Research Question and Pain

Benchmark-Research Critique and PICOT statement

This article is a research critique on the paper titled 'Home Telehealth for Patients with Chronic Obstructive Pulmonary Disease (COPD): An Evidence-Based Analysis' by J. Franek. The research paper under review was published by the Ontario Health Technology Assessment Series.

Although there isn't a direct statement that refers to Problem statement, there is a title that highlights the "Objective of the Analysis." There is an excerpt of the objectives below. The discussion in the objective statement is only centred on the evaluation steps. There is evidence in the literature that the effects of COPD were openly revealed as being core elements of the problem statement in the first place.

"For patients experiencing multiple comorbidities, it is essential to observe routine self-management support. Such support consists of the necessary education to enlighten parents to pick out the symptoms in good time. They will consequently manage their medical gadgets, pinpoint the barriers to adherence therapy procedures and ensure that the amount of physical therapy is enough and appropriate" (Bernocchi, Scalveni, Galli, Volterani, & Vitacca, 2016).

There is no information in the paper about the plans to address post surgery or even rehabilitation after treatment. The north East Quality Observatory System tackles self supported recovery in great detail. The report points out that there is notable overlap between the elements and the method of delivery of the programs to the patients, this report also has some outcomes of pulmonary rehabilitation and others that relate to education and exercise and the ones that emphasize self-management' (Brown, 2014).

Study Purpose

The statement that addresses the purpose of the analysis on the home-based tele-health technologies for COPD patient does so by utilizing evidence-based assessment tools in resonance with the expectations. The authors have highlighted the limitations and those whose point-of-view the paper leans towards. The analysis was one of the many that were carried out to evaluate COPD interventions. The perspective is akin to the Ontario Ministry of health and Long-Term Care. The outfit pays for necessary health services.

Research Question

There are two main questions put forth in this paper.

i. What are the cost effectiveness and safety levels of home tele-monitoring as compared with the normal care for COPD patients?

ii. What are the cost effectiveness and safety levels of stand-alone telephone support compared with the usual COPD care?

It is clear that the questions seek to address tele-monitoring based at home and the stand-alone telephone support subjects. The questions are explicitly defined and point clearly to what the paper seeks to address.

Answers for home tele-monitoring are provided below.

Home telemonitoring largely depends on available technologies, personnel and infrastructure. Consequently, generalization of external factors is low. If a jurisdiction wishes to adopt home-based tele-monitoring, they need to test the interventions in their jurisdictional boundaries before adopting it. Otherwise, they should focus their energies on home-grown interventions that have been approved and proven as effective measures.

The research answers for the telephone only support are listed below

There is evidence, albeit low-quality that shows that there are significant benefits in using the telephone-only support. This is true for ED visits and self-efficacy compared to normal care. There is no evidence that hospitalization actions and length of stay in hospital have any such benefits.

Literature Review

Literature review was unconventional. Majority of the research was done using OVID MEDLINE. This is a software app that collects relevant articles in a specific time frame and classes them in three groups, depending on the relative score used. The approach is time saving compared to the traditional approach. The tool collects all necessary referencing information whenever necessary. There was, therefore, a need to decide what would be included. The following criterion was applied.

i. Inclusion Criteria

a. Frequent transmission of the physiological data of the patient as collected at home with no human intervention and transmitted to the health care professionals for monitoring action via the communication technology platform.

b. Monitoring that is combined with management and feedback using the data transmitted.

c. Telemonitoring as a central element of the intervention measure (determined subjectively).

d. RCTs CCTs, meta-analysis and systematic reviews.

e. Publications between January 1st 2000 and November 3rd 2010.

ii. Exclusion Criteria

a. If published in a language other than English.

b. If the intervention group as opposed to control group includes home visitations by a healthcare professional such as a nurse beyond the set for technology and education to manage or treat a patient.

c. No recording of patient or outcomes of the health system.

d. Failure to use an independent control group that has access to usual medical care.

Theoretical Framework

The paper zeroed in on evidence-based analysis method. It is a complex process in which the researcher is required to obtain data, refine it through several processes, including removing outliers, cleaning it, transforming variables and more. In summary, data analysis is a series of operations that makes an output of one stage become the input for another. The foundation of evidence-based data analysis is that each of the stages in the process should make use of the best methods justified by the available statistical evidence. If it is not possible to agree on a given method at any one stage, there is evidently a gap that must be filled (Irzarry, Peng, & Leek, 2013).

