Advanced Levels of Clinical Inquiry and Systematic Reviews
Part 3: Advanced Levels of Clinical Inquiry and Systematic Reviews
Kelsey Campbell
June 23rd, 2019
Identification and description of chosen clinical issue of interest
Post-traumatic stress disorder (PTSD) has changed and gained new understanding over time. Once thought to only affect war veterans as “shell shock”, then latter added to the DSM-V as PTSD and understood to affect many other populations. According to the diagnostic and statistical manual of mental disorders (DSM-V), a traumatic event is defined as the exposure to actual or threatened death, serious injury or sexual violation and leading to re-experiencing, avoidance, negative cognitions and mood, and arousal.
Post-traumatic stress disorder (PTSD) is seen in children, adolescents and adults. It can occur alone or with other disorders. Currently it is recommended that cognitive behavioral therapy (CBT) and eye movement desensitization and reprocessing (EMDR) be used for the treatment of PTSD.
Description of how I developed a PICO(T) question based on the clinical issue
Because of PTSDs prevalence I’m interested to compare the efficacy of CBT and EMDR in relieving PTSD symptoms, as well as anxiety and depression, in patients diagnosed with PTSD.
(P) – In PTSD diagnosed patients (is)
(I) – eye-movement desensitization and reprocessing (EMDR) therapy
(C) – (verses) Cognitive behavioral therapy (CBT)
(O) – more effective treatment for PTSD
(T) – over 1 year
The key words were: post-traumatic stress disorder, “PTSD”, eye movement desensitization
and reprocessing, “EMDR”, Cognitive Behavioral Therapy, “CBT”. The Boolean connector
AND was used to form different combinations of the keyword.
The 4 research Databases used
Databases and articles
PUBMED – highest level on the Evidence Based Hierarchy – Systematic Review and Meta-analysis
Khan, A. M., Dar, S., Ahmed, R., Bachu, R., Adnan, M., & Kotapati, V. P. (2018). Cognitive Behavioral Therapy versus Eye Movement Desensitization and Reprocessing in Patients with Post-traumatic Stress Disorder: Systematic Review and Meta-analysis of Randomized Clinical Trials. Cureus. doi:10.7759/cureus.3250
MEDLINE - highest level on the Evidence Based Hierarchy – Systematic Review and Meta-analysis
Brown, R. C., Witt, A., Fegert, J. M., Keller, F., Rassenhofer, M., & Plener, P. L. (2017). Psychosocial interventions for children and adolescents after man-made and natural disasters: a meta-analysis and systematic review. Psychological Medicine, 47(11), 1893–1905. https://doi-org.ezp.waldenulibrary.org/10.1017/S0033291717000496
EMBASE - highest level on the Evidence Based Hierarchy – Meta-analysis
Lewey, J.H., Smith, C.L., Burcham, B. et al. (2018) Comparing the Effectiveness of EMDR and TF-CBT for Children and Adolescents: A Meta-Analysis. Journal of Child and Adolescent Trauma, 11 (4), 457–472. https://doiorg.ezp.waldenulibrary.org/10.1007/s40653-018-0212-1
CINAHL - highest level on the Evidence Based Hierarchy – Systematic Review and Meta-analysis
Chen, L., Zhang, G., Hu, M., & Liang, X. (2015). Eye Movement Desensitization and Reprocessing Versus Cognitive- Behavioral Therapy for Adult Posttraumatic Stress Disorder : Systematic Review and Meta -Analysis. The Journal of Nervous and Mental Disease, 203(6), 443-451. doi:10.1097/nmd.0000000000000306
explanation of the strengths of using systematic reviews for clinical research
Using systematic review for clinical research has many strengths. Systematic reviews combine quantitative data with the purpose to understand the effects of treatments or interventions, while trying to reach a specific outcome or desired result. The first step of a systematic review is to form a question or hypothesis. The initial question will help determine what is unknown and what data needs to be gathered for further analysis. It is very important to have a clear plan of interest. After the clinical issue is decided on, it is then important to have a protocol for gathering the data. The data gathered needs to be unbiased and abstracted accurately so that the outcomes can be analyzed subjectively. In meta-analysis, multiple similar studies and their results are collected and compared with the end goal being to precisely pinpoint desired outcomes of treatments and interventions. Mata-analysis can also recommended further research in specific areas if needed. Essentially a meta-analysis is the gathering of multiple systematic reviews.
specific example
In the article, “Cognitive Behavioral Therapy versus Eye Movement Desensitization and Reprocessing in Patients with Post-traumatic Stress Disorder: Systematic Review and Meta-analysis of Randomized Clinical Trials” they systematically searched EMBASE, Medline and Cochrane for randomized clinical trials that compare CBT and EMDR in PTSD patients. Fourteen studies out of 714 were eligible after the inclusion criteria was established. Meta-analysis of 11 studies showed that EMDR is better than CBT in reducing post-traumatic symptoms. However, meta-analysis of four studies at three-month follow-up revealed no statistically significant difference. The EMDR was also better than CBT in reducing anxiety but there was no difference between CBT and EMDR in reducing depression. Large population randomized trials with longer follow-up are recommended to build more quantitative data.
Key term Number of
articles in
PubMed
Number of
articles in
MEDLINE
Number of
articles in
EMBASE
Number of
articles in
CINAHL
Post-traumatic stress disorder AND EMDR and
reprocessing AND CBT
49 35 29 2
PTSD AND EMDR AND CBT 59 36 46 8
PTSD AND eye movement desensitization and
reprocessing AND CBT
48 35 20 3
PTSD AND eye movement desensitization and
reprocessing AND Cognitive Behavioral Therapy
110 110 7 4
Post-traumatic stress disorder AND eye movement
desensitization and reprocessing AND Cognitive
Behavioral Therapy
98 106 6 3
Post-traumatic stress disorder AND eye movement
desensitization and reprocessing AND CBT
41 34 20 2