Evidence-Based Practice: Critical Appraisal and Application Report

This report provides a critical appraisal of a research article focusing on the 6-minute walk test (6MWT) for heart failure patients. It begins with a rationale for article exclusion, utilizing a PRISMA flow diagram to summarize the screening process. The report then summarizes the critical appraisal using the CRAP test (currency, reliability, authority, and purpose) to evaluate the article's credibility. The application to practice section discusses the 6MWT's impact, emphasizing the benefits of physical activity, the ease of use of the test, and its implications for healthcare professionals. The report concludes by highlighting the test's cost-effectiveness and its role in monitoring patient health and response to therapies. The report also acknowledges potential barriers to implementing research findings, such as financial constraints and lack of resources. Overall, the report underscores the significance of the 6MWT in assessing functional capacity and guiding treatment strategies for heart failure patients.

EVIDENCE BASED
PRACTICE
1

TABLE OF CONTENTS
Rationale for article exclusion and finding of articles for critical appraisal................................3
Summary of the critical appraisal................................................................................................4
Application to practice.................................................................................................................6
CONCLUSION................................................................................................................................8
REFERENCES..............................................................................................................................10

Rationale for article exclusion and finding of articles for critical appraisal
PRISMA flow diagram mainly refer as the summarised screening process (Agostoni and
et.al 2018). It holds the records of the articles and then initiates the selection process by reporting
the specific decisions that has been taken in distinct staged of systematic review.
3
Total number of the articles
that has been searched using
CINAHL, PubMed,
Medline, Science direct
software
(n= 25000)
Records after deleting the duplicate articles
n=15000
Additional article records
that has been identified
from other sources
(n=0)
No of duplicate removed
n=10000
Records screened
n=15000
Records excluded
n=13000
Full text articles that are analysed for the
eligibility
n=2000
Full text articles that are excluded
with rationale (n=1999)
Some of the articles are out of
scope which is n=750
Improper details n= 450
Unstructured n=500
Limited diligence n=299
Studies that included in project synthesis
n=1

Thus above evaluation of the PRISMA diagram shows the screening of the articles that has
been used for continuing the project. In its every stage it shows the inclusion and exclusion of the
article as some of the records are excluded because of irrelevancy and other factors and also
there is no structured and proper information are present in those that is why after screening that
articles are excluded (Tucker and et.al 2018). Thus overall this tool is effective to provide the
desirable and reliable source as final outcome.
Summary of the critical appraisal
Critical appraisal tool helps in analysing the reliability, applicability of the source. CRAP
test which stands for currency, reliability, authority and purpose which is used to analyse the
credibility of any source (Kemps and et.al 2019). It is the evaluation method; it discusses the
article that is “6 minute walking test a useful tool in the management of heart failure
patients”( Giannitsi and et.al 2019)
CURRENCY: This factor involves the description to answer the questions like how recent the
data is, as how currently the data is updated on website. Thus in context with this article it is
published online in august 23 in year 2019 which shows the data is current also for conducting
this study for analysing that either diet and exercise are helpful in reducing the risk for the heart
attacks. Thus latest information helps in drawing the conclusion of the study. As this articles
source is current enough to discuss the study topic.
RELIABILITY: In this stage of Crap test it identifies to account the questions which are type of
the information that is included in the source, its content is balanced or not and also to check
whether the references are present in the source for checking the reliability of the article. Thus
the article 6-minute walk test is reliable because of the information that is present in source as it
is online published and all data is verifiable that helps in providing the enough details to be
discuss over the topic (Roeh and et.al 2019). Type of data is medically or clinical data as 6-
minute walk test can help in assessing the functional tolerance of the heart failure patients in
regular clinical practice. As last the list of references are present which ensures its reliability.
Also it is correctly written and language is used in structure manner which shows its reliability.
AUTHORITY: For this stage it accounts the factors which are to check whether the source are
authorised, trustable and who published this and its URL ends with. For this article it is found
that it is authorised and online published article, its authors are Sophia giannitsi, mara bougiakli

