Healthcare scholars and leaders are tasked with the art of finding the best evidence to implement into practice. Evidence-based practice (EBP) begins with the PICO (T) question. This first step specifies the problem or patient in question (P), intervention, or issue (I), comparing the intervention of interest (C), the outcome (O), and the expected time to meet this outcome (O) (Melnyk & Fineout-Overholt, 2019). Critical appraisal of the evidence can lead to stronger interventions in the PICOT practice. This paper provides critical appraisals, comparisons, and executive summaries for two different research studies. The qualitative appraiser for Howson, Turell, and Roc (2018) looks at patient perception to self-care when living with B-cell non-Hodgkin Lymphoma (NHL). The quantitative appraisal is for a randomized control study by Dorleijn et al. (2018) investigating glucocorticoid injection and pain reduction for hip osteoarthritis.
Successful research appraisal begins with understanding the key components of the study. Research works can range from a few pages to a few hundred. Key elements help the appraiser avoid overload from huge amounts of data and identify those relevant to the clinical problem (Al-Jundi & Sakka, 2017). Grainger (2021) identifies key elements as research evidence, knowledge of experts in the field, and the opinions of experts. Evidence comes as quantitative data showing statistical significance of variables in question and/or from qualitative themes that explain phenomenon and culture. Research is broken down into sections, each containing the information needed to complete an accurate appraisal. The author sections of an article include the author and affiliation, journal name and type, and the article title. These key elements help determine the quality based on peer review, author bias based on any affiliations, and objectives of the research trial (Al-Jundi & Sakka, 2017). Studies may or may not contain an abstract, which provides a quick way to understand the research ai, methods, and conclusions. This provides an abbreviated method to rule in or out initial research based on the PICOT question. The appraiser gets a better understanding of why the study was carried out via the background section. The research evidence is found through examining the methods/materials, results, and discussions sections. Al-Jundi and Sakka (2017) highlight these areas as containing the raw data, tables and graphs, statistical analysis, and interpretations of findings. These sections provide answers for determining validity and credibility. Validity relates to the credibility of the research in that it measured precisely what the intention or purpose of the study showed (Grainger, 2021). The research evidence found in the data and discussion sections provides the detail in determining the impact the independent variable (s) had on the dependent variable. Reliability refers to the consistency or ability to repeat the research. Reliability strength is found in the study’s method, showing the actual survey used (Grainger, 2021). An appraiser should be able to reproduce the study following the specific method, tools/instruments when the conditions are the same.
Critical Appraisal - QualitativeRAPID CRITICAL APPRAISAL QUESTIONS FOR QUALITATIVE EVIDENCE
|1.Are the results of the study valid (i.e., trustworthy and credible)? There is no obvious bias in this study. The study appears trustworthy. The method appears logical and results appear credible.|
|a.How were study participants chosen? Participants were selected based on a diagnosis of B-cell Non-Hodgkin Lymphoma (NHL). Eligibility for the study included: confirmed diagnosis of B-cell NHL, residents of the USA, and recalled the viewing of a 60-minute education program. Participants of the education program were emailed an invitation and screened accordingly.|
|b.How were accuracy and completeness of data assured? The researchers did not know any of the 12 participants interviewed. Interviews were audio-recorded into a web-based software system, transcribed word for word, and imported software system designed for data analysis. A constant comparison process was used for specific interviews and between the interviews, using three components. The components are data immersion and familiarization, descriptive data coding, and thematic coding. The study’s aim integrity was confirmed by the principal investigator.|
|c.How plausible/believable are the results? Study results seem plausible and believable. Themes appear realistic following the completion of the education program. Self-care activities for health and well-being, learning the hard way, developing a relationship with your oncologist, self-education and preparation, and connecting with other people seem believable.|
|i.Are implications of the research stated?||Yes||No||Unknown|
|1.May new insights increase sensitivity to others’ needs?||Yes||No||Unknown|
|2.May understandings enhance situational competence?||Yes||No||Unknown|
