Critical Appraisal of a Qualitative Study on PTSD and Yoga

This essay critically appraises a qualitative study on post-traumatic stress disorder (PTSD) for its trustworthiness, and rigour by exploring its objective, design and results. The article defined all the key components of the PICO framework. The evidence will help readers realize the potential advantage of yoga in post-traumatic stress disorder.

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Title page
Student Name:
HLSC122 Semester 2, 2018
Assessment 3: Critical appraisal of evidence
Word count: 1319
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Introduction:
The interdisciplinary approach of evidence based practice (EBP) forms an
essential component of clinical practice and has gained attention over the past twenty
decades. The process of EBP focuses on three core principles namely, (1) using best
available evidences for determining effectiveness and safety of interventions, (2) clinical
judgment skills, and (3) taking into consideration the values and preferences of the
clients (LoBiondo-Wood, Haber, Berry & Yost, 2013). Critical appraisal of scientific
evidences is imperative owing to the fact that it facilitates the procedure of careful and
systematic assessment of the results of outcome research, thus assisting the process of
ascertaining the value, trustworthiness, relevance and value of the scholarly evidence,
in a specific context (Singh, 2013).
The essay will critically appraise a qualitative study on post-traumatic stress
disorder (PTSD) for its trustworthiness, and rigour by exploring its objective, design and
results. This will be followed by examination of barriers to the implementation of
evidence in the scenario based on Tasso.
Body:
Jindani, F. A., & Khalsa, G. S. (2015). A yoga intervention program for patients suffering
from symptoms of posttraumatic stress disorder: A qualitative descriptive study.
Journal of Alternative and Complementary Medicine, 21(7), 401-408.
doi:10.1089/acm.2014.0262
PART A
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Authorship- The article for appraisal has been published in the Journal of
alternative and complementary medicine and has been written by Farah A. Jindani and
G.F.S. Khalsa. The first author holds a doctorate degree at the Centre for Addiction and
Mental Health, Toronto. The other author is from the University of Toronto Mult-Faith
Centre for Spiritual Study and Practice. This establishes qualification for writing the
paper. The researchers did not declare any competing interests. Although they founded
their research on other findings that elucidated the benefits of mind-body interventions
on physical and mental stress related disorders, they did not have any prior knowledge
on the impacts of yoga on PTSD symptoms (Klatte, Pabst, Beelmann & Rosendahl,
2016). Lack of sound understanding or an in-depth perspective on the effects of the
proposed intervention is unexpected of researchers (Greenhalgh, Bidewell, Crisp,
Lambros & Warland, 2017).
Research questions- All qualitative research are exploratory in nature and build
on the objective of gaining a sound understanding of underlying opinions, reasons, and
motivations behind a phenomenon, thus providing insight into the issue being
investigated. Jindani and Khalsa (2015) stated that their primary objective was to
explore the experiences of the PTSD participants who enrolled in trauma sensitive
Kundalini yoga (KY) intervention. This objective was justified since the effectiveness of
yoga in treating a plethora of psychiatric disorders has already been established
(Jindani & Khalsa, 2015). Although there is lack of substantial qualitative evidence on
the benefits of yoga in PTSD treatment, the researchers emphasized on the potential
advantages that yoga practices exert on the mental and physical wellbeing of an
individual (Greenhalgh, Bidewell, Crisp, Lambros & Warland, 2017).
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Research design- It is essential to understand that conduction of a qualitative
research is imperative for investigating techniques and methodologies that place an
emphasis on investigation of variables in the natural settings (Hoffmann, Bennett & Del
Mar, 2013). The methodology was a randomized controlled trial that lowered selection
bias, while testing the efficacy of the intervention. It was identified that the research was
based on a phenomenological approach that helped in describing how the participants
experienced the KY intervention (Jindani & Khalsa, 2015).
Owing to the fact that phenomenological study eliminates preconceived
assumptions and biases about human understandings, responses, and to a particular
situation (Liamputtong, 2016). It allows the researchers to probe into the perspectives,
understandings, perceptions, and feelings of those persons who have actually
experienced or endured the occurrence or condition of interest (Lewis, 2015). Thus, it
can be stated that the researchers had adopted an appropriate research design in the
trial.
Research methods- The use of telephone for data collection of qualitative
interviews is dejected by traditionalists who interpret it as a mediocre data gathering tool
(Ward, Gott & Hoare, 2015). Hence, it can be stated that the researchers implemented
an inferior data collection method that prevented them from observing the body
language of the respondents and was an expensive alternative, in comparison to face-
to-face interviews. The sample of 40 participants for the randomized controlled trial was
inadequate since small sample size reduces the power of the study and also lowers the
precision of the result estimates (Cleary, Horsfall & Hayter, 2014). The use of semi-
structured interview questions was beneficial owing to the role in allowing the inflow of
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new ideas from the responses of the participants (O’brien, Harris, Beckman, Reed &
Cook, 2014).