and et.al. where the author Sophia works in cardiology and Michaelidion Cardiac Centre,
Greece. Thus it shows that the article is authorised and published and it is distributed under the
creative common attribution non-commercial license (Tofas and et.al 2019). Also URL ends
with the .gov domain that is the federal governmental site. And lastly it is published from the
reputable sponsors which shows its authority.
PURPOSE: It is the final element of the CRAP test which needs to answer the source is based
on facts or opinions also there are citation or not. Thus for the article 6-minute walk test, it
clearly reflects the purpose and the data is factual, information is totally understandable which
shows that 6 MWT is the alternative for the cardiopulmonary exercise test for risk stratification
in the heart failure patients (Long and et.al 2019). In this creator wants to state the utilisation of
the 6MWT in heart failure patients and also to find its effectiveness and limitations for everyday
medical practice among the population with heart failure.
As from the critical appraisal of the source it is identified that the source is authentic and
can be useful for the study. With the description of this tool it helps in examining every factor of
the source whether it is reliable or not, is it published and most importantly it includes the
enough details that helps in examining the study topic. As for the quality concern there is no such
issues found in the source and data is properly evaluated and helps in developing the in depth
understanding to address the issue. In this article it is discussed that proper 6 minute walk test
has been carried out which is done in indoor premises on flat and straight surface for almost
about the 30 meter long path (Fontana, 2018). In this patient has been told to remain calm and
have to take their medicines and also to wear the comfortable shoes and clothes. In this
supervisor has record the baseline oxygen saturation and also records the heart rate and arterial
blood pressure and lastly records the borge scale rate that for fatigue. After understanding all
instruction by the supervisor the test begins. Thus with this description it shows that this resource
is enough and appropriate for addressing the research question.
In this article abstract has been written over the top of the page, where the information is
written in structured manner. As this particular part highlighted what this articles has covered
regarding the 6 MWT. As this article is able to answer the question regarding the clinical
question. There is no such attempt for limiting the biases as the activity which is 6 MWT has
been done on the heart failure patient irrespective of their age. There is no such attempt in the
article is found to contextualize the irrelevant data for portraying the significance. Therefore,
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overall article is able to catch the attention of the reader as language in this is written in simple
manner so it can easily have developed the readability and helps in enhancing the knowledge.
Thus overall from the article it can be said that 6MWT can be efficiently taken out for the
patients with the heart failure as this test is being used in different clinical studies for responding
to the interventions in the patients for measurement to evaluating the treatment effect on patient’s
functional situation. As this test tool is easy to conduct and also widely available and
questionable role in the heart failure patient. Thus overall it can be stated that this process helps
in analysing the aerobic endurance in patient, therefore it helps in tracking the response for the
heart treatment so that further treatment procedures can be carried out (Carbone and et.al 2019).
Thus by using the crap analysis tool it helps in analysing the essential factor about the article,
therefore after all useful factor this article has been selected for answering the study issue.
Application to practice
It has been evaluated from the study that 6MWT has significant impact over the patient
with the heart failure. As it is found that the physical activity is more useful as compared to the
diet control, it is determined that walk for almost 20-30 minutes per day for the heart failure
patient is effective and it can be done on the regular basis that helps in achieving the health
benefit. But it is also important to consult with the doctor so that they suggest the exercise which
need to be taken out they also set the time duration so that it helps in providing the health
benefits (Kiyuna, and et.al 2018). As in this article, it summarised the test for the patient with
the heart failure it shows that supervisor have recorded each activity such as to count the rating
for blood pressure, arteries and others so that to analyse the successfulness of the test. It is found
that more than diet control physical activity provides the efficient and fast result over the health
of the people, additionally it can also be said that both diet and physical activity are useful for the
optimal health, it also helps in controlling the health and often reduces the chances for the heart
disease and it improvise the mental health (Aengevaeren and et.al 2019).
It is identified that the 6MWT is easy to use and also there are no such additional
requirement for the specialised equipment and other training facilities for the physicians, because
of the easy approach physicians can easily use this test tool and analyse the submaximal level
about the functional endurance of the person while doing walk on flat surface for almost 6
minutes (Tian and Meng, 2019). Thus this test helps in evaluating every response about the
system which include during the exercise, but it is also identified that in case of CPET which is

