Critical Appraisal of Otago Exercise for Elderly Patients with Rheumatoid Arthritis

This paper critically appraises a peer-reviewed journal article on the application of Otago exercise for elderly patients with rheumatoid arthritis. It analyzes the title, methodology, findings, and recommendations of the study.

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Critical appraisal is the strategic framework that uses a series of questions and
implemented for identification of credibility, and reliability of the paper so that the paper could
be rated as per its future use and application (Munn et al., 2014). In this paper, the discussion
focuses on the critical appraisal of a peer review journal article by Abdulrazaq et al. (2018) that
focuses on the application of Otago exercise for the elderly patients that are prone to fall due to
rheumatoid arthritis. This paper would critically analyze all the aspects starting from the title of
the paper to the application of its findings in the future research.
Chosen paper Title: “A prospective cohort study measuring cost-benefit analysis of the Otago
Exercise Programme in community dwelling adults with rheumatoid arthritis” by Abdulrazaq et
al. (2018).
Introduction
The title of the research article mentioned about the application of Otago exercise therapy
and analyses its cost effective nature for the elderly patients that are suffering from rheumatoid
arthritis (Abdulrazaq et al., 2018). Further it also clearly identified the type of study this research
utilizes for the data collection. Hence as per (), this research article followed all the important
aspects of providing a clear and concise title so that readers could understand the purpose and
aim of the research by the research title.
The primary aim of this study was to understand the economic burden of falls in the
elderly patients affected with rheumatoid arthritis and then compare the cost effective nature of
Otago exercise program (OEP) that is the subject intervention of this research (Abdulrazaq et al.,
2018). As per Rudan et al. (2015), falls in elderly patients with rheumatoid arthritis is a major
concern and it was seen that OEP is effective in reducing the prevalence of fall by 35%. Hence,

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this research was significant to conduct in such condition as Palvanen et al. (2014) has also
included fall as one of the primary concern for elderly patients around the world. Hence, it was
important to analyze the cost effective nature of one such important intervention that can reduce
the rate of fall by 35%. All these aspects were clearly and sequentially mentioned that provides a
brief yet effective idea of the content of the paper and the aim of the researchers with the paper
(Abdulrazaq et al., 2018). Hence, the sequential description of the paper was able to provide an
effective insight of the research paper that increases the interest of the reader in the research
findings and hence as per Wiens (2017), followed the accurate sequence and design of a research
paper writing.
As it was observed in the paper by Abdulrazaq et al. (2018), the paper collected data from
NHS England, National Schedule of Reference and National Institute for Health and Clinical
Excellence all the data and economic statistics collected for the identification of cost of fall in
patients with rheumatoid arthritis, the credibility of the data cannot be questioned (Abdulrazaq et
al., 2018). Further, as the researchers conducted primary research, the literature review was
focused in the introduction and background section only, however those articles were also
credible due to its research type (systematic review and randomized control trial) as per Leung
(2015) and high level of evidence (level 1) as per Moore et al. (2015).
Methodology and Design
The research article by Abdulrazaq et al. (2018) included the study design in which all
the participants that were suffering from rheumatoid arthritis and suffering from the risk and
incidences of fall were selected. The aim of the study was to understand the cost effective nature
of the OEP intervention on the patients of rheumatoid arthritis so that it could be applied on the

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patients that are suffering from rheumatoid arthritis. As the research process focused on the
understanding the mathematical and statistical aspects of the applied intervention and the way it
effects the health improvement of rheumatoid arthritis patients, this research method and study
was philosophically important and hence this research method was used for the data exploration
and assessment (Abdulrazaq et al., 2018). Further, it was also understood that the study was
conducted to understand the basis of this research associated with the identification of economic
benefit to the elderly patients with rheumatoid arthritis and high risk of fall (Abdulrazaq et al.,
2018).
The research design that is selected for this study is the prospective cohort study and as
per Cesaroni et al. (2014), this study type is the method which is a type of longitudinal cohort
study, in which two group of people are involved that differ on the basis of few aspects and then
for a specific time period observes the groups so that a specific outcome could be collected (van
Dyk et al., 2017). The strengths of this study are: its ability to provide a detailed calculation and
incidence as well as its ability to avoid the selected bias for the research study. Therefore, with
application of these aspects, the researchers are able to provide a detailed comparison of two
study groups (Clarsen et al., 2014). On the other hand, the weaknesses are large number of
participants and due to this it is very critical to assess the large number of participant and analyze
their data. Further, it was also mentioned that such process are time consuming and expensive to
conduct and hence, the process should be avoided (Abdulrazaq et al., 2018). Therefore, these are
the strengths and weaknesses of the prospective cohort study so that with application of the OEP
and associated intervention could be assessed for its application in the healthcare of the elderly
patients with rheumatoid arthritis and risk of fall could be obtained (van Dyk et al., 2017).

