■ New and Updated
corporates several important contemporary perspectives.
Perhaps most notable is the new design, intended to
First, regardless of the role we play in healthcare, be
make the text more reader-friendly and engaging with
it clinician, administrator, policy maker, or researcher,
full color. Tables and figures have a new look to facilitate
we all need to be critical consumers of evidence to in-
interpretation. Starting with the book’s title, the empha-
form decisions. This requires at least a basic understand-
sis on EBP is clear, including the Focus on Evidence and
ing of principles of measurement, design, and analysis to
Case in Point features in each chapter that illustrate the
enable reasonable and critical evaluation.
direct application of concepts in the literature. Addi-
Second, the concept of evidence-based practice
tional information is included in boxes to clarify content,
(EBP), although ubiquitous in healthcare discussion,
emphasize key points, offer interesting background and
must be understood in terms of its full purpose for clin-
historical context—and a few fun facts along the way.
ical decision-making, relying not only on literature but
Commentaries build on important concepts. Online re-
also on clinical expertise, patient values, and environ-
sources have also been expanded, with chapter supple-
mental conditions. These considerations have influenced
ments, access to data files, and materials for instructors
translational research and the need to address meaning-
and students.
ful outcomes.
Five new chapters have been included in this edition,
Third, today’s healthcare enterprise mandates atten-
focusing on translational research (Chapter 2), evidence-
tion to interprofessional collaboration. I have included
based practice (Chapter 5), health measurement scales
examples throughout the book to illustrate various con-
(Chapter 12), clinical trials (Chapter 14), and qualitative
cepts. These are drawn from many different fields, with
research (Chapter 21). All of these address content that
the intent that all examples have wide application. I be-
was covered in previous editions but with greater depth
lieve this is a distinct advantage of this book, to under-
and application.
score the importance of appreciating research within and
Many chapters also include new or updated content
beyond one’s own field.
to address current clinical research issues. For example,
And finally, the content will work for those who want
to plan or implement research. Detailed examples are in- • Examples provided throughout the book have been
cluded for those who want more depth, both in the text updated with more recent literature.
as well as in online supplements. • The stronger emphasis on EBP includes use of the
These directions and priorities continue to define re- PICO strategy to answer clinical questions as well as
search philosophies that guide the conduct of clinical in- to generate research questions. The EBP emphasis
quiry, the types of questions that are deemed important, reflects a comprehensive model that includes research
and how they influence advances in measurement and evidence, clinical expertise, patient values, and clinical
analysis techniques. circumstances.

v
6113_FM_i-xxiv 05/12/19 1:31 pm Page vi

vi Preface

• The chapter on searching the literature has been

reorganized to provide stronger guidance in that
■ Organization
process.
Although the overall organization of the book remains
• The chapter on ethical principles has been
the same with content in five parts, some chapters have
updated to reflect recent changes in regulations
been rearranged to better reflect their role in the re-
and definitions.
search process. Each section focuses on a different phase
• Measurement chapters provide a stronger emphasis
of that process.
on relative and absolute reliability, a broader context
for construct validity, and extensive discussion on • Part 1- Foundations of Research and Evidence
measuring change. focuses on fundamental concepts that define
• The chapter on health measurement scales focuses the clinical research enterprise, such as types of
on construct validity and reliability for question- research, frameworks of health, translational
naires that are used to measure function, quality of research, application of theory, ethical principles,
life, and personal characteristics that impact health. how to frame clinical and research questions, litera-
It includes expanded coverage of Rasch analysis. ture search strategies, and the overarching structure
• Chapters on foundations of design cover contempo- of EBP for clinical decision-making. These chapters
rary issues related to clinical trials, such as transla- provide an overview of the research process that
tional research, efficacy and effectiveness, serves as a foundation for the rest of the text.
superiority and non-inferiority trials, pragmatic • Part 2- Concepts of Measurement includes the
trials, N-of-1 trials, and implementation studies. basic premises of measurement for all types of data
• Content related to observational designs has collection, including validity and reliability. The
increased emphasis on use of these designs for chapter on surveys has been relocated to this section
diagnosis and prognosis, as well as for evaluating to emphasize their role as data collection tools
causal relationships. rather than a design. Fundamental concepts in the
• Qualitative research has a stronger presence design of health measurement scales are presented.
throughout the book, including a new chapter • Part 3- Designing Clinical Research includes con-
that also addresses mixed methods. Although this tent on descriptive, observational, and explanatory
coverage cannot substitute for a full reference on research, with extensive examples related to validity
this topic, this content should facilitate reading and and application of these designs. These include a
interpreting the literature, and will reinforce the rel- variety of clinical trial designs, single-subject designs,
evance of qualitative research in a variety of contexts. observational studies using cohort and case-control
• The International Classification of Functioning, designs, and descriptive and qualitative studies.
Disability and Health (ICF) is used as a framework • Part 4- Analyzing Data presents the full scope of
for terminology as part of understanding patient- statistical content, starting with descriptive statistics
oriented research. and developing concepts through multivariate
• Statistics chapters have added coverage of validity procedures. Parametric and nonparametric statistics
measures and regression and multivariate meth- are described for comparative, predictive, and
ods, such as exploratory and confirmatory factor descriptive studies, validity and reliability, studies
analysis and structural equation modeling. Data of diagnostic tests, and epidemiology related to
files for all examples presented in tables can be risk assessments. Information is presented from an
accessed online. intuitive perspective without emphasis on mathemat-
• Information on power, effect size, and sample size ical derivation or statistical notation. These chapters
calculations are integrated with statistical proce- include a review of output using SPSS to illustrate
dures and illustrated in detail in chapter supple- how statistical results can be interpreted. Data files
ments. Some analyses are done using SPSS and can also be accessed online for all analyses.
others using G*Power. • Part 5- Putting It All Together focuses on the aspects
• The chapters on critical appraisal and dissemination of research that incorporate all the principles of de-
include information on use of reporting guidelines sign and analysis that have been covered in preceding
for different types of studies. chapters. Chapter 35 describes guidelines for devel-
• The chapter on systematic reviews has been oping a research proposal. Chapter 36 addresses the
expanded to include more detail related to process of critical appraisal for several types of stud-
meta-analyses and now includes information ies. Chapter 37 provides an overview of methods
on scoping reviews. for conducting and evaluating systematic reviews,
6113_FM_i-xxiv 05/12/19 1:31 pm Page vii

Preface vii

meta-analyses, and scoping reviews. Finally, Chapter 38 No matter how many years I have engaged in re-
presents a format for preparing and disseminating search, I continue to learn about advances in design and
research through publications and presentations. analysis that set new directions and priorities for clini-
cal inquiry. This edition is intended to strengthen our
Appendix A includes reference tables for major statis-
collective commitment to new knowledge, discovery
tical tests and additional tables are provided in Appendix
and innovation, and implementation of evidence, as we
A Online. Appendix B includes an algorithm for choos-
strive to provide the most effective care. The process
ing a statistical procedure based on design and measure-
remains a challenge to all of us engaged in healthcare,
ment considerations. Appendix C covers content related
and this text will always be a work in progress. I look
to management of quantitative data, including data trans-
forward to continuing to hear from colleagues across
formation. The glossary, also available online, provides
disciplines regarding how to make this volume most
a handy reference to define terms, symbols, and common
useful.
abbreviations.
6113_FM_i-xxiv 05/12/19 1:31 pm Page viii
6113_FM_i-xxiv 05/12/19 1:31 pm Page ix

Contributors
Jessica Bell, MS K. Douglas Gross, MPT, DPT, ScD,
Director of Library and Instructional Design FAAOMPT, CPed
MGH Institute of Health Professions Associate Professor, Department of Physical Therapy
Boston, Massachusetts MGH Institute of Health Professions
School of Health and Rehabilitation Sciences
Marianne Beninato, DPT, PhD Boston, Massachusetts
Professor Emerita
MGH Institute of Health Professions Catherine Lysack, PhD, OT(C)
Boston, Massachusetts Associate Professor, Occupational Therapy
and Gerontology
Peter S. Cahn, PhD Eugene Applebaum College of Pharmacy and Health
Associate Provost for Academic Affairs Sciences
MGH Institute of Health Professions Wayne State University
Boston, Massachusetts Detroit, Michigan

Heather Fritz, PhD, MSOT David A. Scalzitti, PT, PhD

Assistant Professor, Occupational Therapy Program Assistant Professor, Physical Therapy and Health
and Institute of Gerontology Care Sciences
Eugene Applebaum College of Pharmacy and Health School of Medicine and Health Sciences
Sciences The George Washington University
Wayne State University Washington, DC
Detroit, Michigan

ix
6113_FM_i-xxiv 05/12/19 1:31 pm Page x
6113_FM_i-xxiv 05/12/19 1:31 pm Page xi

Reviewers
Jason Browning, OTR/L Joanne Gallagher Worthley, EdD, OTR/L, CAPS
Assistant Professor Professor
Occupational Therapy Occupational Therapy
Jefferson College of Health Sciences Worcester State University
Roanoke, Virginia Worcester, Massachusetts

Stephen Chao, PT, DPT, CSCS Sean F. Griech, PT, DPT, OCS, COMT
Clinical Assistant Professor Assistant Professor
Physical Therapy Department Doctor of Physical Therapy Program
School of Health Technology and Management DeSales University
State University of New York at Stony Brook Center Valley, Pennsylvania
Southampton, New York
Emmanuel B. John, PT, DPT, PhD, MBA
Jennifer B. Christy, PT, PhD Associate Professor & Chair
Associate Professor Department of Physical Therapy
Physical Therapy Chapman University
The University of Alabama at Birmingham Irvine, California
Birmingham, Alabama
Steven G. Lesh, PhD, PT, SCS, ATC
Peter C. Douris, PT, EdD, DPT, OCS Chair and Professor of Physical Therapy
Professor Southwest Baptist University
Physical Therapy Bolivar, Missouri
New York Institute of Technology
Old Westbury, New York Jean MacLachlan, PhD, OTR/L
Associate Professor
Winnie Dunn, PhD, OTR, FAOTA Occupational Therapy
Distinguished Professor Salem State University
Occupational Therapy Salem, Massachusetts
University of Missouri
Columbia, Missouri Dennis McCarthy, PhD, OTR/L, FAOTA
Associate Professor
Ashraf Elazzazi, PT, PhD Occupational Therapy
Associate Professor Nova Southeastern University
Chair, Department of Physical Therapy Tampa, Florida
Utica College
Utica, New York Raymond F. McKenna, PT, PhD, CSCS
Clinical Associate Professor
Simon French, BAppSc, MPH, PhD Physical Therapy
Associate Professor Stony Brook University
School of Rehabilitation Therapy Stony Brook, New York
Queen’s University
Kingston, Ontario, Canada

xi
6113_FM_i-xxiv 05/12/19 1:31 pm Page xii

xii Reviewers

Saurabh Mehta, PT, PhD Eric Schussler, PhD, PT, ATC

Assistant Professor Assistant Professor
School of Physical Therapy School of Physical Therapy and Athletic Training
Marshall University Old Dominion University
Huntington, West Virginia Norfolk, Virginia

Tamara Mills, PhD, OTR/L, ATP Mary P. Shotwell, PhD, OT/L, FAOTA
Assistant Professor Professor
School of Occupational Therapy School of Occupational Therapy
Brenau University Brenau University
Norcross, California Gainesville, Georgia

Pablo Mleziva, PT, OCS, CSCS Matt S. Stock, PhD

Physical Therapist-Assistant Professor Assistant Professor
Physical Therapy Department of Health Professions
Loma Linda University University of Central Florida
Loma Linda, California Orlando, Florida

Shannon Petersen, PT Ying-Chih Wang, PhD

Associate Professor Associate Professor
Physical Therapy Occupational Science & Technology
Des Moines University University of Wisconsin – Milwaukee
Des Moines, Iowa Milwaukee, Wisconsin

Lenny Ramsey, PhD Jennifer B. Wasserman, DPT, MS, PhD

Assistant Professor Associate Professor
Physical Therapy Physical Therapy
Carroll University Franklin Pierce University
Waukesha, Wisconsin Manchester, New Hampshire

David A. Scalzitti, PT, PhD Mark Patrick Wilhelm, PT, DPT

Assistant Professor, Physical Therapy and Health Care Assistant Professor
Sciences Physical Therapy
School of Medicine and Health Sciences Walsh University
The George Washington University North Canton, Ohio
Washington, DC
6113_FM_i-xxiv 05/12/19 1:31 pm Page xiii