(cardiopulmonary exercise test), this 6MWT does not provide the specific information about the
functions. It is also analysed that in correlation of 6MWD with the peak VO2, changes in the
6MWD cannot be consider as the reliable predictor for the changes found in peak VO2, therefore
it cannot be considering as the better alternative for the CPET for the heart failure patient
assessment (Aggarwal and et.al 2018). It can be also said that for the population purpose this
research has shown the relevant details, also in this article it is clearly shown that the test can be
carried out on the heart failure patient, it cannot be concluded as 6 MWT is the better substitute
for the CPET but it can be used for monitoring the health of the patient and also it is easy to use
so any physicians can proceed with such, for that they do not required specific training (Poole
and et.al 2018).
Therefore, for the research implication it is found that physical activity such as aerobic
exercise walking can be beneficial for the patient with the heart failures. This study is beneficial
to analyse the factor that helps in reducing the chances for the cardiovascular diseases (Wang
and et.al 2018). In context with the 6-minute walking test it helps in providing the details about
the functional capacity and responses to the therapies and prognosis across the areas of the
cardiopulmonary status. Thus it has been evaluated that this test is cost effective and simpler to
use and it also accept the test that covers the elderly and deconditioned patients. Thus in this
outcome can be varied to patient to patient where it shows the result which highlights the
distance covered by the patient within the six minutes. There can be some barriers which restricts
the effective implementation of the research findings that can be lack of availability of the
resources which are financial, improper guidance, lack of time and also conflicts with other is
also an obstacle (Carlisle and et.al 2019). Also for research it is important to have the proper
resources so that it can be produced at time, for organising the study it is foremost to initiates
with the proper strategies and planning’s that aims to provide the desirable outcome. Therefore,
financial resource have the major impact without proper budgeting one cannot proceed with the
study, without proceeding with the proper budget can liable to stop the research study in between
that also gives the negative impact, therefore for overcoming this barrier it is necessary to consult
with the finance expert so that proper budget can be carried out (Pearson and Smart, 2018).
Other barriers for the implication of the research finding can be lack of availability of the
resources it is one of the cause that acts as an hindrance for achieving the desired result. It is
analysed that the if the resources are not properly arranged or identified then it affects the whole
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research process as well as it cause the time delay which is not good for the successful and better
result. At the end it can be said that for implementing this research study analyst will be able to
implement the research findings, as the article is identified in the study is efficient to address the
research question (Powell and et.al 2018). It is also found that the study has shown the proper
details which conclude that some aerobic exercise that is walking can be beneficial for the heart
failure patient and it can be also said that diet control is also important along with the exercise
for the fast and better health results.
CONCLUSION
From the above report it is concluded that the exercise and diet both are important for the
health as it helps in reducing the risk of cardiovascular and other disease, but the condition with
both are applied, that it is essential for the patient to first consult with their doctors to proceed
with specific diet and exercise plan. Thus report have evaluated the discussion about the physical
activity and diet that aims to help the patient with the heart disease. It illustrated that the heart
attacks is been increasing in the people with the time because of the reduction in the healthcare
awareness and also inadequate life style of the people, all this factors are the major reason for the
cardiovascular diseases. Report further evaluated the search key terms for the articles that
address the issue, it also highlighted the use of the databases to select the article. Moving on
further it highlighted the PRISMA evaluation for screening the article at end it selects the one
article to discuss. It finally concluded with the critical evaluation of the article that is based on
the 6-minute walk test for the heart failure patient, it uses the CRAP test for testing the currency,
reliability and other essential factor of the article, it also discusses the research findings and in
last it covered the reflection part.
Reflection
As for me I have learn about the importance of the physical activities and proper diets
that can be used for reducing the chances for the diseases. As in this I have come across to the
different clinical databases which are PubMEd, medline, Cochrane library, scopus that helps in
searching the relevant article that can be used for addressing the research issue. Also by using the
PICO criteria it helps in proper searching by the keywords so that best and relevant resources can
be used. As for me I have developed the searching skills that can be beneficial for my career. As
for incorporating with the evidence based practice in the clinical work, I will continue the study

