Critical Appraisal Role Of Physiotherapy Health And Social Care Essay

Critical Appraisal Role Of Physiotherapy Health And Social wangle EssayThe engage of this assignment is to critically appraise the scientific look into topic The role of physical therapy in the treatement of subacromial impacted tooth syndrome by Dickens, Williams Bhamra (2005) term detailing the objectives of the writing, research methods used and the out(p)comes of the research determinations.What is the scientific paper is slightly?The aims of the research paper according to Dickens Williams Bhamara (20051) was to investiagte the strong suit of a physiatrics broadcast in patients with subacromial impingement syndrome.This paper did non outline proper(postnominal) modalities and was reliant on convincing the reader that physical therapy should be aspected as a first line circumspection for subacromial impingement syndrome against the present orthepedic view which would swing towards operative intervention as the corrective action.The paper was promulgated by El sevier for the Chartered Society of Physiotherapy by a unite assemblage of physiotherapists and Orthepedic surgeons and was funded by the Physiotherapy Research Foundation. When combined these assemblys whitethorn pull up stakes the paper to be viewed as self servicing and lead the reader to pinpoint a neglect of impartiality.Patients for the research where taken from a delay tip for surgery for subacromial impingement syndrome. Each of these patients was independently reviewed by surgeon James L Williams, a coauthor of the paper, and had underwent three steroid injections into the subacromial space, granted at 6-weekly intervals as part of an exisiting protocol (Dickens et al, 2005160).The instruction was conducted in a randomised fashion in that the eighty five clients were selected by free a client on a surgical waiting incline an envelope that had in spite of appearance it any fancy or physiotherapy, 45 join the physiotherapy class while 40 joined the control chemical group. thither were atomic number 6 envelopes split 5050 mingled with the groups which leads the reader to commit this whitethorn collapse been quasi-randomised.In order to assess physiotherapy without incline clients who had previous physiotherpay treatement were excluded from the think over according to Dickens et al. Also clients with signs of cervical radiculopathy, adhesive agent capsulitis or clinically obvious rotator cuff tears or a grade III subacromial spur on their shoulder suprasinatus outlet radiograph (Dickens et al, 2005160). The randomised fashion was administered by human administrators and non via a computerised system.A control group was used and this group had no alternative merely to continue on towards surgical intervention, this progress tod a bias for this group since the hazard for having surgical intervention was P-1.Intitially the group of patients numbered eighty five patients from an initial dance orchestra of 100 envelopes. 9 of t he initial 40 patients in the control group refused to attend the repeat assessmemt at the end of the program, 3 of the physiotherapy group gloamped out for social reasons leaving 42 partcipating in thither group. over out-of-pocket to the substantial number of dropouts weight must be given to the number of unfairness to any comparsion portrayed in the paper.Follow up occurred by and by a 6 month period and performed by James L Williams, a coauthor of the paper, and may not experience been blind since he could have easily discussed whether they felt they still needed surgery (Dickens et al, 2005161).How the study was designed?The aims of the research paper according to Dickens Williams Bhamara (20051) was to investigate the nubiveness of a physiotherapy programme in patients with subacromial impingement syndrome. According to the Webster mental lexicon the word effectiveness means to produce a coveted effect, the desired effect is not designateed in the aim. This ambiguity a fat the aim of the paper leaves any conclusion open to interpretation by the reader. When the paper is read in its entirety you could potentially interpret the aim as conveying the message that physiotherapy should be first line management for subacromial impingement therefore moving interventive surgery to second line.There is no published pilot data therefore we cannot correctly establish if the consume size for the scientific paper is justified. We do know that the randomisation exploit catered for 100 patients, 100 envelopes, of which solo 85 were taken up, 72 patients successfully making it to the reassessement stage.The age ranges within the groups have relevance to the outcome of the scientific research. We save have a mean age of each group without an destination to outliers who could locomote the statistical data. It is clear that the more junior males react better under all conditions. This contradicts the statement the two groups were well matched for age, devol ve on and initial constant score (Dickens et al, 2005161).The probability values (p-values) have been averaged (pThis lack of depth in the data provided does not tolerate the reader to establish if a null scheme was proved and may lead them to intrust this was pure coincidence. Scientific research should always start from the null conjecture point of view to ensure impartiality.The selection emergence for patients, waiting list for surgery, post steroid injection, exclusion of specific pathologies, clinical history and interrogative meant the group may have been skewed to fulfill the authors aims. Steriod injections can provide an improvement in subacromial impingement due to its anti- inflammatory effect. The selection offshoot did not seem to take into account the duration nor the severity of the impingement syndrome on the individual nor if they were receiving sermon from other practitioners not listed.There is no comminuted in dression regarding the treatment programme dispensed to the physiotherapy patients. If a specific treatment programme had been documented and applied to all patients in this group more quantative data and allowed the research to be replicated and potentially formalise by other authors. This would have also allowed the treatments to be cross indite with socio demographic data from each patient and establish sub sets within the master data.We be unsure how the null findings be interpreted since the authors do not detail this. Nor have they given any data around the chi-squ ared test. Probability values are give in a round format (pThe constant score has a low systematic misplay but is not reliable for clinical follow up in patients.The constant scores taken at the start of the research were establish on 85 patients not on the same 72 patients whom allowed themselves to be reassessed at the end of the programme. This lead to a lack of confidence in the method used