Acknowledgments
Taking on this edition as a solo effort has been an in- I’d also like to acknowledge my dear friend and writing
teresting challenge. I am so appreciative for the sup- partner Mary Watkins, who retired several years ago and
port of many friends and colleagues who have helped is happily ensconced in New Hampshire with her family.
me through it. I am indebted to those who contributed Our collaboration was a special part of our lives for more
to writing chapters—Jessica Bell, Marianne Beninato, than 20 years, and I sorely missed her this time around.
Peter Cahn, Heather Fritz, Doug Gross, Cathy Lysack, Over the past 50 years of my professional life, of which
and David Scalzitti. I am thankful to John Wong for 45 were spent in academia, I have had the good fortune
many hours of invaluable guidance on statistics. I am to work with thousands of students, faculty colleagues,
also grateful to those who took the time to review sec- and teachers who have inspired and challenged me. Too
tions of the book and provide valuable feedback— numerous to mention by name, I thank them all for their
Marjorie Nicholas, Winnie Dunn, Lisa Connor and friendship, mentorship, and dedication. I am also grateful
Saurabh Mehta among others. I also want to acknowl- to many people, some I know and many I have never met,
edge the long-time support of colleagues at the MGH from all over the world, who over the years have taken
Institute of Health Professions, especially Alex John- the time to stop me at conferences, or to call or send
son, Mary Ellen Ferolito, Denis Stratford and the en- emails, telling me how much they appreciated the book—
tire IT team, as well as the graduate assistants Jasmin and pointing out the mistakes and where information
Torres and Baothy Huynh, who will both be awesome needed updating. Those comments have been immensely
Doctors of Occupational Therapy. I reserve a special rewarding and incredibly helpful. I hope these colleagues
note of deep appreciation for David Scalzitti who has are pleased with the revisions they have inspired.
reviewed every page of this book and who freely of- And of course, there is no way a project like this gets
fered his advice along the way, in every instance pro- done without support and sacrifice from those closest
viding important comments to make things more to me. My parents, who were so proud of this work,
accurate, complete, and useful. Many of his “pearls” have both passed away since the last edition was pub-
are included in the text. Additionally, I’d like to thank lished, but they continue to inspire me every day.
David for creating the online Test Bank questions and My husband Skip has given up so much of our together
PowerPoint slides. Always a wonderful colleague, he time, particularly once we were both supposed to be
has become a good friend. retired. He gave me the space and time I needed, and
The F. A. Davis team was remarkably patient with now I have a lot of dishes to wash to make up my share!
me over many years, providing incredible support. Spe- My children, Devon and Jay and Lindsay and Dan, are
cial thanks to Jennifer Pine, Senior Sponsoring Editor, always there to prop me up with love and understand-
who held my hand and tolerated my missing every ing, and Lindsay was even able to help me through
deadline. Megan Suermann, Content Project Manager, some of the more complex statistics—very cool. And
lived through every word, figure, and table, and all their finally, little Hazel, the ultimate joy that only a grand-
changes. Thank you to everyone who helped with every parent can understand. Her smile and hugs have lifted
aspect of the project—to Cassie Carey, Senior Produc- me up through many tough days. She confirms for me
tion Editor at Graphic World Publishing Services; Kate every day that the future is bright. What they say is so
Margeson, Illustration Coordinator; Nichole Liccio, true—if I’d known grandchildren were so much fun,
Melissa Duffield, and especially to Margaret Biblis, I would have had them first! With no pun intended, the
Editor-in-Chief, who said “yes” so quickly. next chapter awaits!

xiii
6113_FM_i-xxiv 05/12/19 1:31 pm Page xiv

About the Author

Dr. Leslie G. Portney active member of the American Physical Therapy As-
is Professor and Dean Emerita, MGH Institute of Health sociation, having served as chair of the Commission on
Professions, having served as the inaugural Dean of Accreditation in Physical Therapy Education and inau-
the School of Health and Rehabilitation Sciences and gural president of the American Council of Academic
Chair of the Department of Physical Therapy. She Physical Therapy. She is the recipient of several awards,
holds a PhD in Gerontology from the University including receiving the 2014 Lifetime Achievement
Professors Program at Boston University, a Master of Award from the Department of Physical Therapy at
Science from Virginia Commonwealth University, a Virginia Commonwealth University, being named the
DPT from the MGH Institute of Health Professions, 2014 Pauline Cerasoli Lecturer for the Academy of
a certificate in Physical Therapy from the University Physical Therapy Education of the APTA, and being
of Pennsylvania, and a Bachelor of Arts from Queens elected as a Catherine Worthingham Fellow of the
College. Leslie has been an active researcher and edu- American Physical Therapy Association in 2002. Leslie
cator for more than 50 years, with decades of teaching retired in 2018 but continues to contribute to profes-
critical inquiry to graduate students from a variety of sional projects and to consult with educational pro-
disciplines, which contributed to her being a staunch grams. She lives on Cape Cod with her husband, near
advocate of interprofessional education. She remains an to her children and granddaughter.

xiv
6113_FM_i-xxiv 05/12/19 1:31 pm Page xv

How to Use This Book

Since its first printing in 1993, this text has served sev-
Key Point boxes provide important information to
eral different audiences. Students may be assigned read-
emphasize concepts.
ings, using it as a class text. Clinicians may use it as a
reference to explain material found in the literature.
Researchers may use it to help generate questions, de-
sign studies, or develop analysis strategies. Some want Historical Notes offer interesting background that
only conceptual material while others want more in- puts content into an historical context.
depth coverage. I have tried to serve all these goals
efficiently. Some material has been placed online to
supplement content in the text as a way of providing Fun Facts illustrate concepts through a lighthearted look
in-depth material. at relevant information.

■ Examples Statistics boxes are included with discussions of

various designs to suggest relevant statistics that
will be described fully in later chapters.
The extensive use of examples from literature has long
been considered a strength of this text. Examples con-
tinue to be used throughout the book to illustrate how
studies have incorporated specific designs or used various
■ Statistical Material
analysis techniques. The use of these examples does not
Many statistical procedures are described in the text,
necessarily advocate for the methodologic quality of the
some that will include calculations within tables or
study.
boxes. However, most procedures are presented con-
• Case in Point features are used to clarify content ceptually, with the primary purpose of being able to
through a description of a relevant study. The case apply principles to the literature. Formulas are in-
is carried through discussion of a particular topic to cluded for some statistical measures where they are in-
illustrate applications. Some cases are from actual structive. Some more detailed calculations are included
literature and others are hypothetical. in supplements.
• Relevant examples are provided for certain designs
• Many different statistical packages are available for
using short descriptions that are highlighted in blue.
data analysis, some proprietary and others free
• Focus on Evidence features are included in each
online. Their interfaces and formats are varied,
chapter to provide an example of how the material is
and their output may look different, but most will
relevant to evidence-based practice.
generate comparable results. This text uses SPSS
• Numbered boxes within chapters provide relevant
version 25, the most recent version at the time the
information that will enhance understanding of con-
book was published.
tent and will provide examples to illustrate material.
• In chapters 22-34, tables are included that illus-
trate SPSS statistical output. Tables and text will
guide readers through interpretation of the results,
■ Clarifying Information including footnotes to identify relevant informa-
tion. Some material is omitted from the output if
Clarifying information will also be presented in several it does not provide relevant information, but full
small boxes throughout the text: output is included in online files. All data used
for examples in tables are hypothetical unless
Note boxes provide complementary content to enhance otherwise specified.
discussion of particular topics. • Appendix A includes tables of critical values that can
be applied to statistical calculations. Additional

xv
6113_FM_i-xxiv 05/12/19 1:31 pm Page xvi

xvi How to Use This Book

tables are also available in relevant chapter supple- work in any order that fits your needs. Material is cross-
ments as well as in Appendix A Online. referenced throughout the book.
• DATA The Data Download icon will indicate
• It is not necessary to use all the chapters or all of the
that the original data and full output for an
material in a given chapter, depending on the depth
DOWNLOAD
example are available online in SPSS and
of interest in a particular topic. This book has always
CSV files. Full output will also be available as SPSS
served as a teaching resource as well as a comprehen-
files or as PDF files for those who do not have
sive reference for clinicians and researchers who run
access to SPSS. Data and output files will be named
across unfamiliar content as they read through the
according to the number of the table that contains
literature. It will continue to be a useful reference for
the relevant material. Data Files will be available
students following graduation.
online at www.fadavis.com.
• Study Suggestions are given for each chapter, provid-
• Hypothetical data are not intended to reflect any
ing activities and exercises that can be incorporated
true physiological or theoretical relationships. They
into teaching, assignments, or exams. Many include
have been manipulated to illustrate certain statistical
discussion topics that can be used for individual or
concepts—so please don’t try to subject the results
small group work. Where relevant, answers are pro-
to a clinical rationale!
vided, or ideas are given for focusing discussions.
• Examples of how results can be presented in a
• A Test Item Bank includes multiple choice items for
research report are provided for each statistical
each chapter.
procedure.
• PowerPoint slides outline chapter content, and can
• This text is not a manual for using SPSS. Appendix
be incorporated into teaching or other presentations.
C will introduce the basics of data management
• An Image Bank offers access to all images within
with SPSS, but please consult experts if you are
the text.
unfamiliar with running statistical programs.
Several texts are devoted to detailed instructions
for applying SPSS.1,2
■ For Students
This book is intended to cover the concepts that will
■ Supplements allow you to become a critical consumer of literature and
to apply that knowledge within the context of evidence-
Each chapter has supplemental material available online. based practice. It will also serve as a guide for planning
• Chapter Overviews include objectives, key terms, and implementing research projects. Use the online re-
and a chapter summary. sources to complement your readings.
• Supplemental Materials are included for many It is unlikely that you will use the entire textbook
chapters with references highlighted in the text. within your courses but consider its usefulness as you
Chapter material can be understood without refer- move into your future role as an evidence-based practi-
tioner. You may also find you are interested in doing
ring to supplements, but the information in them
some research once you have identified clinical ques-
may be important for teaching or for understanding
tions. Don’t be overwhelmed with the comprehensive
the application of certain procedures. Where
content—the book will be a resource for you going for-
appropriate, supplements also provide links to
ward, so keep it handy on the bookshelf!
relevant references or other resources related to
the chapter’s content.
• Review Questions are included for each chapter as a
self-assessment to reinforce content for readers.
■ Terminology
Answers to these questions are also provided.
This text has a distinct and purposeful focus on inter-
professional practice. However, many professions have
particular jargon that may differ from terms used here.
■ For Instructors I have tried to define terms and abbreviations so that
these words can be applied across disciplines.
The order of chapters is based on the research process
model introduced in Chapter 1. However, instructors • When statistical procedures and designs can be de-
may approach this order differently. The chapters will scribed using different terms, I have included these
6113_FM_i-xxiv 05/12/19 1:31 pm Page xvii

How to Use This Book xvii

alternatives. Unfortunately, there are many such that those we study may represent different roles in
instances. different types of research studies, and second, it is
• The International Classification of Functioning, Disabil- just an effort to vary language. Although the term
ity and Health (ICF) is introduced in Chapter 1, “participant” has gained increasing favor, there is no
defining the terms impairment, activity, and partici- consensus on which terms are preferable, and these
pation. These are used to reflect different types of terms continue to be used in federal regulations and
outcome measures throughout the text. research reports.
• The pronouns “he” or “she” are used casually
throughout the book to avoid using passive voice. REF EREN CES
There is no underlying intent with the choice of
1. Field A. Discovering Statistics Using IBM SPSS Statistics. 5th ed.
pronoun unless it is applied to a particular study. Thousand Oaks, CA: Sage; 2018.
• I have chosen to use the terms “subject,” “partici- 2. Green SB, Salkind NJ. Using SPSS for Windows and Macintosh:
pant,” “patient,” “person,” “individual,” or “case” Analyzing and Understanding Data. 8th ed. New York: Pearson;
2017.
interchangeably for two reasons. First, I recognize
6113_FM_i-xxiv 05/12/19 1:31 pm Page xviii
6113_FM_i-xxiv 05/12/19 1:31 pm Page xix

Contents
What Is Evidence-Based Practice? 56
PART 1 Foundations of Research The Process of Evidence-Based Practice, 57
and Evidence Levels of Evidence, 62
Implementing Evidence-Based Practice, 65
1 Frameworks for Generating
and Applying Evidence, 2 6 Searching the Literature, 70
The Research Imperative, 2 with Jessica Bell
The Research Process, 4
Frameworks for Clinical Research, 5 Where We Find Evidence, 70
Types of Research, 11 Databases, 71
The Search Process, 74
2 On the Road to Translational Keyword Searching, 74
Research, 17 Getting Results, 76
The Translation Gap, 17 Medical Subject Headings, 77
The Translation Continuum, 18 Refining the Search, 80
Effectiveness Research, 21 Expanding Search Strategies, 83
Outcomes Research, 23 Choosing What to Read, 83
Implementation Studies, 25 Accessing Full Text, 84
Staying Current and Organized, 85
3 Defining the Research When Is the Search Done? 85
Question, 29
Selecting a Topic, 29 7 Ethical Issues in Clinical
The Research Problem, 29 Research, 88
The Research Rationale, 32 The Protection of Human Rights, 88
Types of Research, 34 The Institutional Review Board, 91
Framing the Research Question, 34 Informed Consent, 92
Independent and Dependent Variables, 34 Research Integrity, 98
Research Objectives and Hypotheses, 38
What Makes a Good Research Question? 39
PART 2 Concepts of Measurement
4 The Role of Theory in Research
and Practice, 42 8 Principles of Measurement, 106
Why We Take Measurements, 106
Defining Theory, 42
Quantification and Measurement, 106
Purposes of Theories, 42
The Indirect Nature of Measurement, 107
Components of Theories, 43
Rules of Measurement, 108
Models, 44
Levels of Measurement, 109
Theory Development and Testing, 45
Characteristics of Theories, 47 9 Concepts of Measurement
Theory, Research, and Practice, 48
Scope of Theories, 49
Reliability, 115
Concepts of Reliability, 115
5 Understanding Evidence-Based Measuring Reliability, 117
Understanding Reliability, 118
Practice, 53 Types of Reliability, 119
Why Is Evidence-Based Practice Important? 53
Reliability and Change, 122
How Do We Know Things? 54
Methodological Studies: Reliability, 124

xix
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xx Contents

10 Concepts of Measurement 15 Design Validity, 210

Validity, 127 Validity Questions, 210
with K. Douglas Gross Statistical Conclusion Validity, 210
Internal Validity, 212
Defining Validity, 127 Construct Validity, 215
Types of Evidence for Validity, 128 External Validity, 217
Construct Validity, 132 Strategies to Control for Subject Variability, 218
Norm and Criterion Referencing, 135 Non-compliance and Missing Data, 220
Interpreting Change, 136 Handling Missing Data, 223
Methodological Studies: Validity, 138
16 Experimental Designs, 227
11 Designing Surveys and Design Classifications, 227
Selecting a Design, 228
Questionnaires, 141 Pretest–Posttest Control Group Designs, 228
Purposes of Surveys, 141
Posttest-Only Control Group Design, 230
Survey Formats, 142
Factorial Designs for Independent Groups, 231
Planning the Survey, 143
Repeated Measures Designs, 233
Designing the Survey, 144
Sequential Clinical Trials, 236
Types of Survey Questions, 145
Writing Good Questions, 148 17 Quasi-Experimental Designs, 240
Formatting the Survey, 150 Validity Concerns, 240
Selecting a Sample, 150 Time Series Designs, 241
Contacting Respondents, 152 Nonequivalent Group Designs, 244
Analysis of Questionnaire Data, 154
Ethics of Survey Administration, 155 18 Single-Subject Designs, 249
Focus on the Individual, 249
12 Understanding Health Structure of Single-Subject Designs, 250
Measurement Scales, 159 Defining the Research Question, 253
with Marianne Beninato Measuring the Target Behavior, 253
Limitations of the A–B Design, 254
Understanding the Construct, 159 Withdrawal Designs, 254
Summative Scales, 161 Multiple Baseline Designs, 255
Visual Analog Scale, 164 Designs With Multiple Treatments, 257
Cumulative Scales, 167 N-of-1 Trials, 259
Rasch Analysis, 168 Visual Data Analysis, 260
Statistical Analysis, 263
PART 3 Designing Clinical Research Generalization, 267

