Critical Appraisal of Quantitative and Qualitative Articles on Healthcare

Running head: HEALTHCARE
Topic: HEALTHCARE
Name of the Student:
Name of the University:
Author Note:

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Critical appraisal
Quantitative article: Wang, C., Schmid, C. H., Fielding, R. A., Harvey, W. F., Reid, K. F.,
Price, L. L., ... & McAlindon, T. (2018). Effect of tai chi versus aerobic exercise for
fibromyalgia: comparative effectiveness randomized controlled trial. bmj, 360, k851.
1. Did the trial address a clearly focused issue?
This paper is about Fibromyalgia, which is defined as complex disorders characterised by the
chronic fatigue, musculoskeletal pain, and sleep disturbances. While various drug
interventions has shown benefits against fibromyalgia, but recently aerobic exercises has
been recommended as a gold standard of care for the fibromyalgia. This study has compared
effectiveness of aerobic exercises and Tai -Chi for the fibromyalgia. It is also inclusive of
evaluating the effectiveness inclusive of tai-chi depended upon the duration and the dosage.
2. Was the assignment of patients to treatments randomised?
A prospective, randomised and single blinded trial has been conducted in tertiary care
hospital located in the urban areas of United States between March 2012, as well as
September 2016. 226 adult participants were being chosen for the study and there were
randomly assigned to either a aerobic exercise which has been supervised or one in the Yang
style supervised by Tai-chi exercise. Randomisation ensures that experimental control has
been used extensively. It is used for preventing selection based biasness and ensures against
any accidental bias (Senn, 2013). It does so by producing comparable groups and helps to
eliminate the sources of bias the treatment assignments.
3. Were all of the patients who entered the trial properly accounted for at its conclusion?
The trial was not stopped early and adherence of participants to the study was extensively
encouraged in person by the telephone. 12 or 24 weeks inclusive of supervised Tai-Chi

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program interventions were added. The participants had been recruited using various
combinations of advertisements as well as enrolment through clinics located in greater
Boston region.
4. Were patients, health workers and study personnel ‘blind’ to treatment?
This is a single blinded trial. After the participants had been selected and the baseline
assessment has been performed before the enrolment of the six week circle, randomisation
was performed. Factorial based arrangement has been used for ensuring that the Tai- chi
instructor conducted every treatment regimen throughout the trial. All the assessment was
concealed in the sealed and opaque envelope and were opened only by the participants
followed by their consent has been obtained by the study coordinator. Single blinded trial are
mainly done when the knowledge of the participants of the group membership or the identity
of the results might bias the results (Senn, 2013).
5. Were the groups similar at the start of the trial?
Those participants below the age of 21 and who had completed the preliminary diagnostic
criteria for the American College of Rheumatology 1990 and 2010 for fibromyalgia, had been
recruited for the study.
The inclusion criteria included the history especially of disorders like musculoskeletal
pain for both above and below the waist for almost minimum of about 3 months. Only these
participants having a pain index of 7 or more has been selected the study. Those participants
with serious health complications were excluded from the study. Again the participants who
had already have had complementary treatments like Acupuncture or Tai-chi were excluded
from the assignment. Pregnant women and those who cannot speak English and could not
perform the Mini-mental examination were excluded from the study. A suitable inclusion and
exclusion criteria are generally made in order to reduce chance of selection based bias and to
increase reliability of the study conducted (Brannen, 2017).

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6. Aside from the experimental intervention, were the groups treated equally?
Yes, all the groups had been treated equally. All the participants were encouraged to receive
the Tai –chi as well as the aerobic exercise protocol. Each of the Tai-chi lessons lasted for
minimum 60 minutes for 12 and 24 weeks and aerobic exercises sessions were done for 60
minutes twice a week for about 24 weeks. The attendance sheets were used for monitoring
the attendance of each of the participants at the treatment sessions. For both the interventions,
there was a continuous monitoring of the adverse events and safety protocols. It is necessary
to ensure a balance group in the randomised control trials (RCT) in order to measure
outcomes (Brannen, 2017).
7. How large was the treatment effect?
The primary outcome that was measured is any change in revised FIQR total score, from the
baseline till 24 weeks visits. FIQR is a tool that is generally used for measuring severity of
Fibromyalgia, including pain intensity, fatigue, morning tiredness, job difficulty as well as
overall wellbeing of the person (Andrade, 2015). The item is standardised by a scale ranging
from 0-10. These are considered as most important outcomes that has to be examined in the
study. It helps in the reduction of chance of the false positive errors and due to statistical
testing of the outcomes. It also reduces the chance of the false negative error by the provision
of basis for estimating the sample size required for an adequately powered study (Andrade,
2015).
The secondary outcome was measured at the baseline and the 12, 24 and 52 weeks and
included the global assessment of the patients by using a visual analog scale having higher
scores and great impact on the symptoms. Other instruments that were used for the
assessment are the arthritis self-efficacy scale, the Pitrsburg sleep quality index, Beck
depression inventory II.
8. How precise was the estimate of the treatment effect?