Critique of Clinical Research Paper 1: Abdominal Binder Effects

This report provides a comprehensive critique of two randomized controlled trials (RCTs) concerning the effects of elastic abdominal binders on patients following major abdominal surgery. The first study, by Arici et al. (2016), investigated the impact of abdominal binders on gastrointestinal and pulmonary function, mobilization, and pain, while the second, by Cheifetz et al. (2010), assessed the effects on physical function, pulmonary function, and patient-perceived distress. The critique highlights the similarities and differences in study design, patient selection, and outcome measures. The analysis reveals that both studies found abdominal binders to be effective in reducing pain and improving mobilization, but with varying degrees of impact on other factors such as gastrointestinal and pulmonary function. The report discusses the strengths and limitations of each study, including sample size, patient demographics, and specific outcome measures, concluding that further research with larger sample sizes and more uniform patient populations is needed to fully understand the benefits of abdominal binders. The report emphasizes the need for consistent measurement methods and specific parameters for comprehensive evaluation of the binders' impact on various post-operative complications.

Critique of Clinical Research Paper 1
Critique of Clinical Research Paper
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Critique of Clinical Research Paper 2
Effects of abdominal binder on mobility, pain, gastrointestinal and
pulmonary functions in patients who have undergone major abdominal
surgery
Introduction:
The occurrence of post-operative complications is a common occurrence amongst patients who
undergo major surgeries. In cases of major abdominal surgery, complications such as immobility
and pain commonly arise. In several major abdominal surgeries, elastic abdominal binders are
used to enhance the support postoperative walking, mobility, pain and distress as perceived by
the patient. The following article discusses the background of the major abdominal surgery and
postoperative complications. It brings out the comparison and contrasts between studies by Arici
et al, 2016 and Cheifetz et al, 2010 respectively. Both studies focus on the effect of elastic
abdominal binder on the mobility, pain and distress, and related complications. They are based
on the background of the evidence available on the functionality and effectiveness of using an
elastic abdominal binder on postoperative complications. The following article critiques the
purpose, study design, and findings of both the studies aiming to point out similarities and
dissimilarities of findings.
Amongst patients who undergo major abdominal surgery, there is a common risk of development
of several surgery associated complications [1]. The primary complications include nausea,
abdominal distension, infection at the site of surgery, immobility, and pain [1]. There can be
urinary infections, anastomotic leakages, or paralytic ileus in certain cases [1]. Research
indicates that patients following surgery have a higher risk of developing complications post the
surgical operations [1, 2]. Both the studies note that existing research has provided insight into
the use of elastic abdominal binders for support to the area of surgery [1, 2]. Infections at the site
of surgery and compromised mobility are common postoperative complications. Abdominal

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binders are used to provide support to the abdominal regions and enhance the ease of walking,
mobilization, and exercise amongst the patients [1, 2]. However, clinically, several adverse side
effects of such binders have been noticed by physicians [1].
The study by Arici et al, (2016), aims to analyze the different side effects of the usage of
abdominal binders and they have found that there are no significant adverse effects of these
binders on the mobility of patients [1]. This study provides evidence that the use of binders can
help in the reduction of pain and improves mobilization [1]. The results of the study by Arici et
al, (2016), indicate that abdominal binders are safe for incorporation into treatment routines and
protocols for patient after-care [1]. Arici et al note that these complications that result following
surgical procedures typically increase the length of hospital stay, and often lead to chronic
illnesses, and compromised quality of life [1]. The study by Cheifetz et al, (2010) aims at
assessing the effectiveness of elastic binder or incision support system in the improvement of
postoperative physiological functionality and physical mobility activities [2]. The two studies
rely on a similar background of postoperative pain and distress and the effects of abdominal
binder on the physical mobility [1, 2]. However, the two studies differ in the individual factors
that they assess [1, 2]. The study by Cheifetz et al (2010) analyses the influence of the binder on
the physical function and mobility along with assessing the pulmonary function impairment and
experience of pain and perception of distress [2]. The study by Arici et al (2016) hypothesizes
that abdominal binders do not have any influence on the gastrointestinal and pulmonary function,
mobilization, pain; secondarily, a converse hypothesis suggests that the abdominal binder
effectively impacts the aforesaid aspects in patients after major abdominal surgery [1]. The
primary difference in the factors assessed is that the study by Arici et al (2016) assesses a wider
range of factors and postoperative conditions in comparison to the study by Cheiftain et al, 2010.

