Evidence based plan- EBP Plan assignment. due 11/23

1

Qualitative Research Article Critique

Qualitative Research Article Critique

Deep venous thrombosis (DVT) is difficult to manage in postoperative clients given their substantial periods of inactivity. Nevertheless, leg exercises and sequential compression devices (SCD) can still be used to improve the quality of life of such clients despite the low potential for timely recovery. Therefore, it is necessary to understand the effectiveness of these interventions and the manner in which they are applied in order for nurses and other healthcare workers to make informed decisions when caring for postoperative patients with DVT. In Intense Triceps Surae Contraction Increases Lower Extremity Venous Blood Flow, Tsuda et al. (2017) compares the effectiveness of three interventions namely the leg exercises, SCDs, and intermittent pneumatic compression (IPC) devices. The results imply that IPCs are the most effective followed by SCDs, and lastly leg exercises. Although the external validity of the findings is low, the article successfully illustrates how SCDs ere more effective than leg exercises, which can be of good use to healthcare workers when caring for DVT clients.

Methods

Protection of Participant’s Rights

In the study published in the article Intense Triceps Surae Contraction Increases Lower Extremity Venous Blood Flow, Tsuda et al. (2017) gave all participants an opportunity to decide whether to participate or not. Eligible participants were given written documents, and verbal information to affirm their willingness to participate in the research, hence the participants were not forced to participate in the study. The Kitasato University allied Health Sciences Research Ethics Committee approved the study, and confirmation was with Declaration of Helinski (Tsuda et al., 2017). However, there are no explanations from the authors of the ethical perspective of the safety levels of the study activities.

Research Design

Tsuda et al. (2017) used the prospective non-randomized control trial design involving 20 participants in the study. The design was rigorous since the authors measured blood flow using tricep surae (TS) and peak velocity (PV) of blood to measure blood flow. They also measured muscular activities, muscle force, and movement task. Appropriate comparisons were made among the study participants using the aforementioned variables. The number of data-collection points was appropriate since the authors engaged the respondents in two tests in a day, and subsequent trials were conducted in different days. Tsuda et al. (2017) used derived the effect-size function as 1.02, and -0.25 for peak velocity for TS and PV respectively. Tsuda et al., (2017) also set the alpha error probability at 0.05 raised to power 0.95, and non-sphericity correction as 0.2 to increase internal validity.

Population and Sample

The sample population that participated in the study were identified and described in details. For instance, the total number of participants was 20 young men aged between 21-23 years; height of 166.3-175.9 cm; their weight was 63.2 ± 7.6 kg; body mass index of 21.5 ± 1.9 kg/m² (Tsuda et al., 2017). Application of the prospective non-randomized sampling technique used was not relatively inappropriate since it does not enhance representativeness of the sample population. For instance, all the participants selected were male, and the non-randomized approach creates the possibility for biasness, which can significantly reduce external validity and generalizability of the study (Tsuda et al., 2017). Nevertheless, internal validity was enhanced by setting effect size and alpha probability to ensure that groups of respondents had minimum required characteristics that would enable data saturation. The sample size of 20 respondents was adequate since an average of are adequate in qualitative researches. Sample-size estimation was conducted using G*Power 3.1.9.2. Tool, which increased the reliability of the collected data.

Data Collection and Measurement

The operational and conceptual definitions are congruent in the study. The operational definition include peak velocity (PV), tricep surae (TS), and maximum voluntary contraction (MVC). These definitions are congruent with conceptual definitions such as baseline values and the mean of the operational constructs, which guide the direction of measuring variables (Bhattacharya, 2017). The key variables were measured through observation of how the FV and PV changed with isometric contraction of the TS, which was appropriate since taking such measurements require technical competencies that, and the changes in the dependent variables cannot be explained by the respondents. Tsuda et al. (2017) have adequately described. For example, TS isometric contraction-force and muscular activity were measured using a dynamometer and electromyogram feedback unit respectively for movement tasks for both the leg exercise option and sequential. There is evidence in the report that the observations approach yielded valid and reliable results in that it was possible to obtain highly reliable data from the figures that were observed from the measurement instruments that were used to measure the dependent variables.

