Critical Appraisal of Risk Perception of Nonspecific LBP Among Nurses

This report provides a critical appraisal of a qualitative research article focusing on nurses' risk perceptions of nonspecific low back pain (LBP). The appraisal, using the CASP tool, examines the study's aims, methodology, and findings. The research, conducted in Iran, investigates the prevalence and impact of LBP among nurses and employs semi-structured interviews for data collection. The report evaluates the appropriateness of the qualitative approach, research design, recruitment strategy, data collection methods, role of the researcher, ethical considerations, and data analysis techniques. Strengths include the use of data saturation and a structured interview guide based on the protection motivation theory. However, limitations such as the lack of focus groups and unclear exclusion criteria are also discussed. The report concludes with an assessment of the study's value and implications for healthcare interventions aimed at mitigating LBP among nurses.

Running head: CRITICAL APPRAISAL
CRITICAL APPRAISAL - RISK PERCEPTION OF NONSPECIFIC LOW BACK PAIN
AMONG NURSES: A QUALITATIVE APPROACH
Name of the Student
Name of the University
Author Notes

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Table of Contents
Introduction......................................................................................................................................2
Critical Appraisal.............................................................................................................................2
Clear statement of aims...............................................................................................................2
Appropriateness of the Qualitative approach..............................................................................3
Research design...........................................................................................................................4
Recruitment Strategy...................................................................................................................4
Data collection.............................................................................................................................5
Role of the researcher..................................................................................................................6
Ethical issues...............................................................................................................................6
Data analysis................................................................................................................................7
Clear statement of findings..........................................................................................................8
Value of research.........................................................................................................................9
Conclusion.......................................................................................................................................9
Reference List................................................................................................................................10

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Introduction
The work by Abedini et al., (2014), is based on a qualitative analysis of the various risk
factors associated with low back pain (LBP) among nurses. Critical appraisal is a process that
involves an in depth analysis of a particular research paper with the help of critical appraisal
tools. Critical appraisal tools are used for analysis of systematic reviews, cohort studies,
randomized controlled trials, case studies, among others (Shea et al., 2017). The problem
depicted by Abedini et al., (2014) in their paper is highly relevant because healthcare sectors are
associated with a large number of work related injuries or illnesses (Gomaa & Sprigg, 2014, pp.
405-410). These health concerns affecting the healthcare professionals are musculoskeletal
injuries resulting in LBP, needle stick injuries, shift works and workplace violence (Sehume,
2016).
This essay carries out a critical appraisal of the research article “Risk perception of
nonspecific LBP among nurses: A qualitative approach”. The critical appraisal was carried out
by using the CASP tool checklist. The CASP approach involves critical analysis of the research
into 3 steps. These include the validity of the research, analysis of the results of the study and
whether the results are valid or not (Critical appraisal skills programmes, 2018).
Critical Appraisal - Body
Clear statement of aims
The title of the article indicates the use of qualitative approaches in the identification of
risk perceptions of the nurses with respect to LBP. The abstract is a structured summary
providing a background on which the research was based, the methods, results and conclusion.

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The goal or objective of the research was to determine the various risk perceptions associated
with non-specific LBP among the nursing staff present in the healthcare organizations of Bandar
Abbas City in southern Iran (Abedini, Morowatisharifabad, Enjezab, Barkhordari & Fallahzadeh,
2014, pp. 221). This article defines LBP as a health condition that is not associated with any
pathological cause. The research carried out in this field is highly relevant as it is a serious
concern among the nurses and it is a highly prevalent and serious disorder affecting the quality of
life and work of the healthcare professionals (Budhrani-Shani, Berry, Arcari, Langevin &
Wayne, 2016; d'Errico et al., 2013, pp. 276-283). In Iran, the situation is highly relevant as in
one year, the rate of incidence of LBP among nurses increased from 49.4% to 81%. Perceiving
the consequences of LBP among the nursing staff is important in order to develop intervention
programs targeted against these risk factors (Abedini, Morowatisharifabad, Enjezab, Barkhordari
& Fallahzadeh, 2014, pp. 221). Keeping in mind the Consolidated Criteria for Reporting
Qualitative Research (COREQ) checklist, the study defines the research methodology utilized in
this study, which is a semi-structured interview process (Tong, Sainsbury & Craig, 2015, pp.
349-357). The study efficiently identifies the various risk perceptions of the nurses with regards
to LBP. Such studies are required in order to develop interventions in the future, in order to
ensure that healthcare professionals, particularly nurses do not suffer from LBP, which in turn
affects their professional and personal lives.
Appropriateness of the Qualitative approach
The study was important as it helped to determine the attitudes, behaviors and
experiences of the nurses, thereby helping to develop an evidence base, which is not possible in
the case of a quantitative research design. Moreover, pain perception is different among different
individuals, due to variations in mental experiences. Thus, necessary interventions can be

