Journal Article Evaluation: EBP107 Assessment 3 Report

This report presents an evaluation of a journal article that investigated the effectiveness of Zingiberaceae extracts in pain reduction. The study, a systematic review and meta-analysis, utilized a PRISMA checklist for critical appraisal. The report details the article's methodology, including the search strategy using databases like Cochrane Library and PubMed, and the inclusion/exclusion criteria. It highlights the findings related to the analgesic properties of Zingiberaceae extracts, such as ginger and turmeric, and their potential applications in managing chronic pain, pain during pregnancy, and postoperative recovery. The evaluation also discusses the limitations of the study, including the small number of journals screened and a gender skew towards female subjects. Furthermore, the report connects the study's findings to evidence-based practices (EBP) and clinical decision-making, emphasizing the potential of Zingiberaceae extracts as a complementary treatment option. The report concludes with an assessment of the study's strengths, such as its robust methodology, and weaknesses, such as the lack of review of the toxic effects of Zingiberaceae. The report provides a comprehensive overview of the research, its implications, and its relevance to healthcare practice.

Running Head: Assessment 3: Journal Article Evaluation: Using A Critical Appraisal Tool
ASSESSMENT 3: JOURNAL ARTICLE EVALUATION:
USING A CRITICAL APPRAISAL TOOL

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Assessment 3: Journal Article Evaluation: Using A Critical Appraisal Tool
Table of Contents
Introduction................................................................................................................................3
Reviewing the effectiveness of Zingiberaceae extracts for pain...............................................3
Conclusion..................................................................................................................................7
Reference list..............................................................................................................................8
Appendix..................................................................................................................................11

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Assessment 3: Journal Article Evaluation: Using A Critical Appraisal Tool
Introduction
This study is evaluating a selected journal article that has conducted a systematic
review and meta-analysis. The following article has focused on the effectiveness of
Zingiberaceae extracts in reducing pain. This paper has been selected after reviewing search
techniques, selection techniques and references of this article. As authors have used
appropriate methodology, the outcome of this article has been found authentic and reliable.
Evidence of the data analysis has been included in this study that has made it more
acceptable. This journal has successfully answered the research question. PRISMA has been
considered an appropriate critical appraisal tool for this study.
The chosen article:
Lakhan, S. E., Ford, C. T., & Tepper, D. (2015). Zingiberaceae extracts for pain: a
systematic review and meta-analysis. Nutrition journal, 14(1), 50. Retrieved
from:https://nutritionj.biomedcentral.com/articles/10.1186/s12937-015-0038-8
Reviewing the effectiveness of Zingiberaceae extracts for pain
For evaluating the research, a PRISMA checklist has been used. Different sections of
study including abstract, title, method and discussion were evaluated through the help of this
critical appraisal tool.
Evaluating the article by using PRISMA tool
The title of the research article shows that it is based on systematic review and meta-
analysis. Moreover, in the abstract, there is a structured summary that includes the
background of the article, methods and results, and keywords. This study is based on the
members of the Zingiberaceae family and its main aim is to find whether extracts of this
group of traditional medicine can be considered as clinically effective analgesics agents.
Zingiberaceae family includes ginger, galangal and Javanese ginger that are considered as
traditional medicines. As opined by Hunter (2018), commonly prescribed drugs for pain relief

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Assessment 3: Journal Article Evaluation: Using A Critical Appraisal Tool
may have side effects that can impact the body. Systematic review was conducted by
searching for articles using keywords like Zingiberaceae, pain, and VAS for achieving this
aim of the article. It was found that a significant dose of this medicine reduces chronic pain,
which meta-analysis results found that inappropriate intake of these medicines can cause
internal bleeding and its unsafe for pregnant women or people suffering from chronic
diseases. The rationale of this study is also clearly described that states that members of
Zingiberaceae family are considered as traditional medicines, which have an analgesic
property and can be used as an intervention to cure chronic pain. As stated by Treede et al.
(2019), chronic pain is the main symptom of different long term conditions including
arthritis, neural injury and others. The main objective is to find the effectiveness of this
group of medicines.
This chosen article can be accessed by anyone through the DOI 10.1186/s12937-015-
0038-8. The method of this research has been described in detail by the authors under
subheadings. In 2015, this study was published and it was done under the attribution license.
This journal can be obtained from Biomed Central. Patients who were suffering from pain for
at least 24 hours and more have been mentioned as diagnostic criteria. As mentioned by
Munn et al. (2018), appropriate databases need to be chosen in case of conducting a
systematic review of authentic papers. In the case of this study, top reliable databases
including database of Cochrane Library, PubMed and Science Direct have been considered
appropriate for selecting resources for screening. On the other hand, Rieh, Collins-
Thompson, Hansen, & Lee (2016) have mentioned that appropriate terms need to be used
while searching for authentic resources. Considering this fact, taxonomic and common names
of Zingiberaceae species and their effectiveness have been used as search terms. According
to Zorzela et al. (2016), if a paper is made by following the PRISMA guideline, it can be
assumed that there are no risks of biases. The authors of this article have manually checked