13 Choosing a Sample, 180 19 Exploratory Research:

Populations and Samples, 180 Observational Designs, 271
Sampling, 183 with K. Douglas Gross
Probability Sampling, 185
Nonprobability Sampling, 188 Exploring Relationships, 272
Longitudinal Studies, 274
14 Principles of Clinical Trials, 192 Cross-Sectional Studies, 276
Types of Clinical Trials, 192 Cohort Studies, 278
Manipulation of Variables, 193 Case-Control Studies, 280
Random Assignment, 194
Control Groups, 198 20 Descriptive Research, 285
Blinding, 199 Developmental Research, 286
Ideal Versus Pragmatic, 200 Normative Studies, 287
Phases of Clinical Trials, 201 Descriptive Surveys, 288
Comparing Treatments: Better or No Case Reports, 289
Worse? 204 Historical Research, 293
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Contents xxi

21 Qualitative Research, 297 26 Multiple Comparison Tests, 383

with Heather Fritz and Cathy Lysack Corrections and Adjustments, 383
Post Hoc Multiple Comparisons, 384
Human Experience and Evidence, 297 Post Hoc Tests for Factorial Designs, 390
The Research Question: Beyond “What” Post Hoc Tests for Repeated Measures, 392
to “Why”, 299 Planned Comparisons, 394
Perspectives in Qualitative Research, 302
Methods of Qualitative Data Collection, 305 27 Nonparametric Tests for Group
Sampling, 308 Comparisons, 400
Data Analysis and Interpretation, 309 Criteria for Choosing Nonparametric
Mixed Methods, 312 Tests, 400
Procedure for Ranking Scores, 402
Tests for Independent Samples, 403
PART 4 Analyzing Data Tests for Related Samples, 407
22 Descriptive Statistics, 318 28 Measuring Association for
Frequency Distributions, 318 Categorical Variables:
Shapes of Distributions, 322
Measures of Central Tendency, 322 Chi-Square, 415
Measures of Variability, 324 Testing Proportions, 415
The Normal Distribution, 328 Goodness of Fit, 416
Tests of Independence, 419
23 Foundations of Statistical Power and Effect Size, 423
Inference, 333 McNemar Test for Correlated Samples, 424
Probability, 333 29 Correlation, 428
Sampling Error, 334 Concepts of Correlation, 428
Confidence Intervals, 336 Linear and Curvilinear Relationships, 430
Statistical Hypothesis Testing, 338 Pearson Product–Moment Correlation
Errors in Hypothesis Testing, 340 Coefficient, 431
Type I Error and Significance, 340 Correlation of Ranked Data, 432
Type II Error and Power, 342 Correlation of Dichotomies, 435
Concepts of Statistical Testing, 346 Interpreting Correlation Coefficients, 435
Parametric Versus Nonparametric Partial Correlation, 437
Statistics, 348
30 Regression, 440
24 Comparing Two Means: The Basics of Regression, 440
The t-Test, 351 Simple Linear Regression, 441
The Conceptual Basis for Comparing Multiple Regression, 446
Means, 351 Power and Effect Size for Regression, 449
The Independent Samples t-Test, 353 Stepwise Multiple Regression, 449
Paired Samples t-Test, 359 Dummy Variables, 453
Power and Effect Size, 360 Nonlinear Regression, 454
Inappropriate Use of Multiple t-Tests, 363 Logistic Regression, 456
Analysis of Covariance, 461
25 Comparing More Than Two
Means: Analysis of Variance, 365 31 Multivariate Analysis, 468
ANOVA Basics, 365 Exploratory Factor Analysis, 468
One-Way Analysis of Variance, 365 Structural Equation Modeling, 474
Two-Way Analysis of Variance, 370 Cluster Analysis, 477
Repeated Measures Analysis of Variance, 373 Multivariate Analysis of Variance, 478
Mixed Designs, 378 Survival Analysis, 481
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xxii Contents

32 Measurement Revisited: Studies of Diagnostic Accuracy, 564

Studies of Prognosis, 565
Reliability and Validity
Qualitative Studies, 567
Statistics, 486 Critically Appraised Topics, 568
with K. Douglas Gross
37 Synthesizing Literature:
Intraclass Correlation Coefficient, 486 Systematic Reviews and
Standard Error of Measurement, 492
Agreement, 494
Meta-Analyses, 574
with David Scalzitti
Internal Consistency, 497
Limits of Agreement, 499
Purpose of Systematic Reviews, 575
Measuring Change, 501
The Research Question, 576
33 Diagnostic Accuracy, 509 Methods, 578
Validity of Diagnostic Tests, 509 Results, 581
Pretest and Posttest Probabilities, 514 Discussion and Conclusions, 586
Receiver Operating Characteristic (ROC) Meta-Analysis, 587
Curves, 519 Appraisal of Systematic Reviews and Meta-
Clinical Prediction Rules, 523 Analyses, 591
Scoping Reviews, 592
34 Epidemiology: Measuring
Risk, 529 38 Disseminating Research, 597
with Peter S. Cahn
The Scope of Epidemiology, 529
Descriptive Epidemiology, 530
Choosing a Journal, 597
Analytic Epidemiology: Measures of Risk, 533
Authorship, 599
Analytic Epidemiology: Measures of Treatment
Standards for Reporting, 599
Effect, 539
Structure of the Written Research Report, 602
Submitting the Manuscript, 605
PART 5 Putting It All Together Presentations, 607
Promoting Your Work, 610
35 Writing a Research Proposal, 548
Purposes of the Research Proposal, 548
The Research Team, 548 Appendices
Components of a Proposal, 549
Plan for Administrative Support, 552
A Statistical Tables, 613
Writing the Proposal, 554 B Relating the Research Question to
Funding, 555
Submitting the Proposal, 555
the Choice of Statistical Test, 622

36 Critical Appraisal: Evaluating C Management of Quantitative

Research Reports, 557 Data, 629
Levels of Evidence, 557 Glossary, 637
The Appraisal Process, 558
Core Questions, 558 Index, 659
Intervention Studies, 562
6113_FM_i-xxiv 05/12/19 1:31 pm Page xxiii

Online Supplements
1 Frameworks for Generating 12 Understanding Health
and Applying Evidence Measurement Scales
Evolving Models of Healthcare 1. Likert Scales: The Multidimensional Health
Locus of Control Scale
2 On the Road to Translational 2. Further Understanding of Rasch Analysis
Research
Ernest Codman: The “End Result Idea” 13 Choosing a Sample
1. Generating a Random Sample
3 Defining the Research Question 2. Weightings for Disproportional Sampling
Links to Study Examples
14 Principles of Clinical Trials
4 The Role of Theory in Research No supplement
and Practice 15 Design Validity
No supplement
No supplement
5 Understanding Evidence-Based 16 Experimental Designs
Practice Sequential Clinical Trials
Barriers and Facilitators of Evidence-Based
Practice 17 Quasi-Experimental Designs
No supplement
6 Searching the Literature
Databases and Search Engines for Health 18 Single-Subject Designs
Sciences 1. Variations of Single-Subject Designs
2. Drawing the Split Middle Line
7 Ethical Issues in Clinical Research 3. Table of Probabilities Associated
2019 Changes to the Common Rule With the Binomial Test
4. Statistical Process Control
8 Principles of Measurement 5. Calculating the C Statistics
No supplement

9 Concepts of Measurement 19 Exploratory Research:

Reliability Observational Designs
No supplement
No supplement

10 Concepts of Measurement 20 Descriptive Research

Writing and Appraising Case Reports
Reliability
1. Content Validity Index 21 Qualitative Research
2. Sources of Evidence to Support Construct No supplement
Validity
22 Descriptive Statistics
11 Designing Surveys and Calculating Variance and Standard Deviation
Questionnaires 23 Foundations of Statistical
1. Delphi Surveys
2. Q-Sort Methodology Inference
3. Edwards et al: Are People With Chronic Introduction to G*Power
Diseases Interested In Using Telehealth?
A Cross-Sectional Postal Survey

xxiii
6113_FM_i-xxiv 05/12/19 1:31 pm Page xxiv

xxiv Online Supplements

24 Comparing Two Means: 32 Measurement Revisited:

The t-Test Reliability and Validity Statistics
1. Calculation of the Unpaired t-Test 1. Calculating the Intraclass Correlation
With Unequal Variances Coefficient
2. Estimating Power and Sample Size: t-Test 2. Generating ICCs With SPSS
3. Weighted Kappa
25 Comparing More Than Two 4. Response Stability: Method Error
Means: Analysis of Variance
1. Calculation of Sums of Squares 33 Diagnostic Accuracy
2. Estimating Power and Sample Size: Analysis Nomogram to Determine Posttest Probabilities
of Variance
34 Epidemiology: Measuring Risk
26 Multiple Comparison Tests Estimating Sample Size: Cohort and
1. Critical Values of the Studentized Range Case-Control Studies
Statistic, q
2. Calculating the Harmonic Mean
35 Writing a Research Proposal
The NIH Biosketch Format
3. Choosing Multiple Comparison Tests

27 Nonparametric Tests for Group 36 Critical Appraisal: Evaluating

Comparisons Research Reports
1. Appraisal Resources
1. Multiple Comparisons for Nonparametric
2. Critical Appraisal Worksheets
Tests
2. Tables of Critical Values for Nonparametric 37 Synthesizing Literature:
Tests
3. Estimating Power and Sample Size:
Systematic Reviews and
Mann-Whitney U and Wilcoxon Meta-Analyses
Signed-Ranks 1. Reporting Guidelines: PRISMA
2. Appraising Systematic Reviews: AMSTAR-2
28 Measuring Association for Checklist
Categorical Variables: 3. Resources for Systematic Reviews and
Meta-Analyses
Chi-Square 4. Data Extraction Forms
Estimating Power and Sample Size: Chi-Square
5. Lucas et al: Interventions to Improve Gross Motor
29 Correlation Performance in Children with Neurodevelopmental
1. Calculation of the Pearson and Spearman Disorders: A Meta-Analysis
Correlations 6. Olding et al: Patient and Family Involvement in
2. Correlation of Dichotomies Adult Critical and Intensive Care Settings: A
3. Eta Coefficient for Non-Linear Correlation Scoping Review
4. Estimating Power and Sample Size:
Correlation
38 Disseminating Research
1. Links to Reporting Guidelines
30 Regression 2. Annotated Article: Travier et al: Effects of an
1. Calculating Linear Regression Coefficients 18-Week Exercise Programme Started Early
2. Probabilities in Logistic Regression During Breast Cancer Treatment: A Randomised
3. Estimating Power and Sample Size: Controlled Trial
Regression

31 Multivariate Statistics
1. Principal Components Analysis and
Exploratory Factor Analysis
2. Direct, Indirect, and Total Effects in
Sequential Equation Modeling
6113_Ch01_001-016 02/12/19 4:56 pm Page 1

Foundations of
PART
1
Research and
Evidence
CHAPTER 1 Frameworks for Generating and Applying
Evidence 2
CHAPTER 2 On the Road to Translational Research 17
CHAPTER 3 Defining the Research Question 29
CHAPTER 4 The Role of Theory in Research and Practice 42
CHAPTER 5 Understanding Evidence-Based Practice 53
CHAPTER 6 Searching the Literature 70
CHAPTER 7 Ethical Issues in Clinical Research 88

ractice
dp
se
idence-ba

1. Identify the
arch question
rese
Ev

s
ing

2.
De
ind

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te f

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5. Dissemina

study

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4.

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e
A

ly z th
ed e nt
ata p le m
3. I m

1
6113_Ch01_001-016 02/12/19 4:56 pm Page 2

CHAPTER

1 Frameworks for
Generating and
Applying Evidence
The ultimate goal of clinical research is to max- Clinical research is essential to inform clinical judg-
ments, as well as the organization and economics of prac-
imize the effectiveness of practice. To that end,
tice. We must all exercise a commitment to scientific
health professionals have recognized the neces- discovery that will lead to improvement in standards of
sity for generating and applying evidence to care and patient outcomes. The task of addressing this
need is one that falls on the shoulders of all those en-
clinical practice through rigorous and objective
gaged in healthcare (whether we function as scientific in-
analysis and inquiry. vestigators who collect meaningful data and analyze
The purpose of this text is to provide a frame outcomes, or as consumers of professional literature who
critically apply research findings to promote optimal care
of reference that will bring together the com-
(see Box 1-1).
prehensive skills needed to promote critical The importance of engaging in collaborative and
inquiry as part of the clinical decision-making interprofessional efforts cannot be overemphasized, as
researchers and clinicians share the responsibility to
process for the varied and interdependent
explore complex theories and new approaches, as well
members of the healthcare team. as to contribute to balanced scientific thought and
This chapter develops a concept of research discovery.
that can be applied to clinical practice, as a Defining Clinical Research
method of generating new knowledge and pro- Clinical research is a structured process of investigating
viding evidence to inform healthcare decisions. facts and theories and of exploring connections, with the
purpose of improving individual and public health. It
We will also explore historic and contemporary
proceeds in a systematic way to examine clinical or social
healthcare frameworks and how they influence conditions and outcomes, and to generate evidence for
the different types of research that can be ap- decision-making.
Although there is no one universal description of clin-
plied to translate research to practice.
ical research, the National Institutes of Health (NIH)
has proposed the following three-part definition1:
■ The Research Imperative 1. Patient-oriented research: Studies conducted with
human subjects to improve our understanding of the
The concept of research in health professions has evolved mechanisms of diseases and disorders, and of which
along with the development of techniques of practice and therapeutic interventions will be most effective in
changes in the healthcare system. All stakeholders treating them.
(including care providers and patients, policy analysts, 2. Epidemiologic and behavioral studies: Observa-
administrators, and researchers) have an investment tional studies focused on describing patterns of dis-
in knowing that intervention and healthcare services are ease and disability, as well as on identifying
effective, efficient, and safe. preventive and risk factors.