|d.What is the effect on the reader? The study helps understand what people go through when facing a B-cell NHL diagnosis. You can imagine being home and researching your diagnosis, figuring out what your options are and how to keep a positive attitude.|
|1.Are results plausible and believable?||Yes||No||Unknown|
|2.Is the reader imaginatively drawn into the experience?||Yes||No||Unknown|
|2.What were the results? The education session provided valuable insights and knowledge for patients diagnosed with B-cell NHL regarding self-care, treatment options, and side effects, and general disease knowledge.|
|a.Does the research approach fit the purpose of the study?||Yes||No||Unknown|
|i.How does the researcher identify the study approach?||Yes||No||Unknown|
|1.Are language and concepts consistent with the approach?||Yes||No||Unknown|
|2.Are data collection and analysis techniques appropriate?||Yes||No||Unknown|
|ii.Is the significance/importance of the study explicit?||Yes||No||Unknown|
|1.Does review of the literature support a need for the study?||Yes||No||Unknown|
|2.What is the study’s potential contribution? Techniques to support Cancer Patient general understandings for disease, treatments, and self-care.|
|iii.Is the sampling strategy clear and guided by study needs?||Yes||No||Unknown|
|1.Does the researcher control selection of the sample?||Yes||No||Unknown|
|2.Do sample composition and size reflect study needs?||Yes||No||Unknown|
|b.Is the phenomenon (human experience) clearly identified? THe lived experiences of B-cell NHL patients is identified with exemplar quotes from patients.|
|i.Are data collection procedures clear?||Yes||No||Unknown|
|1.Are sources and means of verifying data explicit?||Yes||No||Unknown|
|2.Are researcher roles and activities explained?||Yes||No||Unknown|
|ii.Are data analysis procedures described?||Yes||No||Unknown|
|1.Does analysis guide direction of sampling and when it ends?||Yes||No||Unknown|
|2.Are data management processes described?||Yes||No||Unknown|
|c.What are the reported results (description or interpretation)? Descriptive results state general retention of knowledge post-education session. Participants’ recall was generalized. Interpretation of data resulted in emerged themes for self-care such as daily activity, proper nutrition, rest, and mental attitude.|
|i.How are specific findings presented? Finding are in table format with categories for main theme, definition, and exemplar quotes from participants.|
|1.Is presentation logical, consistent, and easy to follow?||Yes||No||Unknown|
|2.Do quotes fit the findings they are intended to illustrate?||Yes||No||Unknown|
|ii.How are overall results presented?|
|1.Are meanings derived from data described in context?||Yes||No||Unknown|
|2.Does the writing effectively promote understanding?||Yes||No||Unknown|
|3.Will the results help me in caring for my patients? This study provided practical information when caring for, supporting patients with a cancer diagnosis. Education and education recall seems to provide benefits for self-care, disease treatment and awareness. Establishing education programs such as the one in this study act as secondary support for patients.|
|a.Are the results relevant to persons in similar situations?||Yes||No||Unknown|
|b.Are the results relevant to patient values and/or circumstances?||Yes||No||Unknown|
|c.How may the results be applied in clinical practice? Newly diagnosed patients with B-Cell NHL or chronic patients can benefit from self-care, diet, treatments, and treatment side effects. This can provide long-term benefits that may benefit while reducing the frequency of acute care needs.|
|Would you use the study results in your practice to make a difference in patient outcomes?|
•Yes, through implementing a patient education program offering in the oncology clinic or acute care setting. •Yes, this provides supportive care and knowledge needed in the home setting. Greater understanding can lead to treatment adherence and self-care activities that promote wellness.
|Additional Comments/Reflections: |
This research provides insight into how patients feel after viewing education for their diagnosis. It provides supportive information that appears beneficial in self-care. The sample size comprised 12 participants, however, the technique to code themes to have captured those relevant. The interview questionnaires were not provided in the research. Participant selection was through an email invitation, requiring the use and acceptance to be considered for the study. Participants must be well-enough to complete these steps.
|Recommendation for article use within a body of evidence: |
The intervention and themes can provide supportive evidence in a body of evidence. This study is a single qualitative study and provides level VI evidence. This study provides strength for patient perception and challenges with self-care, disease awareness, and the effects of educational programs.