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Assessment 3: Journal Article Evaluation: Using A Critical Appraisal Tool
all the references used by all the available papers. Only papers that have been published after
2014 have been selected for screening.
Articles that are randomized and those have included cases of patients suffering from
pain for more or less 24 hours. Outcomes of all the available journals have been checked to
see whether authors have included the measurement of pain or not. Bodily & Verbert (2017)
have mentioned that inclusion criteria help to reject irrelevant articles during the search
process. In this case, inclusion criteria have helped to select only 8 authentic articles from a
total of 58 records. Size of the sample, mean values and SD values of pain of participants of
considered studies have been reviewed. There were few studies with more than one
participating group. In those cases, only groups that were treated with the Zingiberaceae
species have been considered for evaluating. Data for VAS measurement of pain in different
target groups have been extracted from selected journals. After that these datasets have been
compared and contrasted.
The researcher has not suspected any biases as all the selected journals have
conducted quantitative analysis. However, Tamblyn, Girard, Qian & Hanley (2018) have
mentioned that publication bias needs to be handled carefully with the help of an appropriate
technique. In this case, Funnel plot has been used to reduce the risks of publication error.
Differences in means have been summarized and it has been found that the inconsistency
between studies was very high, as the value of I2 was found 87.5%. No subgroup analysis has
been performed in this case.
8 studies included for quantitative studies and 18 studies were included for the
purpose of qualitative study for achieving the desired result of the study. However, 58 records
were selected for the research purpose. PRISMA flowchart was undertaken to filter the
identified studies and 25 records were excluded. 18 articles were included in the study those
which have passed the eligibility criteria. The characteristics of the studies that were included

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Assessment 3: Journal Article Evaluation: Using A Critical Appraisal Tool
are the same. All of the selected research articles have randomized traits and are related to
either pain management or the Zingiberaceae family. However, no risks of bias have been
suspected within the studies. As mentioned by Schuch et al. (2016), the risk of bias can
impact research by deteriorating the quality of results and impact on the achievement of
desired objectives. PRISMA checklist also concentrates on the result of individual studies. It
was seen in this research that the majority of the studies indicate that pain has reduced
significantly by the application of ginger of other traditional medicines of the Zingiberaceae
family.
From the findings, it has been found that Zingiberaceae can be used in managing
long-term pain. This medicine can be used in case of reducing pain in pregnancy. On the
other hand, it can be used in the case of postoperative recovery. The selected article is limited
to a small number of journals that have been screened. It has limited its outcome as well. On
the other hand, this study has focused strongly on gender skew towards female subjects. The
conclusion of this paper has included both positive and negative impacts of using
Zingiberaceae sp. in managing pain (Lakhan, Ford & Tepper, 2015). It helps to reduce the
intensity of pain during pregnancy and the postoperative recovery phase. However, it may
enhance the risks of bleeding. This topic must be investigated in the future in detail based on
available evidence. On the other hand, it has been mentioned that future researchers need to
research the toxic impact of this medicine. However, this paper has not specifically included
any specific information about the source of funds for this research.
Evidence-based practices (EBP) and recommendations of using EBP
EBP any practice, which relies significantly on scientific and mathematical evidence
for gaining guidance regarding decision making (Dang & Dearholt, 2017). Those practices,
which do not rely on evidence, may rely on tradition or others' opinions. This can impact
decision making and reduce the quality of service. Rousseau & Gunia (2016) stated that in