2
6113_Ch01_001-016 02/12/19 4:56 pm Page 3

CHAPTER 1 Frameworks for Generating and Applying Evidence 3

Box 1-1 Addressing the Triple Aim more accurate than qualitative study because it lends it-
self to objective statistical analysis, but this is an unfor-
Issues related to evidence-based practice (EBP) and population tunate and mistaken assumption because approaches to
health are especially important in light of the economic, quality, inquiry must best match the context of the question
and access challenges that continue to confront healthcare. In
being asked. Each approach has inherent value and each
2008, the Institute for Healthcare Improvement (IHI) proposed
can inform the other.
the Triple Aim framework to highlight the need to improve the
patient experience and quality of care, to advance the health of Qualitative Approach
populations, and to reduce the per capita cost of healthcare.2 Qualitative research strives to capture naturally oc-
This goal will require extensive research efforts to collect data curring phenomena, following a tradition of social
over time, understand population characteristics and barriers to constructivism. This philosophy is focused on the belief
access, and identify the dimensions of health and outcomes that that all reality is fundamentally social, and therefore
are meaningful to providers and patients.
the only way to understand it is through an individual’s
experience. Researchers often immerse themselves
within the participants’ social environment to better
understand how phenomena are manifested under
natural circumstances.
In qualitative methodology, “measurement” is based
on subjective, narrative information, which can be ob-
tained using focus groups, interviews, or observation.
Analysis of narrative data is based on “thick description”
to identify themes. The purpose of the research may
Population Evidence be to simply describe the state of conditions, or it may
health of care
be to explore associations, formulate theory, or generate
hypotheses.

Per capita Qualitative research will be explored in more depth in

cost Chapter 21.

Quantitative Approach
The IHI Triple Aim In contrast, quantitative research is based on a philos-
ophy of logical positivism, in which human experience is
Several organizations have proposed a Quadruple Aim, assumed to be based on logical and controlled relation-
adding the clinician experience (avoiding burnout),3 as well as ships among defined variables. It involves measurement
other priorities, such as health equity.4 of outcomes using numerical data under standardized
conditions.
The advantage of the quantitative approach is the
3. Outcomes research and health services re-
ability to summarize scales and to subject data to statis-
search: Studies to determine the impact of research
tical analysis. Quantitative information may be obtained
on population health and utilization of evidence-
using formal instruments that address physical, behav-
based therapeutic interventions.
ioral, or physiological parameters, or by putting subjec-
All of these approaches are essential to establishing an tive information into an objective numerical scale.
evidence base for clinical practice and the provision of
quality health services. The Scientific Method
Within the quantitative model, researchers attempt to
Qualitative and Quantitative Methods reduce bias by using principles of the scientific method,
The objective nature of research is a dynamic and cre- which is based on the positivist philosophy that scientific
ative activity, performed in many different settings, using truths exist and can be studied.5 This approach is
a variety of measurement tools, and focusing on the ap- founded on two assumptions related to the nature of
plication of clinical theory and interventions. In catego- reality.
rizing clinical inquiry, researchers often describe studies First, we assume that nature is orderly and regular
by distinguishing between qualitative and quantitative and that events are, to some extent, consistent and pre-
methods. Quantitative research is sometimes viewed as dictable. Second, we assume that events or conditions
6113_Ch01_001-016 02/12/19 4:56 pm Page 4

4 PART 1 Foundations of Research and Evidence

are not random or accidental and, therefore, have one or

ractice
more causes that can be discovered. These assumptions dp
se
allow us to direct clinical thinking toward establishing

idence-ba
cause-and-effect relationships so that we can develop 1. Identify the
arch question
rational solutions to clinical problems. rese

Ev
The scientific method has been defined as:

s
ing

2.
De
ind
A systematic, empirical, and controlled critical

sig
te f
examination of hypothetical propositions about the

n the
5. Dissemina
associations among natural phenomena.6

study
The
The systematic nature of research implies a logical Research
sequence that leads from identification of a problem, Process
through the organized collection and objective analysis
of data, to the interpretation of findings.

dy
The empirical component of scientific research refers

stu
4.
to the necessity for documenting objective data through na

e
A
h
ly z n tt
direct observation, thereby minimizing bias. ed me
ata ple
The element of control is perhaps the most important 3. I m
characteristic that allows the researcher to understand
how one phenomenon relates to another, controlling
factors that are not directly related to the variables in Figure 1–1 A model of the research process.
question.
A commitment to critical examination means that the
researcher must subject findings to empirical testing and Step 1: Identify the Research Question
to the scrutiny of others. Scientific investigation is The first step of the research process involves delimiting
thereby characterized by a capacity for self-correction the area of research and formulating a specific question that
based on objective validation of data from primary provides an opportunity for study (see Chapter 3). This
sources of information. requires a thorough review of scientific literature to provide
Although the scientific method is considered the a rationale for the study (see Chapters 6 and 37), justifica-
most rigorous form of acquiring knowledge, the com- tion of the need to investigate the problem, and a theoret-
plexity and variability within nature and the unique ical framework for interpreting results (see Chapter 4).
psychosocial and physiological capacities of individuals During this stage, the researcher must define the type
will always introduce some uncertainty into the inter- of individual to whom the results will be generalized and
pretation and generalization of data. This means that the specific variables that will be studied. Research
researchers and clinicians must be acutely aware of ex- hypotheses are proposed to predict how these variables
traneous influences to interpret findings in a meaning- will be related and what clinically relevant outcomes can
ful way. Qualitative research can serve an important be expected. In descriptive or qualitative studies, guiding
function in helping to understand these types of questions may be proposed that form the framework for
variables that can later be studied using quantitative the study.
methods.
Step 2: Design the Study
In step 2, the researcher designs the study and plans
■ The Research Process methods of implementation (see Chapters 14–21). The
choice of research method reflects how the researcher
The process of clinical research involves sequential steps conceptualizes the research question.
that guide thinking, planning, and analysis. Whether one The first consideration is who will be studied and
is collecting quantitative or qualitative data, the research how subjects will be chosen (see Chapter 13). The re-
process assures that there is a reasonable and logical searcher must carefully define all measurements and in-
framework for a study’s design and conclusions. This is terventions so that outcomes will be reliable and valid
illustrated in Figure 1-1, recognizing that the order of (see Chapters 8–12), and the methods for data analysis
steps may vary or overlap in different research models. are clear (see Chapters 22–34).
Each of these steps is further described in succeeding The completion of steps 1 and 2 leads to the devel-
chapters. opment of a research proposal (see Chapter 35) that
6113_Ch01_001-016 02/12/19 4:56 pm Page 5

