PICO question synthesis and annotated bibliography

¶ … scientific method. The one most common in nursing circles, that is derived from a desire to understand all facets of the question is the PICO method. The first letter of the acronym asks the researcher to label the specific population or the patient problem under examination. After the population or problem is defined, then the researcher must be able to suggest an intervention that is to be the focus of the research. In any good study there is also the opposite to the intervention which is made as a comparison. Finally, the researcher looks at the outcomes of the research to determine whether their hypothesis regarding the intervention was a success or a failure.

This method can be used for any research, and will, in this paper, be used to conduct an analysis of four articles. The population under examination are elderly nursing home patients. The intervention to be used is that these individuals participate in regular exercise. This intervention is compared to similar individuals who do not exercise at all. The expected outcome of the research conducted in the two quantitative and two qualitative articles is that the individuals who perform regular exercise will be better equipped to perform daily living activities. This paper seeks to synthesize four separate studies related to the stated PICO question.

The population that was used in all of the studies was a group of individuals who needed some form of support due to their age. The individuals were all in assisted-living facilities, and each person was experiencing mobility difficulties which affected their ability to complete routine daily living activities. One problem that all but one of the studies but one experienced was that there were very few participants used. This is an issue because it is difficult to extrapolate the data to a larger group when so few are initially used. One of the studies (Wallmann, et al., 2009) made a statement about the small sample size used. The authors suggested that "Further research with a larger sample size is needed to evaluate the impact of lower extremity strengthening exercises on balance and ADL preservation for elders in long-term care facilities." Any study which means to make an impact with its findings needs to have a large enough sample size to effectively answer the question for a larger population. This is often a difficulty with qualitative studies because the design lends itself to very small sample sizes.

All four of the studies were designed to look at how the populations could be helped when a regular exercise program was used. There was also a comparison with the original ability of the group studied before and after the exercise program was used.

Exercise programs that lasted six months were the norm as far as length, but the type of exercise completed was a major difference between the four studies. It has long been debated among exercise experts what the best type of exercise is for increased flexibility and mobility. Studies have been conducted which looked at the benefits of cardiovascular exercises (Fisher, Atler, & Potts, 2007; Stathi & Simey, 2007; Wallmann, et al., 2009) versus the benefits of a weight-bearing regimen (Littbrand, et al., 2009). The reason for this divergence of thought is that one type of exercise offers stretching and improvement of lung and heart function, while the other focuses more on strengthening the muscle so that it adds the above benefits plus. It is necessary for researchers to look into how all types of exercise might work with a given population because there may be a benefit from one type of exercise that is not inherent in the other. It might be that weight-bearing exercises will work better for this population because they have allowed muscles to atrophy over time (Littbrand, et al., 2009). However, other researchers work with the hypothesis that strengthening exercises will not be as effective for a group of participants who have lost a significant amount of muscle mass. The outcomes will hopefully determine which hypothesis is correct.