Fineout-Overholt & Melnyk, 2019. Critical Appraisal - QuantitativeRAPID CRITICAL APPRAISAL QUESTIONS FOR RANDOMIZED CLINICAL TRIALS (RCTS)
|1.Are the results of the study valid? The instruments used to measure pain post-injection are the 11-point numeric rating scale (NRS) and Western Ontario and McMaster University Osteoarthritis Index pain subscale (WOMAC). Both instruments are validated in the literature.|
|a.Were the participants randomly assigned to the experimental and control groups?||Yes||No||Unknown|
|b.Was random assignment concealed from the individuals who were first enrolling participants into the study?||Yes||No||Unknown|
|c.Were the participants and providers blind to the study group?||Yes||No||Unknown|
|d.Were reasons given to explain why participants did not complete the study?||Yes||No||Unknown|
|e.Were the follow-up assessments conducted long enough to fully study the effects of the intervention?||Yes||No||Unknown|
|f.Were the participants analyzed in the group to which they were randomly assigned?||Yes||No||Unknown|
|g.Was the control group appropriate?||Yes||No||Unknown|
|h.Were the instruments used to measure the outcomes valid and reliable?||Yes||No||Unknown|
|i.Were the participants in each of the groups similar on demographic and baseline clinical variables?||Yes||No||Unknown|
|2. What are the results? |
The experimental group showed 2-week post-injection showed hip pain reduction at rest and no change during walking. Results after 4, 6, and 12-weeks showed hip pain reduction while at rest and walking in
|a.How large is the intervention or treatment effect (NNT, NNH, effect size?||Effects lasted 12-weeks for all primary and secondary pain and function outcomes. Sample size: 52 in the experiment group, 54 in the control group. 106 total participants.|
|b.How precise is the intervention or treatment (CI)?||95%|
|3.Will the results help me in caring for my patients?|
Patients with hip pain because of osteoarthritis benefit from an intramuscular injection of glucocorticoid. This is a treatment option with fewer associated side effects than injection into the hip joint.
|a.Were all clinically important outcomes measured?||Yes||No||Unknown|
|b.What are the risks and benefits of the treatment?||Risks: no reduction of pain, injection risks because of the non-sterile procedure. Benefits: No risks for septic join noted in Intra-articular (IA) injection. Pain reductions last up to 12-weeks.|
|c.Is the treatment feasible in my clinical setting?||Yes||No||Unknown|
|d.What are my patient’s/family’s values and expectations for the outcome that is trying to be prevented and the treatment itself?||Pain plays a significant role in everyday life. This study attempts to reduce increased pain associated with OA, reduce painful injections into the joint, and the expectation for overall pain reduction and need for analgesia.|
|Would you use the study results in your practice to make a difference in patient outcomes? |
•Yes, through offering alternative pain control to patients meeting the definition outlined in the study. Alternative IM injections can be offered in the sub-acute setting. •Yes, since the IM injection is less invasive and offers fewer risks than injection into the joint. Results are shown to last for 12-weeks.
It is important to note that participants could use supplement analgesia following injection of steroid or saline. It is unknown the impact this has on the overall study. Patients’ perception of their own pain varies and is subjective. Overall, this seems like a reasonable, clinical option to offer patients experiencing hip pain because of osteoarthritis.
|Recommendation for article use within a body of evidence: |
This article is a randomized controlled trial (RCT) and offers strong clinical data to support evidence-based practice. The RTC is level II data, representing the clinical finding more accurately (Fineout-Overholt & Melnyk, 2019). This data in the body supports the PICO (T) questions based on a specific comparison between IM and IA corticosteroid injections
Fineout-Overholt & Melnyk, 2019.
The qualitative study by Howson, Turell, and Roc (2018) was carried out to understand the impact a 60-minute, online- educational intervention has on patients with B-cell non-Hodgkin lymphoma. The study uses a mixed method to determine if the intervention improved participants’ knowledge. This is important to patients and families and understanding topics around general illness, treatment options, and self-care. Researchers interviewed 12 participants. Interviews were uploaded word for word into a systematic software system and coded into themes. Results showed a positive response to the education program and understanding their disease. The themes generated are useful for ongoing education and considerations for people living with B-cell non-Hodgkin lymphoma. The quantitative study by Dorleijn et al. (2018) is a double-blind randomized controlled trial for people suffering from pain because of osteoarthritis (OA) of the hip. The purpose of the study is to identify pain reduction using intra-muscle injection rather than injection into the hip joint. 106 OA patients were randomly selected into the control group (normal saline injection) and experiment group (glucocorticoid injection) groups. Researchers, physicians, and participants were blinded to which treatment was provided. This study is important in offering optional treatments for OA pain with lesser risks. Major findings show pain reduction at rest and walking at the 4, 6, and 12 week marks post glucocorticoid IM injection. These results provide alternative treatment options for patients dealing with OA pain. Findings based on
Al-Jundi, A., & Sakka, S. (2017). Critical appraisal of clinical research. Journal of Clinical and Diagnostic Research, 11(5), 1–5. https://doi.org/10.7860/JCDR/2017/26047.9942
Grainger, A. (2021). Critiquing a published healthcare research paper. British Journal of Nursing, 30(6), 354–358.
Melnyk, B. M., & Fineout-Overholt, E. (2019). Evidence-based practice in nursing & healthcare. Wolters Kluwer. http://capella.vitalsource.com/reader/books/9781975138493/epubcfi/6/2[%3Bvnd.vst.idref%3Da00_cover]!/4/2/2%4051:78