CHAPTER 1 Frameworks for Generating and Applying Evidence 5

explains the research aims, sampling methods, and ethi- sometimes to address limitations in a study’s design.
cal considerations, including potential benefits and risks Replication may be needed to confirm results with dif-
to participants. The proposal defines methods to show ferent samples in different settings.
that the study can be carried out appropriately and that The loop also includes application of evidence based
it should be able to deliver outcomes of some impact. It on dissemination of research findings (see Chapter 5).
is submitted to an Institutional Review Board (IRB) for This process will often lead to new questions, as we con-
review and approval, to assure that ethical concerns are tinue to deal with the uncertainties of practice.
addressed (see Chapter 7).
Step 3: Implement the Study
■ Frameworks for Clinical Research
In the third step, the researcher implements the plans
designed in steps 1 and 2. Data collection is typically the The context of clinical research is often seen within pre-
most time-consuming part of the research process. Re- vailing paradigms. A paradigm is a set of assumptions,
searchers may conduct pilot studies before beginning the concepts, or values that constitute a framework for view-
full study to confirm that measurement methods and pro- ing reality within an intellectual community.
cedures work as expected, typically on a small sample. Scientific paradigms have been described as ways of
Step 4: Analyze the Data looking at the world that define what kinds of questions
are important, which predictions and theories define a
After data are collected, the researcher must reduce and discipline, how the results of scientific studies should be
collate the information into a useful form for analysis, interpreted, and the range of legitimate evidence that
often using tables or spreadsheets to compile “raw data.” contributes to solutions. Quantitative and qualitative
The fourth step of the research process involves analyz- research approaches are based on different paradigms,
ing, interpreting, and drawing valid conclusions about for example, as they are founded on distinct assumptions
the obtained data. and philosophies of science.
Statistical procedures are applied to summarize and American physicist Thomas Kuhn7 also defined
explore quantitative information in a meaningful way to paradigm shifts as fundamental transitions in the way
address research hypotheses (see Chapters 22–34). In disciplines think about priorities and relationships, stim-
qualitative studies, the researcher organizes and catego- ulating change in perspectives, and fostering preferences
rizes data to identify themes and patterns that are guided for varied approaches to research.
by the research question and its underlying theoretical We can appreciate changes in research standards and
perspective (see Chapter 21). priorities in terms of four paradigm shifts that have
emerged in healthcare, rehabilitation, and medicine in
Step 5: Disseminate Findings the United States as we have moved into the 21st cen-
In the fifth step of the research process, researchers have tury: evidence-based practice, a focus on translational re-
a responsibility to share their findings with the appro- search, the conceptualization of health and disability, and
priate audience so that others can apply the information the importance of interprofessional collaboration.
either to clinical practice or to further research. This step
is the pulling together of all the materials relevant to the Evidence-Based Practice
study, to apply them to a generalized or theoretical The concept of evidence-based practice (EBP) repre-
framework. Through the analysis of results, the re- sents the fundamental principle that the provision of
searcher will interpret the impact on practice and where quality care will depend on our ability to make choices
further study is needed. that are based on the best evidence currently available.
Research reports can take many forms including jour- As shown in Figure 1-1, the research process incorpo-
nal articles, abstracts, oral presentations, poster presen- rates EBP as an important application of disseminated
tations, and conference proceedings (see Chapter 38). research.
Students may be required to report their work in the When we look at the foundations of clinical practice,
lengthier form of a thesis or dissertation. however, we are faced with the reality that often compels
practitioners to make intelligent, logical, best-guess de-
Closing the Loop cisions when scientific evidence is either incomplete or
Note that the research process is circular, as no study is unavailable. The Institute of Medicine (IOM) and other
a dead end. Results of one study invariably lead to new agencies have set a goal that, by 2020, “90% of clinical
questions. Researchers contribute to the advancement of decisions will be supported by accurate, timely, and up-
their own work by offering suggestions for further study, to-date clinical information, and will reflect the best
 Another Random Document on
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in apostasy) in the way of his heart (or, of his own inclination). 18. His
ways I have seen, and I will heal him, and will guide him, and restore
comforts unto him and to his mourners. 19. Creating the fruit of the
lips, Peace, peace to the far off and to the near, saith Jehovah, and I will
heal him.
20. And the wicked (are) like the troubled sea, for rest it cannot, and its
waters cast up mire and dirt. 21. There is no peace, saith my God, to the
wicked.
LVIII.—[The rejection of Israel as a nation is the just reward of their
unfaithfulness, ver. 1. Their religious services are hypocritical, ver. 2.
Their mortifications and austerities are nullified by accompanying
wickedness, vers. 3-5. They should have been connected with the
opposite virtues, vers. 6, 7. In that case they would have continued to
enjoy the divine favour, vers. 8, 9. They are still invited to make trial of
this course, with an ample promise of prosperity and blessing to
encourage them, vers. 10–14.]
1. Cry with the throat, spare not, like the trumpet raise thy voice, and
tell to My people their transgression, and to the house of Jacob their
sins.
2. And Me day (by) day they will seek, and the knowledge of My ways
they will delight in (or, desire), like a nation which has done right, and
the judgment of its God has not forsaken; they will ask of Me righteous
judgments, the approach to God (or, of God) they will delight in (or,
desire).
3. Why have we fasted, and Thou hast not seen (it)? afflicted our soul
(or, themselves) and Thou wilt not know (it)? Behold in the day of your
fast ye will find pleasure, and all your labours ye will exact. 4. Behold,
for strife and contention ye will fast, and to smite with the flat of
wickedness; ye shall not (or, ye will not) fast to-day (so as) to make
your voice heard on high. 5. Shall it be like this, the fast that I will
choose, the day of man’s humbling himself? Is it to hang his head like a
bulrush, and make sackcloth and ashes his bed? Wilt thou call this a
fast, and a day of acceptance (an acceptable day) to Jehovah?
6. Is not this the fast that I will choose, to loosen bands of wickedness,
to undo the fastenings of the yoke, and to send away the crushed (or
broken) free, and every yoke ye shall break? 7. Is it not to break unto
the hungry thy bread? and the afflicted, the homeless, thou shalt bring
home; for thou shalt see one naked and shalt clothe him, and from
thine own flesh thou shalt not hide thyself.
8. Then shall break forth as the dawn thy light, and thy healing
speedily shall spring up; then shall go before thee thy righteousness,
and the glory of Jehovah shall be thy rereward (or, bring up thy rear).
9. Then shalt thou call, and Jehovah will answer; thou shalt cry, and He
will say, Behold Me (here I am), if thou wilt put away from the midst of
thee the yoke, the pointing of the finger, and the speaking of vanity.
10. And (if) thou wilt let out thy soul to the hungry, and the afflicted
soul will satisfy, then shall thy sight arise in the darkness, and thy
gloom as the (double light or) noon. 11. And Jehovah will guide thee
over, and satisfy thy soul in drought, and thy bones shall He invigorate,
and thou shalt be like a watered garden, and like a spring of water
whose waters shall not fail. 12. And they shall build from thee the ruins
of antiquity (or, perpetuity), foundations of age and age (i.e., of ages)
shalt thou raise up: and it shall be called to thee (or, thou shalt be
called) Repairer of the breach, Restorer of paths for dwelling.
13. If thou wilt turn away thy foot from the Sabbath to do thy pleasure
on My holy day, and wilt call the Sabbath a delight (and) the holy (day)
of Jehovah honourable, and wilt honour it by not doing thy own ways,
by not finding thy pleasure and talking talk; 14. then shalt thou be
happy in Jehovah, and I will make thee rule upon the heights of the
earth, and I will make thee eat the heritage of Jacob thy father, for
Jehovah’s mouth hath spoken it.
LIX.—[The fault of Israel’s rejection is not in the Lord, but in
themselves, vers. 1, 2. They are charged with sins of violence and
injustice, vers. 3, 4. The ruinous effects of these corruptions are
described, vers. 5, 6. Their violence and injustice are fatal to themselves
and to others, vers. 7, 8. The moral condition of the people is described
as one of darkness and hopeless degradation, vers. 9–15. In this
extremity, Jehovah interposes to deliver the true Israel, vers. 16, 17. This
can only be effected by the destruction of the carnal Israel, vers. 18. The
Divine presence shall no longer be subjected to local restrictions, vers.
19. A Redeemer shall appear in Zion to save the true Israel, vers. 20. The
old dispensation shall give place to the dispensation of the Word and
Spirit, which shall last for ever, ver. 21.]
1. Behold, not shortened is Jehovah’s hand from saving, and not
benumbed is His ear from hearing. 2. But your iniquities have been
separating between you and your God, and your sins have hid (His)
face from you, so as not to hear.
3. For your hands are defiled with blood, and your fingers with iniquity;
your lips have spoken falsehood, your tongue will utter wickedness.
4. There is none calling with justice, and there is none contending with
truth; they trust in vanity and speak falsehood, conceive mischief and
bring forth iniquity. 5. Eggs of the basilisk they have hatched, and webs
of the spider they will spin (or, weave); the one eating their eggs shall
die, and the crushed (egg) shall hatch out a viper. 6. The webs shall not
become (or, be for) clothing, and they shall not cover themselves with
their works: their works are works of mischief (or, iniquity), and the
doing of violence is in their hands. 7. Their feet to evil will run, and
they will hasten to shed innocent blood; their thoughts are thoughts of
mischief (or, iniquity); wasting and ruin are in their paths. 8. The way
of peace they have not known, and there is no justice in their paths;
their courses they have rendered crooked for them; every one walking
in them knows not peace.
9. Therefore is judgment far from us, and righteousness will not
overtake us; we wait for light, and behold darkness; for splendours,
(and) in obscurities we walk. 10. We grope like the blind for the wall,
like the eyeless we grope; we stumble at noon-day as in twilight, in
thick darkness like the dead. 11. We growl like the bears, all of us, and
like the doves we moan; we wait for justice and there is none, for
salvation (and) it is far from us. 12. For our transgressions are
multiplied before Thee, and our sins testify against us; for our
transgressions are with us, and our iniquities—we know them; 13. to
transgress and lie against Jehovah, and to turn back from behind our
God, to speak oppression and departure, to conceive and utter from the
heart words of falsehood. 14. And judgment is thrust (or, driven) back,
and righteousness afar off stands; for truth is fallen in the street, and
uprightness cannot enter. 15. Then truth was missed (i.e., found
wanting), and whoso departed from evil made himself a prey (or, was
plundered).
Then Jehovah saw it, and it was evil in His eyes that there was no
judgment (or, practical justice). 16. And He saw that there was no man,
and He stood aghast that there was no one interposing; and His own
arm saved for Him, and His own righteousness, it upheld Him. 17. And
He clothed Himself with righteousness as a coat of mail, and a helmet
of salvation on His head, and He clothed Himself with garments of
vengeance (for) clothing. 18. According to (their) deeds, according will
He repay, wrath to His enemies, (their) desert to His foes, to the isles
(their) desert will He repay. 19. And they shall fear from the west the
name of Jehovah, and from the rising of the sun His glory; for it shall
come like a straitened stream, the spirit of Jehovah raising a banner in
it.
20. Then shall come for Zion a Redeemer, and for the converts from
apostasy in Jacob, saith Jehovah. 21. And I (or, as for me)—this (is) My
covenant with them, saith Jehovah. My Spirit which is on thee, and My
words which I have placed in thy mouth, shall not depart out of thy
mouth, nor out of the mouth of thy seed’s seed, saith Jehovah, from
henceforth and for ever (or, from now and to eternity).
LX.—[The prophet describes the approaching change as a new and
Divine light rising upon Zion, ver. 1. He contrasts it with the darkness
of surrounding nations, ver. 2. Yet these are not excluded from
participation in the light, ver. 3. The elect in every nation are the
children of the Church, and shall be gathered to her, vers. 4, 5. On one
side he sees the Oriental caravans and flocks approaching, vers. 6, 7.
On the other, the commercial fleets of western nations, vers. 8, 9.
What seemed rejection is in fact the highest favour, ver. 10. The glory of
the true Church is her freedom from local and national restrictions,
ver. 11. None are excluded from her pale but those who exclude
themselves and thereby perish, ver. 12. External nature shall contribute
to her splendour, ver. 13. Her very enemies shall do her homage, ver. 14.
Instead of being cast off, she is glorified for ever, ver. 15. Instead of
being identified with one nation, she shall derive support from all, ver.
16. All that is changed in her condition shall be changed for the better,
ver. 17. The evils of her former state are done away, ver. 18. Even some of
its advantages are now superfluous, ver. 19. What remains shall be no
longer precarious, ver. 20. The splendour of this new dispensation is a
moral and spiritual splendour, but attended by external safety and
protection, ver. 21, 22. All this shall certainly and promptly come to
pass at the appointed time, ver. 22.]
1. Arise, be light; for thy light is come, and the glory of Jehovah has
risen upon thee. 2. For behold, the darkness shall cover the earth, and a
gloom the nations, and upon thee shall Jehovah rise, and His glory
upon thee shall be seen. 3. And nations shall walk in thy light, and
kings in the brightness of thy rising.
4. Lift up thine eyes round about (i.e., in all directions) and see; all of
them are gathered, they come to thee, thy sons from afar shall come,
and thy daughters at the side shall be borne. 5. Then shalt thou see (or,
fear), and brighten up (or, overflow), and thy heart shall throb and
swell; because (or, when) the abundance of the sea shall be turned
upon thee, the strength of nations shall come unto thee.
6. A stream of camels shall cover thee, young camels (or, dromedaries)
of Midian and Ephah, all of them from Sheba shall come, gold and
incense shall they bear, and the praises of Jehovah as good news. 7. All
the flocks of Kedar shall be gathered for thee, the rams of Nebaioth
shall minister to thee, they shall ascend with good-will (or, acceptably)
My altar, and My house of beauty I will beautify.
8. Who are these that fly as a cloud and as doves to their windows?
9. Because for Me the isles are waiting (or, must wait) and the ships of
Tarshish in the first place, to bring thy sons from far, their silver and
their gold with them, for the name of Jehovah thy God, and for the
Holy One of Israel, because He has glorified thee.
10. And strangers shall build thy walls, and their kings shall serve thee;
for in My wrath I smote thee, and in My favour I have had mercy on
thee. 11. And thy gates shall be open continually, day and night they
shall not be shut, to bring into thee the strength of nations and their
kings led (captive, or, in triumph). 12. For the nation and the kingdom
which will not serve thee shall perish, and the nations shall be
desolated, desolated.
13. The glory of Lebanon to thee shall come, cypress, plane, and box
together, to adorn the place of My sanctuary, and the place of My feet I
will honour.
14. Then shall come to thee bending the sons of thy oppressors, then
shall bow down to the soles of thy feet all thy despisers, and shall call
thee the City of Jehovah, Zion the holy place of Israel (or, the Zion of
the Holy One of Israel).
15. Instead of thy being forsaken and hated, and with none passing
(through thee), and I will place thee for a boast of perpetuity, a joy of
age and age. 16. And they shalt suck the milk of nations, and the breast
of kings shalt thou suck, and thou shalt know that I, Jehovah, am thy
Saviour, and (that) thy Redeemer (is) the Mighty One of Jacob.
17. Instead of brass (or, copper) I will bring gold, and instead of iron I
will bring silver, and instead of wood brass, and instead of stones iron,
and I will place (or, make) thy government peace, and thy rulers
righteousness.
18. There shall be no more heard violence in thy land, desolation and
ruin in thy borders (or, within thy bounds); and thou shalt call
salvation thy walls, and thy gates praise. 19. No more shall be to thee
the sun for a light by day, and for brightness the moon shall not shine
to thee, and Jehovah shall become thy everlasting light, and thy God
thy glory. 20. The sun shall set no more, and thy moon shall not be
withdrawn; for Jehovah shall be unto thee an eternal light, and
completed the days of thy mourning. 21. And thy people, all of them
righteous, for ever shall inherit the earth, the branch (or, shoot) of My
planting, the work of My hands, to glorify Myself (or, to be glorified).
22. The little one shall become a thousand, and the small one a strong
nation; I, Jehovah, in its time will hasten it.
LXI.—[After describing the new condition of the Church, he again
introduces the great Personage by whom the change is to be brought
about. His mission and its object are described by Himself in vers. 1–3.
Its grand result shall be the restoration of a ruined world, ver. 4. The
Church, as a mediator between God and the revolted nations, shall
enjoy their solace and support, vers. 5, 6. The shame of God’s people
shall be changed to honour, ver. 7. The Church once restricted as a
single nation, shall be recognised and honoured among all, ver. 9. He
triumphs in the prospect of the universal spread of truth and
righteousness, vers. 10, 11.]
1. The Spirit of the Lord Jehovah (is) upon me, because Jehovah hath
anointed me to bring good news to the humble, He hath sent me to
bind up the broken in heart, to proclaim to captives freedom, and to
the bound open opening (of the eyes or of the prison doors); 2. to
proclaim a year of favour for Jehovah, and a day of vengeance for our
God; to comfort all mourners, 3. to put upon Zion’s mourners—to give
them a crown instead of ashes, the oil of joy for mourning, a garment
of praise for a faint spirit; and it shall be called to them (or, they shall
be called) the oaks of righteousness, the planting of Jehovah (i.e.,
planted by Jehovah) to glorify Himself.
4. And they shall bind up the ruins of antiquity, the desolations of the
ancients they shall raise, and shall renew the cities of ruin (i.e., ruined
cities), the desolations of age and age. 5. Then shall stand strangers and
feed your flocks, and the children of outland (shall be) your
ploughmen and your vine-dressers. 6. And ye (or more emphatically, as
for you), the priests of Jehovah shall ye be called, the ministers of our
God shall be said to you (or, of you), the strength of nations shall ye
eat, and in their glory shall ye substitute yourselves. 7. Instead of your
shame (ye shall have) double, and (instead of their) confusion they
shall celebrate their portion; therefore in their land shall they inherit
double, everlasting joy shall be to them. 8. For I am Jehovah, loving
justice, hating (that which is) taken away unjustly, and I will give their