Presence of the semi-structured interview guide helped the researchers to
emphasise the interview on the themes at hand devoid of compelling them to a specific
format. While no information was provided on remuneration of the participants, the trial
had obtained an ethical approval from the University of Toronto Office of Research
Ethics, and prior informed consent from all participants (Jindani & Khalsa, 2015).
Results- The researchers used the method of inductive thematic analysis that
allowed them to identify themes and develop theories by conducting an extensive study
of the interview recordings (Greenhalgh, Bidewell, Crisp, Lambros & Warland, 2017).
This helped them identify three distinct domains namely, awareness, self-observed
alterations, and yoga program. Although they found that KY intervention practice
provided the opportunity to people with PTSD symptoms to acquire new strategies for
calming down, attuning the body and mind, becoming mindful of thought patterns, and
controlling emotions, they also found that intrinsic motivation played an important role in
completion of the yoga based intervention.
The fact that the researchers adopted the inductive approach was also beneficial
since there was a lack of previously conducted research on the action of yoga on PTSD
treatment (Jindani & Khalsa, 2015). However, one major drawback of the research was
that the process was time consuming and required an extensive analysis of the
telephonic responses. Nonetheless, the researchers did acknowledge limitations in their
participant recruitment process and absence of an active control. Hence, further
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research is required for investigating the direct impacts of yoga based interventions on
reduction of PTSD symptoms among patients.
PART B
The integration of individual clinical expertise, in association with best available
evidences form the core component of evidence-based practice (EBP). In other words,
it refers to the explicit, conscientious and judicious usage of best suggestions for clinical
decision making, in relation to the individual care of a patient. However, there the
implementation of evidences in real-time settings are confronted by a range of barriers
(DiCenso, Guyatt & Ciliska, 2014). The easily identifiable barrier in the article is the low
level of trustworthiness of the findings due to the presence of selection bias and small
sample size. This was acknowledged by the authors as well. If Tasso is convinced to
join a yoga based treatment program, with the aim of reducing his PTSD symptoms, a
range of organizational barriers might arise.
This can be averted by ensuring that the medical practitioners have proper
access to yoga-based interventions for treating mental disorders. Changing the
organization of care and adopting strategies that correlate research evidences with
successful practice will largely help (Williams, Perillo & Brown, 2015). However,
limitations in the available resources for healthcare services might act as a major
limitation. Poor attitude and lackof belief on the impacts of yoga in preventing or
reducing the PTSD symptoms will be the major individual barriers. Lack of awareness in
research can also impede the process. This would commonly encompass difficulty in
understanding the technical terms and assessing the quality of evidence. Unsupportive
staff and management and lack of training programs are some other organizational
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barriers that can be overcome by a supportive leadership, taking time to appraise the
evidences, learning retrial skills for EBP utilization and using EBP guidelines. The
information gathered from the critical appraisal will be used in clinical practice by
developing effective policies to inspire patients to adhere to healthcare advice.
Difficulties in application of the evidence due to poor access to evidences might also
restrict the clinical decision making process. These can be effectively prevented by
formulating incentives and facilities for encouraging efficient care and enhancing
management of mental illness.
Conclusion:
To conclude, in order to determine the relevance of the selected qualitative
article to the current scenario faced by Tasso, a comprehensive and thorough
assessment of the PICO question was investigated. The article defined all the key
components of the PICO framework. The population was patients with PTSD,
intervention was Kundalini Yoga therapy, compared to control group, for determining
their experiences as the outcome. While the small sample size appeared to have
positive experiences in relation to their PTSD symptoms, the researcher had obtained
an ethical approval. Furthermore, the findings were consistent with other literature that
elaborated on the impacts of yoga on mental health. Thus, the evidence will help Tasso
realize the potential advantage of yoga in post-traumatic stress disorder.
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References
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Jindani, F. A., & Khalsa, G. S. (2015). A yoga intervention program for patients suffering
from symptoms of posttraumatic stress disorder: A qualitative descriptive study.
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Journal of Alternative and Complementary Medicine, 21(7), 401-408.
doi:10.1089/acm.2014.0262
Klatte, R., Pabst, S., Beelmann, A., & Rosendahl, J. (2016). The Efficacy of Body-
Oriented Yoga in Mental Disorders: A Systematic Review and Meta-
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