Part II: Making Use of PICOT Statement Framework

The Objective of the analysed Research Paper

The aim of the review was to examine the uptake levels of telehealth by neck pain patients and to review the factors that determine whether the patients will accept and adopt telehealth for long-term use (Riva, Malik, Burnie, Endicott, & Busse, 2012).

.Introduction

Neck pain is a common complaint among musculoskeletal concerns by patients. It is reported to be second in frequency to lower back pain. Chronic neck pain is the one that lasts longer than three calendar months. It is one of the main driving reasons for visiting chiropractors. The patients are usually subjected to mobilization or spinal manipulation (Riva, Malik, Burnie, Endicott, & Busse, 2012).

Background of Study

Issue for Research

Although there is sufficient evidence on benefits of neck manipulation, there is no sufficient understanding of how much of such manipulation is required.

The Import of Nursing

Consequently, the frequency of the therapy varies among providers. It is notable that characteristics of the patient and those of the clinician may influence the variance. Generally, it has been observed that most mechanical neck pain problems can be treated with minimal spinal manipulation therapy techniques.

Theoretical observation of phenomenon

It is observed that beyond a certain limit of the use of the therapy, there is likely to be no further gain; health-wise (Riva, Malik, Burnie, Endicott, & Busse, 2012).

Research objectives

Three factors are necessary for the successful determination of the ideal therapy dose for neck pain patients.

i. The frequency

ii. Intensity iii. Sum of manipulations

Methods of study

Qualitative Research

The PICOT research framework was adopted for the qualitative research study. The design aspect is also prone to problems of recall by the respondents self-reporting information in case the research people ask them about past events. There is need for a case control study when trying to identify between characteristics of patients and results that take long to show or are rare.

Design of Research:

A factorial RCT design allows researchers to focus on more than one factor for treatment at any one time and observe the potential interactions that might occur between them. The trial design gives room for determining several aspects, i.e. the duration and frequency effects plus whether it works to provide a given number of manipulations on short or long durations.

Sample:

If we consider a 3x4 factorial design, patients would be required to attend from 1 to 3 sessions weekly, i.e. the first frequency factor with manipulation given over a time span of 2 weeks, 4, 6 or not, i.e. the 2nd duration factor. The standard lateral break technique or rotary could be applied in order to obtain a generalized outcome. A common concern among patients with neck pain is pain relief and detection of a resultant difference of 13mm on the 100mm VAS line; which is clinically regarded as an important change of pain intensity for those with chronic pain.

Procedural steps

Some of the key questions in focus are

i. What are the critical questions for research in the field

ii. What new information has been found?

iii. What are the areas that need more exploration?

iv. Will the study add anything to the body of knowledge?

In the design example, the search for literature brought existing knowledge to the forefront in the areas under study. A Cochrane review cited RCTs completed earlier in the area. It highlighted the strengths and weaknesses of the study and offered advice as to what remains unclear currently, and would gain from further research efforts. Research is a demanding and costly affair. It is, therefore, prudent to make use of the best existing knowledge as opposed to struggling to discover what is already known by others (Riva, Malik, Burnie, Endicott, & Busse, 2012).

Results of Study

The recent reports on RCTs show an increase in the cervical motion range and a reduction in self rated neck pain after manipulation of the cervical spine. There is need to determine optimal technique and dose.

What it means to the nursing fraternity

The relevance of the shift from studies to practices based on evidence may depend on the clinician's view of the change. It gains impetus when the clinician sees it as relevant to their routine and daily practice of healthcare. Clinicians commonly express their frustration at the fact that researchers do not ask them questions that are directly related to their daily practice. Similarly, the researchers, on the other hand express frustration at the fact that clinicians do not seem to be able to pinpoint the important ideas that they would love to see investigated in a feasibly researchable way (Riva, Malik, Burnie, Endicott, & Busse, 2012).

How Nursing Will Benefit

A research question should be developed in collaboration and liaison with a diverse group of stakeholders. This is to make sure that it supports both academic interest and the clinical needs. The best research approach should be the benchmark of such expertise. It should propose a feasible project to complete and one that will satisfactorily answer the research question. There is a chance to engage the researchers including the ones from chiropractic institutions in helping to develop effective research questions for clinical research (Riva, Malik, Burnie, Endicott, & Busse, 2012).