hire truly, and an everlasting covenant I strike for them. 9. Then shall
be known among the nations their seed, and their issue in the midst of
the peoples. All seeing them shall acknowledge them that they are a
seed Jehovah has blessed.
10. (I will) joy, I will joy in Jehovah, let my soul exult in my God; for He
hath clothed me with garments of salvation, a mantle of righteousness
has He put on me, as a bridegroom adjusts his priestly crown, and as
the bride arrays her jewels. 11. For as the earth puts forth its growth,
and as the garden makes its plants to grow, so shall the Lord Jehovah
make to grow righteousness and praise before all the nations.
LXII.—[The words of the great Deliverer are continued from the
foregoing chapter. He will not rest until the glorious change in the
condition of His people is accomplished, ver. 1. They shall be
recognised by kings and nations as the people of Jehovah, vers. 2, 3.
She who seemed to be forsaken is still His spouse, vers. 4, 5. The
Church is required to watch and pray for the fulfilment of the promise,
vers. 6, 7. God has sworn to protect her and supply her wants, ver. 8, 9.
Instead of a single nation, all the nations of the earth shall flow unto
her, ver 10. The good news of salvation shall no longer be confined, but
universally diffused, ver 11. The glory of the Church is the redemption
of the world, ver. 12.]
1. For Zion’s sake I will not be still, and for Jerusalem’s sake I will not
rest, until her righteousness go forth as brightness, and her salvation as
a lamp (that) burneth. 2. And nations shall see thy righteousness, and
all kings thy glory; and there shall be called in thee a new name, which
the mouth of Jehovah shall utter. 3. And thou shalt be a crown of
beauty in Jehovah’s hand, and a diadem of royalty in the palm of thy
God. 4. No more shall it be called to thee (shalt thou be called) Azubah
(Forsaken), and thy land shall no more be called Shemamah
(Desolate), but thou shalt be called Hephzibah (my delight is in her),
and thy land Beulah (married), for Jehovah delights in thee, and thy
land shall be married. 5. For (as) a young man marrieth a virgin, (so)
shall thy sons marry thee, and (with) the joy of a bridegroom over a
bride shall thy God rejoice over thee.
6. On thy walls, O Jerusalem, I have set watchmen; all the day and all
the night long they shall not be silent. Ye that remind Jehovah, let
there be no rest to you, 7. and give no rest to Him, until He establish
and, until He place Jerusalem a praise in the earth.
8. Sworn hath Jehovah by His right hand, and by His arm of strength, If
I give (i.e., I will not give) thy corn any more as food to thine enemies,
and if the sons of the outland shall drink thy new wine which thou hast
laboured in (I am not God). 9. For those gathering it shall eat it, and
shall praise Jehovah, and those collecting it shall drink it in My holy
courts (or, in the courts of My sanctuary). 10. Pass, pass through the
gates, clear the way of the people, raise high, raise high the highway,
free (it) from stones, raise a banner (or, a signal) over the nations.
11. Behold, Jehovah has caused it to be heard to the end of the earth,
Say ye to the daughter of Zion, Behold thy salvation cometh; behold,
His reward is with Him and His hire before Him. 12. And they shall call
them the Holy People, the redeemed of Jehovah, and thou shalt be
called Derushah (sought for), Ir-lo-neczabah (city not forsaken).
LXIII.—[The influx of the Gentiles into Zion having been described in
the preceding verses, the destruction of her enemies is now sublimely
represented as a sanguinary triumph of Jehovah or the Messiah, vers. 1–
6. The prophet then supposes the catastrophe already past, and takes a
retrospective view of God’s compassion towards His people, and of
their unfaithfulness during the old economy, vers. 7–14. He assumes
the tone of earnest supplication, such as might have been offered by
the believing Jews when all seemed lost in the destruction of the
commonwealth and temple, vers. 15–19.]
LXIV.—[This chapter is inseparable from the one before it. The
strongest confidence is expressed in the Divine power, founded upon
former experience, vers. 1–3. The two great facts of Israel’s rejection as a
nation, and the continued existence of the Church, are brought
together in ver. 4. The unworthiness of Israel is acknowledged still
more fully, ver. 5, 6. The sovereign authority of God is humbly
recognised, ver. 7. His favour is earnestly implored, ver. 8. The external
prerogatives of Israel are lost, ver. 9. But will God for that cause cast off
the true Israel, His own people? ver. 10.]
1. Who (is) this coming from Edom, bright (as to His) garments from
Bozrah, this one adorned in His apparel, bending in the abundance of
His strength?
I, speaking in righteousness, mighty to save.
2. Why (is there) redness to Thy raiment, and (why are) Thy garments
like (those of) one treading in a wine-press?
3. The press I have trodden by Myself, and of the nations there was not
a man with Me; and I will tread them in My anger, and trample them in
My fury, and in their juice shall spirt upon My garments, and all My
vesture I have stained. 4. For the day of vengeance (is) in My heart, and
the year of My redeemed is come. 5. And I look, and there is none
helping; and I stand aghast, and there is none sustaining; and My own
arm saves for Me, and My fury it sustains Me. 6. And I tread the
nations in My anger, and I make them drunk in My wrath, and I bring
down to the earth their juice.
7. The mercies of Jehovah I will cause to be remembered, the praises of
Jehovah, according to all that Jehovah hath done for us, which He hath
done for them, according to His compassions, and according to the
multitude of His mercies.
8. And He said, Only they are My people, (My) children shall not lie
(or, deceive), and He became a Saviour for them. 9. In all their enmity
He was not an enemy, and the angel of His face (or, presence) saved
them; in His love and in His sparing mercy He redeemed them, and He
took them up and carried them all the days of old. 10. And they
rebelled, and grieved His Holy Spirit (or, Spirit of holiness), and He
was turned from them into an enemy, He himself fought against them.
11. And he remembered the days of old, Moses (and) his people. Where
is He that brought them up from the sea, the shepherd of His flock?
Where is He that put within him His Holy Spirit? 12. Leading them by
the right hand of Moses (and) His glorious arm, cleaving the waters
from before them, to make for Him an everlasting name? 13. Making
them walk in the depths, like the horse in the desert they shall not
stumble. 14. As the herd into the valley will go down, the Spirit of
Jehovah will make him rest. So didst Thou lead Thy people, to make for
Thyself a name of glory.
15. Look (down) from heaven and see from Thy dwelling-place of
holiness and beauty! Where is Thy zeal and Thy might (or, mighty
deeds)? The sounding of Thy bowels and Thy mercies towards me have
withdrawn themselves. 16. For Thou (art) our Father; for Abraham hath
not known us, and Israel will not recognise us; Thou Jehovah art our
Father, our Redeemer of old (or, from everlasting) is Thy name.
17. Why wilt Thou make us wander, O Jehovah, from Thy ways? (why)
wilt Thou harden our heart from Thy fear? Return, for the sake of Thy
servants, the tribes of Thy inheritance. 18. For a little Thy holy people
possessed, our enemies trod down Thy sanctuary. 19. We are of old,
Thou has not ruled over them, Thy name has not been called upon
them. LXIV.—1. Oh that Thou wouldst rend the heavens (and) come
down, (that) from before Thee the mountains might quake (or flow
down), 2. as fire kindles brush, fire boils water—to make known Thy
name to Thine enemies, from before Thee nations shall tremble. 3. In
Thy doing fearful things (which) we expect not, (oh that) Thou
wouldst come down, (that) the mountains before Thee might flow
down. 4. And from eternity they have not heard, they have not
perceived by the ear, the eye hath not seen, a God beside Thee (who)
will do for (one) waiting for Him.
5. Thou hast met with one rejoicing and executing righteousness; in
Thy ways shall they remember Thee; behold, Thou hast been wroth,
and we have sinned; in them is perpetuity, and we shall be saved.
6. And we were like the unclean all of us, and like a filthy garment all
our righteousness (virtues or good works), and we faded like the
(fading) leaf all of us, and our iniquities like the wind will take us up
(or, carry us away). 7. And there is no one calling on Thy name, rousing
himself to lay hold on Thee; for Thou hast hid Thy face from us, and
hast melted us because of (or, by means of) our iniquities.
8. And now Jehovah, our Father (art) Thou, we the clay and Thou our
potter, and the work of Thy hands (are) we all. 9. Be not angry, O
Jehovah, to extremity, and do not to eternity remember guilt; lo, look,
we pray thee, Thy people (are) we all. 10. The holy cities are a desert,
Zion is a desert, Jerusalem a waste. 11. Our house of holiness and
beauty (in) which our fathers praised Thee has been burned up with
fire, and all our delights (or, desirable places) have become a
desolation. 12. Wilt Thou for these (things) restrain Thyself, O Jehovah,
wilt Thou keep silence and afflict us to extremity?
LXV.—[The grand enigma of Israel’s simultaneous loss and gain is
solved by a prediction of the calling of the Gentiles, ver. 1. This is
connected with the obstinate unfaithfulness of the chosen people, ver.
2. They are represented under the two main aspects of their character
at different periods, as gross idolaters and as pharisaical bigots, vers. 3–
5. Their casting off was not occasioned by the sins of one generation,
but of many, vers. 6, 7. But even in this rejected race there was a chosen
remnant, in whom the promises shall be fulfilled, vers. 8–10. He then
reverts to the idolatrous Jews, and threatens them with condign
punishment, vers. 11, 12. The fate of the unbelieving carnal Israel is
compared with that of the true spiritual Israel, vers. 13–16. The gospel
economy is described as a new creation, ver. 17. Its blessings are
represented under glowing figures borrowed from the old
dispensation, vers. 18–19. Premature death shall be no longer known,
ver. 20. Possession and enjoyment shall no longer be precarious, vers.
21–23. Their very desires shall be anticipated, ver. 24. All animosities
and noxious influences shall cease for ever, ver. 25.]
1. I have been inquired of by those that asked not, I have been found by
those that sought Me not; I have said, Behold Me, behold Me, to a
nation (that) was not called by My name. 2. I have spread (or,
stretched) out My hands all the day (or, every day) to a rebellious
people, those going the way not good, after their own thoughts (or,
designs)—3. the people angering Me to My face continually, sacrificing
in the gardens, and censing on the bricks; 4. sitting in the graves, and
in the holes they will lodge, eating the flesh of swine, and broth of
filthy things (is in) their vessels; 5. the (men) saying, Keep to thyself,
come not near to me, for I am holy to thee,—these (are) a smoke in My
wrath, a fire burning all the day (or, every day). 6 and 7. Lo, it is written
before Me, I will not rest except I repay, and I will repay into their
bosom your iniquities and the iniquities of your fathers together, saith
Jehovah, who burned incense on the mountains, and on the hills
blasphemed Me, and I will measure their first work into their bosom.
8. Thus saith Jehovah, as (when) juice is found in the cluster, and one
says, Destroy it not, for a blessing is in it, so will I do for the sake of My
servants, not to destroy the whole. 9. And I will bring forth from Jacob
a seed, and from Judah an heir of My mountains, and My chosen ones
shall inherit it, and My servants shall dwell there. 10. And Sharon shall
be for (or, become) a home of flocks, and the valley of Achor a lair of
herds, for My people who have sought Me.
11. And (as for) you, forsakers of Jehovah, the (men) forgetting My holy
mountain, the (men) setting for Fortune a table, and the (men) filling
for Fate a mingled draught; 12. and I have numbered you to the sword,
and all of you to the slaughter shall bow; because I called and ye did
not answer, I spake and ye did not hear, and ye did the (thing that was)
evil in my eyes, and that which I desired not ye chose.
13 and 14. Therefore thus saith the Lord Jehovah, Lo! My servants shall
eat and ye shall hunger; lo, My servants shall drink and ye shall thirst;
lo, My servants shall rejoice and ye shall be ashamed; lo, My servants
shall shout from gladness of heart, and ye shall cry from grief of heart,
and from brokenness of spirit ye shall howl. 15. And ye shall leave your
name for an oath to My chosen ones, and the Lord Jehovah shall slay
thee, and shall call His servants by another name (lit. call another
name to them), 16. (by) which the (man) blessing himself in the land
(or, earth) shall bless himself by the God of truth, and (by which) the
(man) swearing in the land (or, earth) shall swear by the God of truth,
because forgotten are the former enmities (or, troubles), and because
they are hidden from My eyes.
17. For lo I (am) creating (or, about to create) new heavens and a new
earth, and the former (things) shall not be remembered, and shall not
come up into the mind (lit. on the heart). 18. But rejoice and be glad
unto eternity (in) that which I (am) creating, for lo, I (am) creating
Jerusalem a joy, and her people a rejoicing. 19. And I will rejoice in
Jerusalem, and joy in My people; and there shall not be heard in her
again the voice of weeping and the voice of crying. 20. There shall be
no more from there an infant of days, and an old man who shall not
fulfil his days, for the child a hundred years old shall die, and the sinner
a hundred years old shall be accursed. 21 and 22. And they shall build
houses and inhabit (them), and shall plant vineyards and eat the fruit
of them, they shall not build and another inhabit, they shall not plant
and another eat; for as the days of a tree (shall be) the days of My
people, and the work of their hands My chosen ones shall wear out (or,
survive). 23. They shall not labour in vain, and they shall not bring
forth for terror; for the seed of the blessed of Jehovah are they, and
their offspring with them. 24. And it shall be (or, come to pass), that
they shall not yet have called and I will answer, yet (shall) they (be)
speaking and I will hear. 25. The wolf and the lamb shall feed as one,
and the lion like the ox shall eat straw, and the serpent dust (for) his
food. They shall not hurt and they shall not corrupt (or, destroy) in all
My holy mountain, saith Jehovah.
LXVI.—[This chapter winds up the prophetic discourse with an express
prediction of the change of dispensation, and a description of the
difference between them. Jehovah will no longer dwell in temples
made with hands, ver. 1. Every sincere and humble heart shall be His
residence, ver. 2. The ancient sacrifices, though Divinely instituted, will
henceforth be as hateful as the rites of idolatry, ver. 3. They who still
cling to the abrogated ritual will be fearfully but righteously requited,
ver. 4. The true Israel cast out by these deluded sinners shall ere long
be glorified, and the carnal Israel fearfully rewarded, vers. 5, 6. The
ancient Zion may already be seen travailing with a new and glorious
dispensation, vers. 7–9. They who mourned for her seeming
desolation, now rejoice in her abundance and her honour, vers. 10–14.
At the same time the carnal Israel shall be destroyed, as apostates and
idolaters, vers. 15–17. The place where they once occupied shall now be
filled by the elect from all nations, ver. 18. To gather these, a remnant of
the ancient Israel shall go forth among the Gentiles, ver. 19. They shall
come from every quarter, and by every mode of conveyance, ver. 20.
They shall be admitted to the sacerdotal honours by the chosen people,
ver. 21. This new dispensation shall not be temporary, like the one
before it, but shall last for ever, ver. 22. While the spiritual Israel is thus
replenished from all nations, the apostate Israel shall perish by a
lingering decay in the sight of an astonished world, ver. 23, 24.]
1. Thus saith Jehovah, the heavens (are) My throne, and the earth My
footstool; where is (or, what is) the house which ye will build for Me,
and where is (or, what is) the place of My rest? 2. And all these My own
hand made, and all these were (or, are), saith Jehovah; and to this one
will I look, to the afflicted and contrite in spirit, and trembling at My
word.
3. Slaying the ox, smiting a man—sacrificing the sheep, breaking a
dog’s neck—offering an oblation, blood of swine—making a memorial
of incense, blessing vanity—also they have chosen their ways, and in
their abominations has their soul delighted. 4. I also will choose their
vexations, and their fear I will bring unto them; because I called and
there was no answering, I spake and they did not hear, and they did evil
in My eyes, and that which I delight not in they chose.
5. Hear the word of Jehovah, ye that tremble at His word. Your brethren
say, (these) hating you and casting you out for My name’s sake, Jehovah
will be glorified, and we shall gaze upon our joy—and they shall be
ashamed. 6. A voice of tumult from the city! A voice from the temple!
The voice of Jehovah, rendering requital to His enemies!
7. Before she travailed she brought forth, before her pain came she was
delivered of a male. 8. Who hath heard such a thing? Who hath seen
such things? Shall a land be brought forth in one day, or shall a nation
be born at once? For Zion hath travailed, she hath also brought forth
her children. 9. Shall I bring to the birth and not cause to bring forth?
saith Jehovah. Or am I the one causing to bring forth, and shall I shut
up? saith thy God.
10. Rejoice ye with Jerusalem, and exult in her, all that love her; and be
glad with her with gladness, all those mourning for her. 11. that ye may
suck and be satisfied from the breast of her consolations, that ye may
milk out and enjoy yourselves, from the fulness (or, the full breast) of
her glory. 12. For thus saith Jehovah, Behold, I am extending to her
peace like a river, and like an overflowing stream the glory of nations;
and ye shall suck; on the side shall ye be borne, and on the knees shall
ye be dandled. 13. As a man who his mother comforteth, so will I
comfort you, and in Jerusalem shall ye be comforted. 14. And ye shall
see, and your heart shall leap (with joy), and your bones like grass shall
sprout, and the hand of Jehovah shall be known to His servants, and
He shall be indignant at His enemies.
15. For lo, Jehovah in fire will come, and like the whirlwind His
chariots, to appease in fury His anger, and His rebuke in flames of fire.
16. For by fire is Jehovah striving and by His sword with all flesh, and
multiplied (or, many) are the slain of Jehovah. 17. The (men) hallowing
themselves and the (men) cleansing themselves to (or, towards) the
gardens after one in the midst, eaters of swine’s flesh and vermin and
mouse, together shall cease (or, come to an end), saith Jehovah.
18. And I—their works and their thoughts—it is come—to gather all
the nations and the tongues—and they shall come and see My glory.
19. And I will place in them (or, among them) a sign, and I will send of
them survivors (or, escaped ones) to the nations, Tarshish, Pul, and
Lud, drawers of the bow, Tubal and Javan, distant isles, which have not
heard my fame, and have not seen My glory, and they shall declare My
glory among nations. 20. And they shall bring all your brethren from
all nations, an oblation to Jehovah, with horses, and with chariot, and
with litters, and with mules, and with dromedaries, on My holy
mountain Jerusalem, saith Jehovah, as the children of Israel bring the
oblation in a clean vessel to the house of Jehovah. 21. And also of them,
will I take for the priests, for the Levites, saith Jehovah. 22. For as the
new heavens and the new earth, which I am making (or, about to
make), are standing (or, about to stand) before Me, saith Jehovah, so
shall stand your name and your seed.
23. And it shall be (or, come to pass) that from new-moon to new-
moon (or, on every new-moon), and from Sabbath to Sabbath (or, on
every Sabbath), shall come all flesh to bow themselves (or, worship)
before Me, saith Jehovah. 24. And they shall go forth and gaze upon the
carcasses of the men who revolted (or, apostatised) from Me, for their
worm shall not die, and their fire shall not be quenched, and they shall
be a horror to all flesh.
 TRANSLATION
of the
PROPHECIES OF ISAIAH,