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Assessment 3: Journal Article Evaluation: Using A Critical Appraisal Tool
clinical decision making, different theories and research-based knowledge are used for
making decisions regarding delivery of care in a proper way. The results of this study can be
used as evidence to treat patients suffering from irritable bowel syndrome. It can be seen in
the study that the application of turmeric extract with both higher and lower doses (72 and
144 mg/day) has helped to reduce the pain in the abdomen. Moreover, patients suffering from
dysmenorrheal have also got relief from pain by the application of ginger extract. The
application of 1000 mg/day of this extract has reduced the pain of individuals suffering from
this disease (Lakhan, Ford & Tepper, 2015). The effectiveness of this traditional medicine is
close to that of ibuprofen. Moreover, members of this family have a significant impact on
patients with pain during recovery from surgery. In this study, a placebo-controlled trial is
performed along with a high dose of curcumin (2000 mg/day). It was found that the
application of curcumin has reduced pain in 1 to 3 weeks. This evidence can be used by
clinicians and nurses to make future decisions regarding pain management. However, the
Zingiberaceae family has no significant impact on pain management of patients suffering
from cancer.
Conclusion
From the entire discussion of this essay, it can be concluded that the quality of this
essay was relatively higher. The strength of this study is its method of selecting journals and
the data analysis process. The search strategy, search terms and, inclusion criteria has helped
to select the appropriate journals with quantitative research. It has helped to generate a
reliable outcome. On the other hand, this study has not reviewed the toxic effect of
Zingiberaceae sp. in managing pain. It can be considered a weakness of this study.

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Assessment 3: Journal Article Evaluation: Using A Critical Appraisal Tool
Reference list
Bodily, R., & Verbert, K. (2017, March). Trends and issues in student-facing learning
analytics reporting systems research. In Proceedings of the seventh international
learning analytics & knowledge conference (pp. 309-318). Retrieved
from:https://lirias.kuleuven.be/retrieve/467451
Dang, D., & Dearholt, S. L. (2017). Johns Hopkins nursing evidence-based practice: Model
and guidelines. Sigma Theta Tau.
Hunter, P. (2018). New therapies to relieve pain: The search for more efficient and safer
alternatives to opioid pain killers. EMBO reports, 19(10), e46925. Retrieved
from:https://onlinelibrary.wiley.com/doi/full/10.15252/embr.201846925
Lakhan, S. E., Ford, C. T., & Tepper, D. (2015). Zingiberaceae extracts for pain: a systematic
review and meta-analysis. Nutrition journal, 14(1), 50. Retrieved
from:https://nutritionj.biomedcentral.com/articles/10.1186/s12937-015-0038-8
Munn, Z., Peters, M. D., Stern, C., Tufanaru, C., McArthur, A., & Aromataris, E. (2018).
Systematic review or scoping review? Guidance for authors when choosing between a
systematic or scoping review approach. BMC medical research methodology, 18(1),
143. Retrieved from:https://link.springer.com/article/10.1186/s12874-018-0611-x
Rieh, S. Y., Collins-Thompson, K., Hansen, P., & Lee, H. J. (2016). Towards searching as a
learning process: A review of current perspectives and future directions. Journal of
Information Science, 42(1), 19-34. Retrieved from:
https://deepblue.lib.umich.edu/bitstream/handle/2027.42/145734/Rieh%20et%20al
%20Towards%20searching%20as%20a%20learning%20process%20JIS2016.pdf?
sequence=1

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Assessment 3: Journal Article Evaluation: Using A Critical Appraisal Tool
Rousseau, D. M., & Gunia, B. C. (2016). Evidence-based practice: The psychology of EBP
implementation. Annual Review of Psychology, 67, 667-692. Retrieved from:
http://www.academia.edu/download/53150278/2016_Rousseau___Gunia.pdf
Schuch, F. B., Vancampfort, D., Richards, J., Rosenbaum, S., Ward, P. B., & Stubbs, B.
(2016). Exercise as a treatment for depression: a meta-analysis adjusting for
publication bias. Journal of psychiatric research, 77, 42-51. Retrieved
from:https://kclpure.kcl.ac.uk/portal/files/48157113/1_s2.0_S0022395616300383_ma
in.pdf
Tamblyn, R., Girard, N., Qian, C. J., & Hanley, J. (2018). Assessment of potential bias in
research grant peer review in Canada. CMAJ, 190(16), E489-E499. Retrieved from:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5915246/
Treede, R. D., Rief, W., Barke, A., Aziz, Q., Bennett, M. I., Benoliel, R., ... &
Giamberardino, M. A. (2019). Chronic pain as a symptom or a disease: the IASP
Classification of Chronic Pain for the: International Classification of Diseases:(: ICD-
11:). Pain, 160(1), 19-27. Retrieved
from:https://www.researchgate.net/profile/Michael_Bennett19/publication/
330215345_Chronic_pain_as_a_symptom_or_a_disease_the_IASP_Classification_of
_Chronic_Pain_for_the_International_Classification_of_Diseases_ICD-11/links/
5c3a19fb92851c22a36fa13c/Chronic-pain-as-a-symptom-or-a-disease-the-IASP-
Classification-of-Chronic-Pain-for-the-International-Classification-of-Diseases-ICD-
11.pdf
Zorzela, L., Loke, Y. K., Ioannidis, J. P., Golder, S., Santaguida, P., Altman, D. G., ... &
Vohra, S. (2016). PRISMA harms checklist: improving harms reporting in systematic
reviews. bmj, 352, i157. Retrieved from:https://ora.ox.ac.uk/objects/uuid:22ec9240-
7d2d-4cc0-a942-a46941ba28be/download_file?

