Critical Review Form – Quantitative Studies
ÓLaw, M., Stewart, D., Pollock, N., Letts, L. Bosch, J., & Westmorland, M.
McMaster University
- Adapted Word Version Used with Permission –
The EB Group would like to thank Dr. Craig Scanlan, University of Medicine and Dentistry of NJ, for providing this Word version of the quantitative review form.
Instructions: Use tab or arrow keys to move between fields, mouse or spacebar to check/uncheck boxes.
| CITATION | Provide the full citation for this article in APA format:
Castro, P., Martins, M., Couto, G., & Reis, M. (2018). Mirror therapy and self-care autonomy after stroke: an intervention program.
|
| STUDY PURPOSE
Was the purpose stated clearly?
Yes No
| Outline the purpose of the study. How does the study apply to your research question? The main purpose of the study to determine the impact of the mirror therapy on a motor recovery of an upper extremity. Moreover, the study aims at investigating the effectiveness of typical mirror therapy program amongst the patients suffering from stroke. The purpose of the study applies significantly to the research question since its chief role is to investigate the reliability of mirror therapy amongst the patients suffering from stroke. |
| LITERATURE
Was relevant background literature reviewed? Yes No
| Describe the justification of the need for this study: Based on the background information provided in the article, stroke tends to have a significant negative impact on the victims. For instance, the rapture of Middle Cerebral Artery triggers neurological deficits (such as hemiparesis anesthesia and contralateral hemiparesis) which in turns leads to motor paralysis. Motor paralysis denies the victims self-independence. Hence the study is crucial since it aids in creating awareness regarding the mirror therapy, it is through this study that patients with stroke are offered with a hint regarding the existence of mirror therapy. The background literature is sufficiently reviewing since it offers the issues affecting individuals with stroke and the underlying purpose of the mirror therapy intervention program. |
| DESIGN
Randomized (RCT) cohort single case design before and after case-control cross-sectional case study
| Describe the study design. Was the design appropriate for the study question? (e.g., for knowledge level about this issue, outcomes, ethical issues, etc.): The study employed cross-sectional research design where the researchers measured the outcome as well the exposures amongst the participants (patients exhibiting hemiplegia/hemiparesis) due to the MCA stroke. The cross-sectional design facilitated a significant role in exploring the stroke, also it selected the specific participants who are victims of the MCA stroke. The use of participants suffering from the stroke made it the most appropriate design to tackling the research question. Moreover, the cross-sectional design used was appropriate since it put into consideration of the ethical issues. For instance, acquittance of informed consent from the participants, also the design upheld privacy by not exposing the names of the participants.
Specify any biases that may have been operating and the direction of their influence on the results: One of the major bias evident in the study is the exclusion of the individuals with impaired communication (aphasia). Moreover, the individuals with musculoskeletal and neuromuscular diseases distressing rehabilitation of the upper limbs and the vision problems were excluded from taking part in the study.
|
| SAMPLE
N =30 Was the sample described in detail? Yes No
Was sample size justified? Yes No N/A
| Sampling (who; characteristics; how many; how was sampling done?) If more than one group, was there similarity between the groups? The study used a sample of thirty participants (n=30) who were then divided into an experimental group (n=15) and a control group (n=15). The sample encompassed patients admitted to Rehabilitation unit, Physical medicine and Convalescence Unit (CU). Patients (participants) from the three hospital institutions were characterized with hemiparesis/hemiplegia as a result of the MCA stroke. The study employed a superior criterion when conducting the sampling procedure, the researchers used a Mini-Mental state examination to determine the cognitive ability of the chosen population of the patients. Those with cognitive ability were evaluated to take part in the study. However, despite the detailed description of the sample, the sample size was not justified. The study should have used a large sample size to yield more relevant results regarding the MCA stroke.