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Study design, findings, and conclusion:
The studies by Cheifetz et al (2010) and Arici et al (2016) are both randomized controlled trials
[1, 2]. Chiefetz et al, however, assess a primary criterion including the measurement of physical
function and patient-perceived distress factors along with a secondary criterion to assess the
pulmonary functionality and accompanied pain in patients following operation [2]. Their
inclusion criterion was patients of a minimum age of 19 years who have undergone or are
undergoing major abdominal surgery [2]. The exclusion criterion was orthopaedic, circulatory, or
neuromuscular disorders in patients [2]. Arici et al provide an enhanced scope for analysis as
their criterion for patient recruitment was of a broader frame. They included consenting patients
above the age of 18 and selected the sample from the patients who had undergone planned
abdominal surgery for disorders of the colon, pancreas, esophagus, stomach, rectum, liver,
gastrointestinal system, or the intestines along with those including resection of organ and
adhesiolysis of extensive nature were included according to the criteria of eligibility [1, 2]. The
control group was not given an abdominal binder and in patients, it was found that the elasticity
of the binder reduced the postoperative pain and inordinate distress in the abdominal region [1].
The study by Arici et al includes measurements based on individual types of surgical methods,
duration of administration of anesthesia, time of first stool after operation, nausea, first flatus
time record, and the length of surgical incision [1]. The study by Arici et al included
measurement of pulmonary functions, comfort in various functions, and the measurement of
acute pain [1]. In contrast, the study by Chiefetz et al (2010), measured physical functions to
assess walking and blood pressure variations following the walking task. Additionally, this study
measured pain, pulmonary distress, and perceived distress in patients [2]. The parameters
measured in the study by Chieftez et al are limited [2]. Chieftez et al (2010) fail to measure the
factors in accordance with the specific parameters such as the type of surgery, length of incision

Critique of Clinical Research Paper 5
etc [1, 2]. However, the study by Chieftez et al (2010) measures the effects of binder on patients
undergoing a single type of surgery due to which stability of results is ensured [2].
The findings of the study by Chieftez et al (2010) indicate that the randomized controlled trial is
an effective measurement of effects of elastic abdominal binder [2]. The findings of the studies
by Chieftez et al (2010) and Arici et al (2016) are consistent in the observation that the sensation
of pain is lowered along with enhanced mobilization with the incorporation of abdominal binder
in the postoperative care procedures [1, 2]. Chieftez et al have reported that perceived distress
and pain is lower for patients with the abdominal binder [2]. However, there were no reported
changes in the functionality of lungs in both the control and the test groups [2]. The study by
Arici et al (2016) reveals that gastrointestinal functions and complications such as nausea, first
stool, and first flatus along with pulmonary functions were not improved by the use of the binder
[1]. Consistent with the former study, Arici et al report that the pain and distress in patients is
lowered by the use of non-rigid elasticized binder [1]. However, Chieftez et al (2010) used the
adapted system of distress scale and report that the abdominal binder considerably reduces
perceived distress [1, 2]. However, Arici et al (2016) produce more reliable information and state
that there is no direct impact of the binder on gastrointestinal symptoms of perceived distress [1].
Arici et al found a decrease in the duration of first flatus in patients using the binder; however,
they have not reported definite evidence indicating the role of the abdominal binder in the
reduction of perceived distress [1].
Conclusion:
The study by Arici et al (2016) is broader in perspective and measures more number of factors
based on specific parameters [1, 2]. Arici et al specifically study the effects of abdominal binder
on various gastrointestinal functions (nausea, vomiting, first flatus durations, duration of first

Critique of Clinical Research Paper 6
stool), pain, and mobilization [1]. The design of the study by Arici et al (2016) is well-structured
and involves reliable and precise measurement methods and criteria such as a six-minute long
walk test for mobilization (similar to Chieftez et al), spirometric analyses for assessment of the
pulmonary functions, and status of pain in the test and control groups of patients [1]. The
inclusion criteria of the study by Arici et al involves recruitment of patients in Turkey which
limits the study in that the incidence of gastrointestinal tumors is higher in Turkish men as
compared to the women causing imbalance of the gender aspect [1]. Since the study by Arici et
al includes assessment of different types of surgeries which may lead to inconsistencies in pain
levels due to basic differences in surgical interventions [1]. The study by Arici et al does not
have a high degree of generalizability owing to the relatively small sample size in a local hospital
[2].
The study by Chieftez et al is limited in the factors of measurement, statistical analysis, and
methods of measurement of specific effects such as perceived distress and pulmonary function
[2]. Chieftez et al have not measured the effects of abdominal binder on perceived distress due to
the lack of information about the mechanism by which the abdominal binder affects the
pulmonary function or gastrointestinal function [2]. Additionally, it does not measure parameters
such as durations of first stool and flatus and perceived distress in gastrointestinal functionality
[2]. However, in their study, Chieftez et al display consistency in the study population and are
not limited by gender imbalances as in the study by Arici et al [1, 2]. Chieftez et al maintain
consistency in the type of surgery studied, thus eliminating inconsistencies in pain sensation [2].
Both studies have a scope for improvement in that the analysis of pain, mobilization,
gastrointestinal and pulmonary functions need to be carried out for larger sample sizes
comprising of patients of uniform surgery type, age, socioeconomic considerations, and gender.

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References:
1. Arici, E., Tastan, S., & Fatih, M. (2016). The effect of using an abdominal binder on
postoperative gastrointestinal function, mobilization, pulmonary function, and pain in patients
undergoing major abdominal surgery: a randomized control trial. International Journal of
Nursing Studies, 62, 108-117

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2. Cheifetz, O., Lucy, S.D., Overend, T.J., Crowe, J. (2010). The effect of abdominal support on
functional outcomes in patients following major abdominal surgery: a randomized controlled
trial. Physiother Can., 62, 242–253.