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file_format=pdf&safe_filename=Zorzela%2Bet%2Bal%2B-PRISMA%2Bharms
%2Bchecklist%2Bimproving%2Bharms%2Breporting%2Bin%2Bsysteamtic
%2Breviews.pdf&type_of_work=Journal+article

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Assessment 3: Journal Article Evaluation: Using A Critical Appraisal Tool
Appendix
Appendix 1: PRISMA Checklist
Subjects PRISMA Checklist
Title
Title 1* This report is identified as both systematic review and
metaanalysis
Abstract
Structured
summary
2† Structure summary includes Background, Methods, Result,
conclusion and key words.
Introduction
Rationale 3* Different members of the Zingiberaceae family that includes
ginger, galangal and others were used as traditional medicines.
Extracts of these items shows analgesic properties along with
anti-inflammatory properties.
Objectives 4† Objective of this study was to evaluate previous studies to
understand whether the extracts from the Zingiberaceae can be
considered as effective hypoalgesic agent
Methods

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Assessment 3: Journal Article Evaluation: Using A Critical Appraisal Tool
Protocol and
registration
5† This journal can be accessed with the help of DOI
10.1186/s12937-015-0038-8.
Eligibility criteria 6† This study was published in 2015 and it has an open access
under common attribution license. It is available in biomed
central.
6a.1‡Diagnostic criteria: Patients suffering from pain from last
24 hours or more
Information
sources
7* Not available in the article
Search 8* studies related to the selected topic have been searched in
PubMed, Cochrane Library database and ScienceDirect. Search
terms including taxonomic and common names of Zingiberaceae
species have been searched. References of all available reports
have been manually reviewed. Papers that were published before
december 2014.
Study selection 9† the study needs to be randomized, the study must include a
patient group suffering with chronic pain and pain was measured
with study outcome.

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Assessment 3: Journal Article Evaluation: Using A Critical Appraisal Tool
Data collection
process
10† sample sizes, means and standard deviations about pian were
collected from the studies. If a study has more than one treatment
group, then the data of group treated with Zingiberaceae were
collected.
Data items 11* Only data for the VAS measurement of pain in different cases
have been extracted, compared and contrasted.
Risk of bias in
individual studies
12† Funnel plot was used for avoiding publication error. No other
techniques have been used to assess biases and this study has also
been completed without biases.
Summary
measures
13† Difference in means
Synthesis of
results
14† I2= 87.5%
Risk of bias
across
studies
15†the risk of publication bias was evaluated through a funnel plot
method.
Additional
analyses
16†No subgroup analysis was performed due to less number of
included studies.
Results

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Assessment 3: Journal Article Evaluation: Using A Critical Appraisal Tool
Study selection 17† 8 studies included for quantitative studies and 18 studies
were included for the purpose of qualitative study
Study
characteristics
18* Randomized traits for qualitative and meta analysis have
been extracted. Citations: Bliddal et al. 2000, Altman et al. 2001,
Wigler et al. 2003, Brinkhaus et al. 2005, Black et al. 2010,
Agarwal et al. 2011, Rahnama et al. 2012, Panahi et al. 2014.
Risk of bias
within
studies
19† No risk of biases have been suspected
Results of
individual
studies
20†
Synthesis of
results
21†
Risk of bias
across
studies
22† No

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Assessment 3: Journal Article Evaluation: Using A Critical Appraisal Tool
Additional
analysis
23†No such additional analysis is done.
Discussion
Summary of
evidence
24†Zingiberaceae can be used as a pain management tool. This
group of medicine also helps in postoperative recovery and during
pregnancy.
Limitations 25†small number of studies included which is a major limitation.
The included studies shows strong gender skew towards female
subjects.
Conclusions 26†from meta analysis it was found that recommending
Zingiberaceae treatment can cause adverse impacts like increased
risk of bleeding. Future research is required regarding the toxic
impact of this traditional medicine.
Funding
Funding 27†no specific information given about funding