and also to take help of the peers so that it will help me in practicing the better clinical practices,
it also helps me in carrying out the better treatment plan for the patient. I will efficiently use this
knowledge in my career, as conducting study helps in developing the in depth knowledge so that
I can also help my peers if they face any problem regarding this. Overall study helps me in
clearing my doubt about the study topic and I develop the knowledge and relevant skills that will
helps me in evolving or increasing my further knowledge in it. thus I also come across to the
critical evaluation tool which is CRAP as it is beneficial for analysing the factor regarding
article. Therefore, it is also a beneficial point to know and implement such tools and framework
that helps in assessing the study.
Article link
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6710700/
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REFERENCES
Books and journals
Aengevaeren, V.L. and et.al 2019. Exercise-induced cardiac troponin I increase and incident
mortality and cardiovascular events. Circulation. 140(10). pp.804-814.
Aggarwal, M. and et.al 2018. Lifestyle modifications for preventing and treating heart
failure. Journal of the American College of Cardiology. 72(19). pp.2391-2405.
Agostoni, P. and et.al 2018. Multiparametric prognostic scores in chronic heart failure with
reduced ejection fraction: a long‐term comparison. European journal of heart
failure, 20(4), pp.700-710.
Carbone, S. and et.al 2019. Obesity paradox in cardiovascular disease: where do we
stand?. Vascular health and risk management. 15. p.89.
Carlisle, M.A. and et.al 2019. Heart failure and atrial fibrillation, like fire and fury. JACC: Heart
Failure. 7(6). pp.447-456.
Fontana, L., 2018. Interventions to promote cardiometabolic health and slow cardiovascular
ageing. Nature Reviews Cardiology. 15(9). pp.566-577.
Giannitsi, S. and et.al 2019. 6-minute walking test: a useful tool in the management of heart
failure patients. Therapeutic advances in cardiovascular disease. 13.
p.1753944719870084.
Kemps, H. and et.al 2019. Exercise training for patients with type 2 diabetes and cardiovascular
disease: What to pursue and how to do it. A Position Paper of the European Association
of Preventive Cardiology (EAPC). European journal of preventive cardiology. 26(7).
pp.709-727.
Kiyuna, L.A. and et.al 2018. Targeting mitochondrial dysfunction and oxidative stress in heart
failure: Challenges and opportunities. Free Radical Biology and Medicine. 129. pp.155-
168.
Long, L. and et.al 2019. Exercise‐based cardiac rehabilitation for adults with heart
failure. Cochrane Database of Systematic Reviews. (1).
Pearson, M.J. and Smart, N.A., 2018. Exercise therapy and autonomic function in heart failure
patients: a systematic review and meta-analysis. Heart failure reviews. 23(1). pp.91-108.
Poole, D.C. and et.al 2018. Exercise limitations in heart failure with reduced and preserved
ejection fraction. Journal of applied physiology. 124(1). pp.208-224.
Powell, R. and et.al 2018. Is exercise-based cardiac rehabilitation effective? A systematic review
and meta-analysis to re-examine the evidence. BMJ open. 8(3). p.e019656.
Roeh, A. and et.al 2019. Depression in somatic disorders: is there a beneficial effect of
exercise?. Frontiers in psychiatry. 10. p.141.

Tian, D. and Meng, J., 2019. Exercise for prevention and relief of cardiovascular disease:
prognoses, mechanisms, and approaches. Oxidative Medicine and Cellular
Longevity. 2019.
Tofas, T. and et.al 2019. Exercise-induced regulation of redox status in cardiovascular diseases:
the role of exercise training and detraining. Antioxidants. 9(1). p.13.
Tucker, W.J. and et.al 2018. Impaired exercise tolerance in heart failure: role of skeletal muscle
morphology and function. Current heart failure reports. 15(6). pp.323-331.
Wang, L. and et.al 2018. MicroRNAs in heart and circulation during physical exercise. Journal
of sport and health science. 7(4). pp.433-441.
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