Procedures

There are three interventions that were examined in the study namely; active ankle exercise (AAE), sequential compression devices (SCD)s, and the intermittent pneumatic compression (IPC) device. All the devices were described into details including their levels of effectiveness in reducing venous thromboembolism (VTE). There was no control group in the study as all the participants were subjected to the same conditions. However, only 10 participants were analyzed for muscular activities using TS-isotonic contraction due to noise limitations that obstructed effective measurement (Tsuda et al., 2017). Nevertheless, data was collected in ways that minimizes bias since the instruments used for data-collection processes are automated so that they give actual values on scales. The data cannot be manipulated as the case for questionnaires or interviews that respondents or researchers can give feedback or make entries in ways that suits their interests. The data was collected by the researchers themselves, who have masters and doctorate degrees, and are also tutors in universities so the likelihood of biasness and errors was minimal.

Global Issues

Presentation

The study is well written and organized, and is sufficiently detailed for critical analysis. For instance, the grammar used is coherent and understandable. Although technical terms have been used, Tsuda et al. (2017) have defined all the acronyms, theoretical constructs, and operational concepts as used in the study, which increases the ease of understanding of the concepts presented in the study report. Additionally, the concepts applied in the study are fitting for the type of research, and there are no conceptual contradiction and biases in the report, which significantly increases its internal reliability. Moreover, study findings are consistent with other researches that illustrate how the SCD intervention is more reliable than leg exercises in reducing the effects of VTE among postoperative patients. Further afield, the report has been written in a way that makes the study findings easily accessible to practicing nurses. It has been structured into different sections with clear headings and sub headings that makes it easy to identify the main sections. The findings section has a clear heading that is easily identifiable.

Researcher Credibility

The researchers are all medical doctors with masters and doctorate degrees, and are also lecturers, writers, and researchers. These competencies increase their credibility. Given their high professional competencies, their work can only be credible as they are experienced professionals in the field of medicine hence are expected to exercise the highest research integrity. The article has also been reviewed by the authors’ peers in the medical field, which further increases the reliability of the study findings.

Summary Assessment

There are many limitations in the study including the use of healthy patients, and definition of trial numbers as one per trial that has been used to compare blood-flow changes, and contraction-intensity changes at intervals that ought not to be repeated (Tsuda et al., 2017). Consequently, the research does not provide the TS-contraction threshold required to raise venous flow in sequential AAEs. Nevertheless, the study methods, instruments, and design have sufficiently demonstrated the levels of effectiveness of leg exercises and SCDs in managing VTE in postoperative clients. In this regard, the findings are valid enough to be used for learning and reference purposes. The study also provides enough evidence that can be used in nursing practice to choose appropriate tools for prophylaxis purposes to help manage VTE among postoperative clients. It also provides information of the right settings, and options in all the possible choices for optimal results.

Conclusion

The article has important information that can be used to understand the most effective intervention that can be used to manage VTE among postoperative clients. The study methods, design, and instruments were appropriate for research of that nature. However, the external validity of the findings is low owing to its limited generalizability since all the respondents were healthy young males rather than patients with VTE. Nevertheless, the research accurately illustrates how SCDs are more effective than leg exercises in managing VTE among postoperative clients.

References

Bhattacharya, K. (2017). Fundamentals of qualitative research: A practical guide. Taylor & Francis.

Tsuda, K., Takahira, N., Sakamoto, M., Shinkai, A., Kaji, K., & Kitagawa, J. (2017). Intense triceps surae contraction increases lower extremity venous blood flow. Progress in Rehabilitation Medicine, 2, 20170009. https://www.jstage.jst.go.jp/article/prm/2/0/2_20170009/_html/-char/en