Describe ethics procedures. Was informed consent obtained? The study put into consideration the ethical issues such for instance, privacy, and informed consent of the participants. For instance, the study did not divulge the identity of the participants. Moreover, an informed consent was achieved determining the cognitive ability of the patients to have a good understanding of the exercise instructions. Consequently, the patients were asked on their willingness to participate in the study.
|
| OUTCOMES
Were the outcome measures reliable? Yes No Not addressed
Were the outcome measures valid? Yes No Not addressed
| Specify the frequency of outcome measurement (i.e., pre, post, follow-up): The study employed inferential statistics as the pre measurement to determine the differences amid groups participating in the study. Also, to initiate a comparison between the two groups (the control group and experimental) prior and after the program, the study used Mann-Whitney U test. Moreover, chi-square test was used for the nominal variables. By the end of the intervention, the study was supposed to identify the significant difference between the experimental group and the controlled group to determine the reliability and effectiveness of the program. However, the results obtained exhibited small statistical difference between the two groups, hence the outcome measure is not reliable. Moreover, outcome measure is not varied since they contradict the results obtained by other researchers using large sample size of the participants. | |
| Outcome areas: Pain Dimension Chewing Dimension swallow Self-care dressing Self-care bathing | List measures used.: P-value Mann-Whitney U-test Chi-square Nine-Hole Peg Test Numerical Pain Rating scale | |
| INTERVENTION
Intervention was described in detail? Yes No Not addressed
Contamination was avoided? Yes No Not addressed N/A
Cointervention was avoided? Yes No Not addressed N/A
| Provide a short description of the intervention (focus, who delivered it, how often, setting). Could the intervention be replicated in practice? The main focus of the intervention program was to determine the impact of the mirror therapy on a self-care autonomy amongst the individuals suffering from hemiparesis/hemiplegia due to the MCA stroke. The intervention was imposed by the clinical officers (Rehabilitation nurses) and the study overseen by various researchers. However despite the small statistical difference recorded between the two groups, the significant gain associated with the intervention program to the patients suffering from MCA stroke, indicate that the program can be replicated into practice with use of larger sample and with participants that have more concentration capacity, or through increasing the duration of application of the mirror therapy to twenty hours. The study did not address the existence of cointervention. Moreover, the intervention did not address whether there was presence of the cointervention which might have led to the small statistical difference recorded between the experimental and the control group. | |
| RESULTS
Results were reported in terms of statistical significance? Yes No N/A Not addressed
Were the analysis method(s) appropriate? Yes No Not addressed
| What were the results? Were they statistically significant (i.e., p < 0.05)? If not statistically significant, was study big enough to show an important difference if it should occur? If there were multiple outcomes, was that taken into account for the statistical analysis? The results indicated a gain in the joint range of motion, grip strength, and the manual dexterity of upper limb amongst the participants in the experimental group compared to the participants in the control group. However, despite the existence of the gains in group of the experimental participants, there was a minimal statistical significance difference between the two groups. The difference p< 0.05 was only identified in pain. This indicate that the study was not large enough to indicate the important distinction should occur between the two groups. Hence the study was supposed to have n≥26 in every group to facilitate the detection of the statistical differences. The statistical analysis methods used in the study were not appropriate since they are prone to making type II error which affects the statistical results. It should have used more power statistical tests to attain accurate results. | |
| Clinical importance was reported? Yes No Not addressed
| What was the clinical importance of the results? Were differences between groups clinically meaningful? (if applicable) The results obtained from the study are crucial in the clinical practices when combined with other interventions such as the conventional rehabilitation program. The study indicated that in existence of patients with extreme distal hemiparesis of upper limb observed amongst in the participants of the study, it is crucial to increase frequency of rehabilitation programs to attain statistically significant clinical results. Moreover, the results can act as basis for developing future studies to address the needs of patients with stroke effectively. | |
| Drop-outs were reported? Yes No
| Did any participants drop out of the study? Why? (Were reasons given and were drop-outs handled appropriately?) There was a drop-out of the participants; only five and three participants completed the test in the experimental and control groups, respectively. Hence the other participants drop out; however, the reasons for the drop-out are not addressed.
| |
| CONCLUSIONS AND IMPLICATIONS
Conclusions were appropriate, given study methods and results. Yes No
| What did the study conclude? What are the implications of these results for practice? What were the main limitations or biases in the study? The study concluded that the intervention program was ineffective due to a lack of statistically significant distinction between the two groups. The lack of statistical difference between the two groups was the major limitation that deemed the intervention program ineffective. However, the results obtained from the mirror intervention program are significant since they are capable of guiding future research that might refute or expand this result hence contributing to evidence-based practice necessary to address the needs of patients with stroke.
| |