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provided only if the viewpoints and the perceptions of the nurses who are suffering from the
specific medical condition is taken into consideration. Quantitative approaches are based on a
pre-determined research design, which does take into account the considerations of the affected
individuals, while a qualitative study helps to identify the potential risk factors, the beliefs and
experiences of the individuals in the development of an appropriate intervention strategy (Green
et al., 2015, pp. 508-523). Thus, this study helped to identify the risk perceptions of the nurses
associated with nonspecific LBP.
Research design
The research design was based on qualitative content analysis, which involved the use of
semi-structured interviews and purposeful sampling technique, but they did not discuss the
reasons for using a semi-structured interview method. Semi-structured interviews are pre-
determined questions set out by researchers but changes can be brought about after perceiving
what is appropriate at the particular situation of the interview. Semi structured qualitative studies
consist of interviews and observations and involves systematic and coding of data obtained from
verbal communications. Such interviews are less structured and are used to gather verbal
information. Such interviews can help to understand people’s experiences and perceptions
(Jamshed, 2014, pp. 87). Apart from individual interviews, another qualitative method that could
have been applied here is the use of focus groups. Focus groups includes a group of individuals
suffering from the same problem and group discussions are carried out to understand the
individual view points. Focus group discussions are usually recorded by a researcher to carry out
further studies based on the discussions (Dilshad & Latif, 2013). Focus groups are particularly
useful in healthcare as it helps to carry out a needs assessment of the targeted population, which
is highly essential for the development of interventions. Focus groups allow the participants to

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carry out facilitated discussion based on individual ideas, which in turn allows the researcher to
develop new ideas and understand the meaning behind the facts obtained from survey interviews.
The other advantages of the focus groups are that it provides an opportunity to observe and
interact with a large number of people on the same topic within a limited period. Such
interactions help not only to compare the perceptions of a large number of individuals at the
same time but also helps to save the valuable time of the researcher. The interviewer also gains
access into the views and opinions of the participants with respect to a particular topic and
therefore helps to identify the similarity and differences associated with such opinions. Thus, it
helps to develop interventions that are suited for all keeping in mind the individual opinions and
perspectives (Bowling, 2014; Flick, 2014). This study did not use the approach of focus groups,
which could have helped to carry out a needs assessment and evaluation of the perceptions of the
nurses.
Recruitment Strategy
The research study however utilizes data saturation for determination of the sample size,
which is a gold standard in qualitative research (Fusch & Ness, 2015, pp. 1408). The study
describes the inclusion criteria, which were based on work experiences as a nurse and having
bachelors and masters degree in nursing as well as on consent of the participants. The study
however did not explain the reason for selecting the above mentioned participants and how the
selected participants could have added to the progress of the research. Moreover, the study did
not describe the exclusion criteria, based on which certain individuals were not used in the study
design.

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Data collection
The research study utilized a semi-structured interview rather than a focus group. A
combination of both interview and focus group would have been beneficial in order to obtain the
thorough perceptions of nurses with regards to LBP. However, the researchers did not reveal the
reason behind selecting the semi-structured method and not selecting the use of focus groups,
which can provide a more sensitive and personal information, with the help of which researchers
can align their ideas for the development of intervention strategies. Focus groups are also far
advantageous than individual interviews as it combines the elements of interviewing individual
participants as well as carrying out participant observation in groups (Evalued.bcu.ac.uk, 2018).
The research revealed the use of data saturation in generating an appropriate sample size
(Hancock, Amankwaa, Revell & Mueller, 2016, pp. 2124-2130). However, no information is
given on data saturation with respect to the themes or subthemes discussed in the interviews. The
preparation of the interview guide was thoroughly done by carrying out literature review on LBP
and qualitative approaches. Moreover, the interview guide was based on the protection
motivation theory, which is essential in the analysis of behavioral patterns. The protection
motivation theory is based on four factors, which helps to determine the perceived severity, the
probability of occurrence, perceptions of the efficacy of the prevention strategies and the
perceptions of self-efficacy (Xiao et al., 2014, pp. e3246). Moreover, they had carried out a
review of the questions in the interview guide by allocating specialists. Necessary changes in the
interview guide were done based on the reviews obtained. The development of the interview
guide has been thoroughly described in the study. The interview questions were based on the
perceived severity and vulnerability associated with the medical condition. Moreover, the
researchers also used probing questions in order to determine the underlying facts associated