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Data Collection and sampling design
The research instrument that was used for the completion of this research process was
focused on the statistical analysis of the application of OEP and its benefit related to cost
effectiveness to the patients suffering from rheumatoid arthritis and high risk of falls
(Abdulrazaq et al., 2018). Through the application of standardized questionnaire, and telephonic
interview conducted with the patients in the healthcare facilities, so that all the participants and
their fall and rheumatoid arthritis could be understood (Abdulrazaq et al., 2018). Hence, this is
the research tool that has been used in this research process so that the data of the topic of
interest could be collected and applied in the future research aspect of similar topics.
Validity and reliability of the research conducted by Abdulrazaq et al. (2018), could be
understood from te fact that to provide details of the cost of fall in the elderly patients suffering
from Rheumatoid arthritis, data from renowned organisations such as NHS England, National
Schedule of Reference and National Institute for Health and Clinical Excellence were collected
and analyzed so that the benefits of the new intervention such as OEP could be assessed. Hence,
the research was validated and reliable depending on this aspect (Abdulrazaq et al., 2018).
The target population of this study was elderly population that is suffering from risk of
falls and is affected with rheumatoid arthritis. As Palvanen et al. (2014) mentioned that fall is a
prevalent concern of the elderly patients, this community and age group was selected for the
research project.
The sample was collected in the North West of England and four rheumatology clinics
were chosen for the process and all the patients were selected for the process. The time limit
chosen for collection of participants and their data were collected within the year 2008 and 2009

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(Abdulrazaq et al., 2018). The inclusion criteria hence, was high fall risk, Rheumatoid arthritis
and elderly patients, whereas exclusion criteria was patients that overcome their health
complications prior to research process.
The study collected ethical approval from the National Research Ethics Committee and
the reference is 08/H1009/41. Further, consent was collected from the participants so that
ethically competent research could be conducted. Hence ethical approval was collected
(Abdulrazaq et al., 2018).
Data analysis, Findings, discussion and recommendations
The robust nature of data analysis process could be understood from the fact that majority
of the participants and their replies were collected and analyzed on the basis of statistical
analysis and after proper calculation of standard deviation, the assessment of the data was
conducted (Abdulrazaq et al., 2018).
Further, the results conducted from the study, it was found that £374,354 was the primary
cost of the medical interventions of the rheumatoid arthritis and high risk of falls. Further, it was
seen that the average estimated cost per fall was found to be £1120. On the other hand the OEP
intervention cost was found to be £217.72; hence the cost effectiveness of the study was
understood from the study. Hence, the findings were able to address the aims of the study
(Abdulrazaq et al., 2018).
Therefore, after conducting the study, it was seen that the application of OEP program for
the patients suffering from rheumatoid arthritis so that their risk of fall could be reduced and in a
cost effective manner, the cost effective nature of OEP could be understood (Abdulrazaq et al.,
2018).

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The paper did not provide any recommendations for the future application in healthcare
and research process.
As the data collected for the research was based on the self report and hence it was seen
that the data did not provided a detailed and accurate research of the falls in the selected the
group. Further the fall calendar provided on follow up were not verified and hence, this was not
assessed clearly and hence this was the limitation of the study (Abdulrazaq et al., 2018).
All the research data that was selected for the study were collected from the literatures
and research processes that are conducted within 10 years of the research process. Hence, the
data were relevant to the research process (Abdulrazaq et al., 2018).

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