By Delitzsch and Martin.[1]

general title.—chap. i. 1.
Seeing of Yesha’-yahu, son of Amoz, which he saw over Judah and
Jerusalem in the days of Uzziyahu, Jotham, Ahaz, and Yehizkiyahu, the
kings of Judah.

PART I.
prophecies relating to the onward course of the great mass of the
people towards hardening of heart.—chaps. i.–vi.
Opening Address Concerning the Ways of Jehovah with His Ungrateful
and Rebellious Nation.—Chap. i. 2., sqq.
2. Hear, O heavens; and give ear, O earth; for Jehovah speaketh! I have
brought up children, and raised them high, and they have fallen away
from Me. 3. An ox knoweth its owner, and an ass its master’s crib: Israel
doth not know, my people doth not consider.
4. Woe upon the sinful nation, the guilt-laden people, the miscreant
race, the children acting corruptly! They have forsaken Jehovah,
blasphemed Israel’s Holy One, turned away backwards.
5. Why would ye be perpetually smitten, multiplying rebellion? Every
head is diseased, and every heart is sick. 6. From the sole of the foot
even to the head there is no soundness in it: cuts, and stripes, and
festering wounds; they have not been pressed out, nor bound up, nor
has there been any soothing with oil. 7. Your land . . . a desert; your
cities . . . burned with fire; your field . . . foreigners consuming it before
your eyes, and a desert like overthrowing by strangers. 8. And the
daughter of Zion remains like a hut in a vineyard; like a hammock in a
cucumber field, as a besieged city. 9. Unless Jehovah of hosts had left
us a little of what had escaped, we had become like Sodom, we were
like Gomorrah.
10. Hear the word of Jehovah, ye Sodom judges; give ear to the law of
our God, O Gomorrah nation! 11. What is the multitude of your slain
offerings to Me? saith Jehovah. I am satiated with the whole offerings
of rams, and the fat of stalled calves; and blood of bullocks and sheep
and he-goats I do not like. 12. When ye come to appear before My face,
who hath required this at your hands, to tread My courts? 13. Continue
not to bring lying meat offering; abomination incense is it to Me. New-
moon and Sabbath, calling of festal meetings . . . I cannot bear
ungodliness and a festal crowd. 14. Your new-moons and your festive
seasons My soul hateth; they have become a burden to Me; I am weary
of bearing them. 15. And if ye stretch out your hands, I hide Mine eyes
from you; if ye make ever so much praying, I do not hear: your hands
are full of blood.
16. Wash, clean yourselves; put away the badness of your doings from
the range of My eyes; cease to do evil; 17. learn to do good, attend to
judgment, set the oppressor right, do justice to the orphan, conduct
the cause of the widow.
18. O come, and let us reason together, saith Jehovah. If your sins come
forth like scarlet cloth, they shall become white as snow; if they are red
as crimson, they shall come forth like wool! 19. If ye then shall willingly
hear, ye shall eat the good of the land; 20. if ye shall obstinately rebel,
ye shall be eaten by the sword! for the mouth of Jehovah hath spoken
it.
21. How is she become an harlot, the faithful citadel! she, full of right,
lodged in righteousness, and now——murderers. 22. Thy silver has
become dross, thy drink mutilated with water. 23. Thy rulers are
rebellious and companions of thieves; every one loveth presents, and
hunteth after payment; the orphan they right not, and the cause of the
widow has no access to them.
24. Therefore, saying of the Lord, of Jehovah of hosts, of the Strong
One of Israel; Ah! I will relieve Myself on Mine adversaries, and will
avenge Myself upon Mine enemies; 25. and I will bring My hand over
thee, and will smelt out thy dross as with alkali, and will clear away all
thy lead. 26. And I will bring back thy judges as in the olden time, and
thy counsellors as in the beginning; afterwards thou wilt be called City
of Righteousness, Faithful Citadel.
27. Zion will be redeemed through judgment, and her returning ones
through righteousness; 28. and breaking up of the rebellious and
sinners together; and those who forsake Jehovah will perish. 29. For
they become ashamed of the terebinths, in which ye had your delight;
and ye must blush for the gardens, in which ye took pleasure. 30. For ye
shall become like a terebinth with withered leaves, and like a garden
that hath no water. 31. And the rich man becomes tow, and his work
the spark; and they will both burn together, and no one extinguishes
them.

FOOTNOTES:

[1] Reprinted from the Biblical Commentary on the Prophecies of

Isaiah, by Franz Delitzsch, D.D. Translated from the German by the
Rev. James Martin, B.A. 2 vols. 8vo. Edinburgh: T. & T. Clark.

the way of general judgment; or the course of israel from false glory to
the true—chaps. ii.–iv.
II.—1. The word which Isaiah the son of Amoz saw of Judah and
Jerusalem.
2. And it cometh to pass at the end of the days, the mountain of the
house of Jehovah will be set at the top of the mountains, and exalted
over hills; all nations pour unto it. 3. And peoples in multitude go and
say, Come, let us go up to the mountain of Jehovah, to the house of the
God of Jacob; let Him instruct us out of His ways, and we will walk in
His paths: for instruction will go out from Zion, and the word of
Jehovah from Jerusalem. 4. And He will judge between the nations, and
deliver justice to many peoples; and they forge their swords into
coulters, and their spears into pruning-hooks. Nation lifts not up
sword against nation, neither do they exercise themselves in war any
more.
5. O house of Jacob, come, let us walk in the light of Jehovah.
6. For Thou hast rejected Thy people, the house of Jacob; for they are
filled with things from the east and are conjurors like the Philistines;
and with the children of foreigners they go hand in hand. 7. And their
land is filled with silver and gold, and there is no end in their treasures;
and their land is filled with horses, and there is no end of their
chariots. 8. And their land is filled with —— idols; the work of their
own hands they worship, that which their own fingers have made.
9. Thus, then, men are bowed down, and lords are brought low; and
forgive them—no, that Thou wilt not. 10. Creep into the rock, and bury
thyself in the dust, before the terrible look of Jehovah, and before the
glory of His majesty. 11. The people’s eyes of haughtiness are humbled,
and the pride of their lords is bowed down; and Jehovah, He only,
stands exalted in that day.
12. For Jehovah of hosts hath a day over everything towering and lofty,
and over everything exalted; and it becomes low. 13. As upon all the
cedars of Lebanon, the lofty and exalted, so upon all the oaks of
Bashan; 14. as upon all mountains, the lofty ones, so upon all hills the
exalted ones; 15. as upon every high tower, so upon every fortified wall;
16. as upon all ships of Tarshish, so upon all works of curiosity. 17. And
the haughtiness of the people is bowed down, and the pride of the
lords brought low; and Jehovah, He alone, stands exalted in that day.
18. And the idols pass utterly away. 19. And they will creep into caves in
the rocks, and cellars in the earth, before the terrible look of Jehovah,
and before the glory of His majesty, when He ariseth to put the earth in
terror. 20. In that day will a man cast away his idols of gold; and his
idols of silver, which they made for him to worship, to the moles and to
the bats; 21. to creep into the cavities of the stone-blocks, and into the
clefts of the rocks, before the terrible look of Jehovah and before the
glory of His majesty, when He arises to put the earth in terror.
22. Oh then, let man go, in whose nose is a breath, for what is he to be
estimated at? III.—1. For, behold, the Lord, Jehovah of hosts, takes
away from Jerusalem and from Judah supporter and means of support,
every support of bread and every support of water; 2. hero and man of
war, judge and prophet, and soothsayer and elder; 3. captains of fifty,
and the highly distinguished, and counsellors, and masters in art, and
those skilled in muttering. 4. And I will give the boys for princes, and
caprices shall rule over them. 5. And the people oppress one another,
one this and another that; the boy breaks out violently upon the old
man, and the despised upon the honoured. 6. When a man shall take
hold of his brother in his father’s house, Thou hast a coat, thou shalt
be our ruler, and take this ruin under thy hand; 7. he will cry out in that
day, I do not want to be a surgeon; there is neither bread nor coat in my
house: ye cannot make me the ruler of the people.
8. For Jerusalem is ruined and Judah fallen; because their tongue and
their doings are against Jehovah, to defy the eyes of His glory. 9. The
look of their faces testifies against them, and their sin they make
known like Sodom, without concealing it: woe to their soul! for they do
themselves harm. 10. Say of the righteous, that it is well with him; for
they will enjoy the fruit of their doings. 11. Woe to the wicked! it is ill;
for what his hands have wrought will be done to him. 12. My people, its
oppressors are boys, and women rule over it; my people, thy leaders are
misleaders, who swallow up the way of thy paths.
13. Jehovah has appeared to plead, and stands up to judge the nations.
14. Jehovah will proceed to judgment with the elders of His people, and
its princes. And ye, ye have eaten of the vineyard; prey of the suffering
is in your houses. 15. What mean ye that ye crush My people, and grind
the face of the suffering? thus saith the Lord of hosts.
16. Jehovah hath spoken: because the daughters of Zion are haughty,
and walk about with extended throat, and blinking with the eyes, walk
about with tripping gait, and tinkle with their foot-ornaments: 17. the
Lord of all makes the crown of the daughters of Zion scabbed, and
Jehovah will uncover their shame. 18. On that day the Lord will put
away the show of the ankle-clasps, and of the head-bands, and of the
crescents; 19. the ear-rings, and the arm-chains, and the light veils;
20. the diadems, and the stepping-chains, and the girdles, and the
smelling-bottles, and the amulets; 21. the finger-rings and the nose-
rings; 22. the gala dresses, and the sleeve-frocks, and the wrappers, and
the pockets; 23. the hand-mirrors, and the Sindu-cloths, and the
turbans, and the gauze mantles. 24. And instead of balmy scent there
will be mouldiness, and instead of artistic ringlets a baldness, and
instead of the dress-cloak a frock of sack-cloth, branding instead of
beauty. 25. Thy men fall by the sword, and thy might in war. 26. Then
will her gates lament and mourn, and desolate is she and sits down
upon the ground. IV.—1. And seven women lay hold of one man in that
day, saying, We will eat our own bread, and wear our own clothes; only
let thy name be named upon us, take away our reproach.
2. In that day will the Sprout of Jehovah become an ornament and
glory, and the fruit of the land pride and splendour for the redeemed of
Israel. 3. And it will come to pass, whoever is left in Zion and remains
in Jerusalem, holy will he be called, all who are written down for life in
Jerusalem: 4. when the Lord shall have washed away the filth of the
daughters of Zion, and shall have purged away the blood-guiltiness of
Jerusalem from the midst thereof, by the spirit of judgment and by the
spirit of sifting. 5. And Jehovah creates over every spot of mount Zion,
and over its festal assemblies, a cloud by day, and smoke, and the
shining and flaming fire by night; for over all the glory comes a canopy;
6. and it will be a booth for shade by day and covert from storm and
from rain.
 judgment of devastation upon the vineyard of jehovah.—chap. v.
Closing Words of the First Cycle of Prophecies.
1. Arise, I will sing of my beloved, a song of my dearest touching His
vineyard.
My beloved had a vineyard on a flatly-nourished mountain-horn,
2. and dug it up and cleared it of stones, and planted it with noble
vines, and built a tower in it, and also hewed out a winepress therein;
and hoped that it would bring forth grapes, and it brought forth wild
grapes.
3. And now, O inhabitants of Jerusalem and men of Judah, judge, I pray
you, between Me and My vineyard! 4. What could have been done
more to My vineyard that I have not done in it! Wherefore did I hope
that it would bring forth grapes, and it brought forth wild grapes?[1]
5. Now then, I will tell you what I will do at once to My vineyard: Take
away its hedges, and it shall be for grazing; pull down its wall, and it
shall be for treading down; 6. and I will put an end to it: it shall not be
pruned nor dragged, and it shall break out in thorns and thistles, and I
will command the clouds to rain no rain over it. 7. For the vineyard of
Jehovah of hosts is the house of Israel, and the men of Judah are the
plantation of His delight: He waited for justice, and behold, grasping;
for righteousness, and behold, a shriek!
8. Woe unto them that join house to house, who lay field to field, till
there is no more room, and ye alone are dwelling in the midst of the
land. 9. Into mine ears, Jehovah of hosts: Of a truth many houses shall
become a wilderness, great and beautiful ones deserted. 10. For ten
yokes of vineyard will yield one pailful, and a quarter of seed-corn will
produce a bushel.
11. Woe unto them that rise up early in the morning to run after strong
drink: who continue till late at night with wine inflaming them! 12. And
guitar and harp, kettle-drum, and flute, and wine is in their feast; but
they regard not the work of Jehovah, and see not the purpose of His
hands.
13. Therefore My people go into banishment without knowing; and
their glory will become starving men, and their tumult men dried up
with thirst. 14. Therefore the under-world opens its jaws wide, and
stretches open its mouth immeasurably wide; and the glory of
Jerusalem descends, and its tumult, and noise, and those who rejoice
within it. 15. Then are mean men bowed down, and lords humbled, and
the eyes of lofty men are humbled. 16. And Jehovah of hosts shows
Himself exalted in judgment, and God the Holy One sanctifies Himself
in righteousness; 17. and lambs feed as upon their pasture, and nomad
shepherds eat the waste places of the fat ones.[2]
18. Woe unto them that draw crime with cords of lying, and sin as with
the rope of the waggon; 19. who say, Let Him hasten, accelerate His
work, that we may see; and let the counsel of the Holy One of Israel
draw near and come, that we may experience it.
20. Woe to those who call evil good, and good evil; who give out
darkness for light, and light for darkness; who give out bitter for sweet,
and sweet for bitter.
21. Woe unto them that are wise in their own eyes, and prudent in their
own sight.
22. Woe unto those who are heroes to drink wine, and brave men to
mingle strong drink; 23. who acquit criminals for a bribe, and take away
from every one the righteousness of the righteous.
24. Therefore, as the tongue of fire devours stubble, and hay sinks
together in the flame, their root will become like mould, and their
blossom fly up like dust; for they have despised the law of Jehovah of
hosts, and scornfully rejected the proclamation of the Holy One of
Israel. 25. Therefore is the wrath of Jehovah kindled against His people,
and He stretches His hand over them, and sites them; then the hills
tremble, and their carcass become like sweepings in the midst of the
streets.
For all this His anger is not appeased, and His hand is stretched out
still, 26. and lifts up a banner to the distant nations, and hisses to it
from the end of the earth; and, behold, it comes with haste swiftly.
27. There is none exhausted, and none stumbling among them: it gives
itself no slumber, and no sleep; and to none is the girdle of his hips
loosed; and to none is the lace of his shoes broken; 28. he whose arrows
are sharpened, and all his bows strung; the hoofs of his horses are
counted like flint, and his wheels like the whirlwind. 29. Roaring issues
from it as from the lioness: it roars like lions, and utters a low murmur;
seizes the prey, carries it off, and no one rescues. 30. And it utters a
deep roar over it in that day like the roaring of the sea: and it looks to
the earth, and behold darkness, tribulation, and light; it becomes night
over it in the clouds of heaven.[3]