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with the perceptions of the nurses with respect to LBP. The study participants were selected from
a range of categories in order to have a thorough understanding of the risk perceptions. However,
there is some controversy in the inclusion criteria, as the research study initially declares the use
of only those individuals in the research study, who had a nursing experience of greater than 1
year; however, in another part they have stated the use of individuals having different work
experiences. The study carried out data collection in the form of interview recordings, which
were used later for further analysis. Moreover, the qualitative research should be combined with
randomized controlled trials, blinding or allocation concealment, however, it is not applicable in
this study as there are no interventions or treatments being tested (Drabble, O’Cathain, Thomas,
Rudolph & Hewison, 2014, pp. 24; Garg, 2016, pp. 640).
Role of the researcher
The researcher played an important role in the formulation of the interview questions by
critically examining the viability of the questions by getting feedbacks from specialists in
behavioral and health education. They also formulated the interview guide questions based on
the protection motivation theory. Whenever needed they carried out further questioning in order
to deeply probe into the problem. Moreover, the researcher helped to create a friendly
atmosphere in order to make the interviewee comfortable.
Ethical issues
Ethical principles in qualitative research involve autonomy, beneficence and justice.
Autonomy describes the importance of the protection of human rights. Beneficence refers to the
preventing harm to the participants. Justice refers to the prevention of abuse and exploitation of
the participants (Aluwihare-Samaranayake, 2012, pp. 64-81). In this study, informed consent was
obtained from the participants. Before the start of the interview, the participants were informed

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about the purpose of the research, reasons for recording of the interviews and confidentiality of
the interviewees were maintained. However, there is no mention of any approval obtained from
the ethics committee before initiation of the research work.
Data analysis
The data analysis has been described properly. The data analysis was based on recording
and transcribing the discussions carried out in the interviews. The validity of the transcribed texts
were determined by verifications with the interview recordings. Moreover, the authenticity of the
data analysis was confirmed by reviewing the transcribed texts repeatedly. Moreover, the data
was also analyzed by using the Version 10 of the software MAXQDA10. Deductive content
analysis was used to process the data. Key concepts were obtained by analyzing and processing
the data obtained from the recordings and transcripts. Data were classified according to the
similarity of the primary codes, from which primary categories were obtained. The primary
categories were then used to produce the main categories. Moreover, sub-categories were also
determined by carrying out further analysis of data. In order to increase the relevance of the data
in qualitative research, it is necessary to determine the credibility, conformability, dependability
and transferability of the data (Sutton & Austin, 2015, pp. 226). Dependability, conformability
and transferability was determined by reviewing the transcripts with the recordings, generating
sub themes and matching it with the data obtained in the transcripts and by describing the key
features of the participants, data collection methods and data analysis techniques so that the
research can be carried out by others. However, there is no information of the use of statistical
methods for representation of the data obtained from the interviews. Information like age,
working experience, history of LBP were considered by the researchers during data analysis.
However, no contradictory data has been described in the study. Avoidance of bias in qualitative

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research is highly essential (Corbin, Strauss & Strauss, 2014). In this study, also the researchers
have tried to prevent potential bias by reviewing, using alternative models, using softwares,
among others.
Clear statement of findings
The results are described explicitly by the use of themes and sub-themes. The findings
presented in the study thoroughly addresses the research question put forth by the researchers.
They have showed the various perceptions of the nurses and in the process have identified the
different situations that can give rise to LBP as well as the consequences associated with LBP.
The results obtained in this study was validated by data obtained from other studies. However,
the data obtained with respect to impacts on married life has been described in this study for the
first time. However, there was no data that was against the hypotheses put forth by the
researchers. All the findings were discussed keeping in mind the identification of risk
perceptions associated with LBP. However, credibility of the data, which is highly essential was
obtained only through reviewing by other analysts and there is no mention of obtaining
validation of the data from the participants. Triangulation is an important approach for data
validation in qualitative research (Hussein, 2015). In this study, only interview method has been
used to obtain the data and the resultant data has not been verified by other methods except by
verifying with previous research data.
Value of research
The study has described the importance of the risk perceptions of LBP findings with
respect to the current situations at the workplace and profession. Moreover, it has contributed
new information in the form of impact of LBP on marital life. They have indicated the
requirement of further research in the field of risk factors of LBP in order to provide effective

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interventions. However, they have not discussed the applicability of these findings with respect
to other populations apart from the field of nursing.
Conclusion
This essay provides a critical analysis of a research article that deals with determination
of the risk perceptions of nurses with respect to development of LBP. The study did not combine
the use of focus groups along with the interview process. The study identified various risk
perceptions as well as the impacts associated with LBP. The study was carried out keeping in
mind the principles of ethics with respect to autonomy. The findings obtained has been grouped
into various themes and sub themes and the data were validated by reviewing with peers as well
as from existing literatures. This study has therefore identified various risk factors and they have
indicated the requirement of further research in this field before development of interventions.
However, they have not shown the application of this research with respect to other fields.

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