by the authors to compare pre and post programme data, they may not have itemised which data belonged to each patient and therefore could not remove this anomoly.The involvement of James L Williams in the reassessment process ensured a lack of blinding and a bias, though the authors clearly did not see this position the follow up assessments were performed by JLW in a blinded situation (Dickens et al, 2005162). All assessments should have been performed by a formalise third party reusing the initial assessment criteria.Since we have no detailed information about the modalities utilised, treatment cycles matched with socio demographic information there is no clinical relevance to the outcomes. To have clinical relevance the process postulate to be reproducable which is highly unlikely based on the information presented in the scientific paper.How was the study conducted?A quasi-randomised human administer method of 100 envelopes split evenly between the control and physiotherapy groups were handed out to 85 patients. All 85patients were to ld that participation on the programme would not affect there standing on a waiting list for surgery. This insure may have affected participation since they would have already been win over of the necessity for surgery by an orthepedic surgeon.The dropping out of patients in both(prenominal) groups weakened the statistical data which the paper relies upon and imbalanced any findings. construe clinical programmes requires greater participants reducing any potential for the play of chance.How was the study analysed and were there limitation and errors in the study?Each treatment group should have been similar based on age, sex, duration of syndrome, decrease in range of movement and similar capacities to perform the home care plan. establish on the information conveyed in the paper we must assume no(prenominal) of these points were established and therefore does not allowed for each group to have a comparable baseline. The quasi-randomised allocation of each patient to a group en sured that the treatment groups were not comparable.Since all participants stayed within their allocated groups we can establish that the intention was for the results to be analysed by intention to treat. Unfortunately there were patient withdrawals from the programme which would allow to construe that the comparision of treatments would no longer be fair. Also the treatment get within the physiotherapy group as a whole may have differed from individual to individual but no patient move between groups.Not enough importance was placed on statistical information like the control group having members who improved, yet were not convolute in the physiotherapy programme. Also confounding may have occured due to the pre programme steroid injection. Steroid injections are interrelated to anti inflammatory improvements in a range of impingement syndromes. The report had no reference to any confidence intervals which would have ensured the removal of the chance effect and imporved the su bstance of any statistics.The lack of statistical data in table format and the reliance on prose within the paper show the paper to be more a marketing document than a reliable get-go of data. Quantative data tables would have allowed the reader to view and validate the authors outcomes. This lack of emancipation in data lead the reader to wonder does the data very support the outcome. The approach of only conveying results taken by the authors, could create suspicion in the mind of the reader, undermines the credibility of the paper.Side make are an important factor in all scientific research papers. What if the brass effect of the treatment modalities outwayed the alternative approach taken by the control group. Effectiveness of treatment and a lesser set of side effects would need to be established against the control group to ensure there is no bias. Since there is no mention of side effects for either groups we can only assume that the authors wished to purposefully withho ld this information. This factor only would ensure that it clinical relevant is negated.How would you interpret the study and what if any are the implications of the study for your practice?The main finding confirms that a physiotherapy programme is of benefit (Dickens et al, 2005163) does not confirm the objective of the scientific paper. All the paper conveys is that there are successful alternatives to surgery for a subset of the population. There are too many pervasive factors to rely on the statistical implication of the data put forward by the authors. No true finding can be extracted from the paper and it portrays a message set by the authors who went out to prove it.Therefore I cannot see any render by the authors to perform a null hypothesis test which should have been their approach. The only assumption to an attempt at a null hypothesis is the assumption that at the outset of the programme no difference existed between all patients in each group. Other alternatives coul d account for the 11 physiotherapy group patients improving, steriod injection, age, multifariousness in lifestyle etc.This overlooking of the steroid injection pre programme participation has a major impact on the validity of the results. The severity and duration of the syndrome on the patient could potentially have an impact of any positive results. The research funder being a physiotherapy organisation has may have had an effect on the interpretation of data. The duration of gap between the post surgery and final step in the physiotherapy programme and final assessment may have had an effect on the results. Rehabilitation programmes may not have been adhered to during this period. Why not take periodical assessements every fortnight over the final 6 month period? We also do not know how the drop outs from the programme affect the data use to support the outcome. We can only assume if this data was removed the outcome may have not supported the objective and therefore shown the physiotherapy is not or no more effective than surgery.Alarmingly this scientific research paper references 26 papers published prior to 2000, the oldest being from 1973, while only 5 papers are based between 200 and the time of sack of the paper. This points to either a lack of interest in the particular land or a selective extraction of papers to support the authors objective. unremarkably supporting information referencing in other reports should be relatively up to date and from journals of quality.Ideally a research paper should look to ever-changing your clinical practice. This paper does not provide me with any rational to change nor if it had a credible case would I understand what I should be changing. Since I cannot replicate the treatment modalities used within the study I cannot change practise nor would I recommend another practioner to perform the same.