FOOTNOTES:

[1] Barnes, Birks, Henderson, Kay, Strahey, and the Revised English
Bible, translate this clause substantially as it is in the A. V.:—e.g.,
Henderson, “Why, when I expected it to produce grapes did it
produce bad grapes?”
[2] Henderson’s translation of this paragraph is especially vigorous
and beautiful:—
13. Therefore My people are led captive at unaware
Their nobility are starvelings,
And their multitude are parched with thirst.
14. Therefore Sheol enlarges her appetite,
And gapes immeasurably with her mouth;
And down go her nobility and her multitude.
Her noisy throng, and whoever in her that exultest.
15. The man of mean condition is bowed down,
And the man of rank is brought low;
And the eyes of the haughty are humbled.
16. But Jehovah of hosts is exalted through justice,
And the Holy God is sanctified through righteousness.
 17. The lambs shall feed wherever they are driven,
And the waste fields of the rich, strange flocks shall consume.
[3] And one shall look to the earth,
And lo! darkness! trouble!
And the light is obscured by the gloomy clouds.—Barnes.
And one shall look unto the earth, and, behold, darkness; even the
light is an adversary (or, is anguish); dark is it amidst the clouds
thereof.—Kay.

the prophet’s account of his own divine mission.—chap. vi.

1. The year that king Uzziah died, I saw the Lord of all sitting upon a
high and exalted throne, and His borders filling the temple. 2. Above it
stood the seraphim: each one had six wings; with two he covered his
face, with two he covered his feet, and with two he did fly. 3. And one
cried to the other, and said,
Holy, holy, holy! is Jehovah of hosts!
Filling the whole earth is His glory.
4. And the foundation of the threshold shook with the voice of them
that cried; and the house became full of smoke.
5. Then said I, Woe unto me! for I am lost; for I am a man of unclean
lips, and I am dwelling among a people of unclean lips: for mine eyes
have seen the King, Jehovah of hosts.
6. And one of the seraphim flew to me with a red-hot coal in his hand,
which he had taken with the tongs from the altar. 7. And he touched
my mouth with it, and said, Behold, this hath touched thy lips, and
thine iniquity is taken away; and so thy sin is expiated.
8. Then I heard the voice of the Lord, saying, Whom shall I send, and
who will go for us? Then I said, Behold me here; send me!
9. He said, Go, and tell this people, Hear on, and understand not; and
look on, but perceive not. 10. Make ye the heart of this people greasy,
and their ears heavy, and their eyes sticky; that they may not see with
their eyes, and hear with their ears, and their heart understand, and
they be converted, and one heal them.
11. Then said I, Lord, how long?
And He answered, Until towns are wasted without inhabitant, and
houses are without men, and the ground shall be laid waste, a
wilderness, 12. and Jehovah shall put men far away, and there shall be
many forsaken places within the land. 13. And is there still a tenth
therein, this also is given up to destruction, like the terebinth and like
the oak, of which, when they are felled, only a root stump remains:
such a root stump is the holy seed.[1]

FOOTNOTES:

[1] And though there be only a tenth part in it, even that shall be
again consumed; yet as a teil-tree, and as an oak, whose stocks
[stumps] remain to them, when they are felled, so the holy seed
shall be the stock [stump] thereof.—Strachey.

PART II.
consolation of immanuel in the midst of the assyrian oppressions.—
chaps. vii.–xii.
Divine Sign of the Virgin’s Wondrous Son.—Chap. vii.
1. It came to pass, in the days of Ahaz the son of Jotham, the son of
Uzziah, king of Judah, that Rezin the king of Aramæa, and Pekah the
son of Remaliah, king of Israel, went up toward Jerusalem to war
against it, and (he) could not make war upon it. 2. And it was told the
house of David, Aram has settled down upon Ephraim: then his heart
shook, and the heart of the people, as trees of the wood shake before
the wind.
3. Then said Jehovah to Isaiah, Go forth now to meet Ahaz, thou and
Shear-jashub thy son, to the end of the aqueduct of the upper pool, to
the road of the fuller’s field; 4. and say unto him, Take heed, and keep
quiet; and let not thy heart become soft from these two smoking
firebrand stumps! at the fierce anger of Rezin, and Aram, and the son
of Remaliah. 5. Because Aram hath determined evil over thee, Ephraim
and the son of Remaliah, saying, 6. We will march against Judah, and
terrify it, and conquer it for ourselves, and make the son of Tabeal king
in the midst of it: 7. thus saith the Lord Jehovah, It will not be brought
about, and will not take place. 8. For head of Aram is Damascus, and
head of Damascus Rezin, and in five-and-sixty years will Ephraim as a
people be broken to pieces. 9. And head of Ephraim is Samaria, and
head of Samaria the son of Remaliah; if ye believe not, surely ye will
not remain.
10. And Jehovah continued speaking to Ahaz as follows: 11. Ask thee a
sign of Jehovah thy God, going deep down into Hades, or high up to
the height above. 12. But Ahaz replied, I dare not ask, and dare not
tempt Jehovah. 13. And he spake, Hear ye now, O house of David! Is it
too little to you to weary men, that ye weary my God also? 14. Therefore
the Lord, He will give you a sign: Behold, the virgin conceives, and
bears a son, and calls his name Immanuel. 15. Butter and honey will he
eat, at the time that he knows to refuse the evil and choose the good.
16. For before the boy shall understand to refuse the evil and choose
the good, the land will be desolate, of whose two kings thou art afraid.
17. Jehovah will bring upon thee, and upon thy people, and upon thy
father’s house, days such as have not come since the day when Ephraim
broke away from Judah—the king of Asshur. 18. And it comes to pass in
that day, Jehovah will hiss for the fly which is at the end of the Nile-
arms of Egypt, and the bees that are in the land of Asshur; 19. and they
come and settle all of them in the valleys of the slopes, and in the clefts
of the rocks, and in all the thorn-hedges, and upon all grass-plats.
20. In that day will the Lord shave with a razor, the thing for hire on the
shore of the river, with the king of Assyria, the head and the hair of the
feet: and even the beard it will take away. 21. And it will come to pass in
that day, that a man will keep a small cow and a couple of sheep;
22. and it comes to pass, for the abundance of the milk they will give he
will eat cream: for butter and honey will every one eat that is left within
the land. 23. And it will come to pass in that day, every place where a
thousand vines stood at a thousand silverlings will have become thorns
and thistles. 24. With arrows and with bows will men go, for the whole
land will have become thorns and thistles. 25. And all the hills that
were accustomed to be hoed with the hoe, thou wilt not go to them for
fear of thorns and thistles; and it has become a gathering-place for
oxen, and a treading-place for sheep.

two omens of the immediate future.—chap. viii. 1–4.

1. Then Jehovah said to me, Take a large slab, and write upon it with
common strokes, “In speed spoil, booty hastens:” 2. and I will take to
me trustworthy witnesses, Uriyah the priest, and Zehcaryahu the son
of Yeberechyahu.
3. And I drew near to the prophetess; and she conceived, and bare a
son: and Jehovah said to me, Call his name In-speed-spoil-booty-
hastens (Maher-shalal-hash-baz): 4. for before the boy shall know how
to cry, My father, and my mother, they will carry away the riches of
Damascus, and the spoil of Samaria, before the king of Asshur.

esoteric addresses—chap. viii. 5–xii.

A.—Consolation of Immanuel in the Coming Darkness.—Chap. viii. 5–
ix. 6.
5. And Jehovah proceeded still further to speak to me, as follows:—
6. Forasmuch as this people refuseth the waters of Siloah that go softly,
and regardeth as a delight the alliance with Rezin and the son of
Remalyahu, 7. therefore, behold! the Lord of all bringeth up upon
them the waters of the river, the mighty and the great, the king of
Assyria, and all his military power: and he riseth over all his channels,
and goeth over all his banks, 8. and presses forward into Judah,
overflows and pours onward, till it reaches the neck, and the
spreadings out of its wings fill the breadth of thy land, Immanuel.
9. Exasperate yourselves, O nations, and go to pieces; and see it, all
who are far off in the earth! Gird yourselves, and go to pieces; gird
yourselves, and go to pieces! 10. Consult counsel, and it comes to
nought; speak the word, and it is not realised: for with us is God.
11. For Jehovah hath spoken thus to me, overpowering me with God’s
hand, and instructing me not to walk in the way of this people, saying,
12. Call ye not conspiracy all that this people calls conspiracy; and what
is feared by it, fear ye not, neither think ye dreadful. 13. Jehovah of
hosts, sanctify Him; and let Him be your fear, and let Him be your
terror. 14. So will He become a sanctuary, but a stone of stumbling and
a rock of offence (vexation) to both the houses of Israel, a snare and a
trap to the inhabitants of Jerusalem. 15. And many among them shall
stumble, and shall fall; and be dashed to pieces, and be snared and
taken.
16. Bind up the testimony, seal the lesson in my disciples. 17. And I will
wait upon Jehovah, who hides His face before the house of Jacob, and
hope for Him. 18. Behold, I and the children which God hath given me
for signs and types in Israel, from Jehovah of hosts, who dwelleth upon
mount Zion. 19. And when they shall say to you, Inquire of the
necromancers, and of the soothsayers that chirp and whisper:—should
not a people inquire of its God? for the living to the dead? 20. To the
teaching of God, and to the testimony! If they do not accord with this
word, they are a people for whom no morning dawns. 21. And it goes
about therein hardly pressed and hungry: and it comes to pass, when
hunger befalls it, it frets itself, and curses by its king and by its God,
and turns its face upward, 22. and looks to the earth, and behold
distress and darkness, benighting with anguish, and thrust out into
darkness.
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