Critical Appraisal of Nursing Research on Low Back Pain: A Report

This report presents a critical appraisal of the research article by Abedini et al. (2014), focusing on the issue of low back pain (LBP) among nurses. The study aimed to examine nurses' risk perceptions of non-specific LBP. Using the CASP tool for qualitative research, the report evaluates the study's methodology, including the appropriateness of the qualitative approach, research design, recruitment strategy, data collection methods, and consideration of ethical issues. The analysis highlights the strengths and weaknesses of the research, such as the use of semi-structured interviews and purposive sampling. The report also critiques the data analysis process and the statement of findings, discussing the subcategories that emerged regarding perceived severity and vulnerability related to LBP. The conclusion emphasizes the impact of LBP on nurses' lives and job performance, linking the findings to the existing literature and identifying new insights, such as the impact on married life. The report assesses the study's contribution to evidence-based practice.

0Running head: EVIDENCE BASED NURSING RESEARCH
Evidence based nursing research
Name of the student:
Name of the University:
Author’s note

1EVIDENCE BASED NURSING RESEARCH
Introduction
Critical appraisal is an important process to implement evidence based practice.
Critical appraisal skill can help a person to evaluate the effectiveness of a research study
and the judge the article for applicability in real setting (LoBiondo-Wood & Haber, 2017).
In case of health care studies, reviewing the quality of clinical research is necessary to
ascertain its validity, credibility and generalizability for real setting or target group
(Holloway & Galvin 2016). The process of critical appraisal is the systematic process to
judge the trustworthiness, value and relevance of the evidence in a particular context
(Elwood, 2017). This essay paper is mainly concerned at looking at the evidence regarding
the issue of low back pain in nurses and it mainly aims to critically appraise the article by
Abedini et al., (2014) to understand the strength and weakness of the article in presenting
the findings. The CASP (Critical Appraisal Skills Programme) tool for qualitative research
article has been used to critically appraise the article and find its utility in evidence based
practice.
Critical appraisal of qualitative research article
Statement of the aim of research
The main aim of the research study by Abedini et al., (2014) was to examine the
risk perceptions of non-specific low back pain (LBP) among nurses in Bandar Abbas City,
Southern Iran. Research in this area was considered important because LBP has become a
serious health issue among nurse and it is the main reason for absenteeism at work. The
issue has been found to increase risk of chronic disease among nurses as well as increase

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the burden of the health care system (Traeger et al., 2014). This research is considered
useful because it focuses on getting better understanding about nurse’s perception related to
LBP and this knowledge will prove useful to effectively implement interventions for
nurses. Different perception of pain and individualized experience may help to determine
how pain education or other interventional program can be implemented for nurses. The
study is found relevant to address performance related challenges for nurses and address
barriers that affect workflow in health care setting.
Critique of qualitative methodology
To collect data related to risk perception of non-specific low back pain among
nurses, Abedini et al., (2014) used qualitative research approach by conducting semi-
structure interview with nurses. Quantitative research methodology is considered
appropriate for research when the main aim is to study about behavior, experiences and
attitudes of people in different context. This research approach helps in getting in-depth
information about human behavior and finding the behavior of people in different context
(Jirojwong, Johnson & Welch, 2014). As Abedini et al., (2014) also aimed to study about
nurse’s perception related to LBP, the use of qualitative methodology is a good decision by
researcher. The inductive nature of inquiry facilitated collecting lived experience of
participants. The decision to not go for quantitative research methodology is also right
because quantification of nurse’s belief cannot give any new insight or useful data.
Appropriateness of research design
In accordance with COREQ (Consolidated Criteria for Reporting Qualitative
Research) checklist, Abedini et al., (2014) specified the methodological orientation for the

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study and also explained the reason for selecting those approaches. For instance, qualitative
content analysis design was used for the research and the researcher justified the decision
by explanation on situations during which qualitative methods are adopted in research and
is relevance with purpose of the research. The justification provided is correct because
evidence has also showed that qualitative content analysis is mostly used in nursing science
research (Polit & Beck, 2012). Qualitative content analysis is one of the methods to analyze
and interpret research data. The advantage of using this approach is that the objective
means of explaining any phenomenon helps in dividing the concepts to different categories
or conceptual map (Elo et al., 2014). However, the validity of such research is determined
by the manner in which results were developed and analyzed.
Effectiveness of recruitment strategy
As per COREQ checklist, the article by Abedini et al., (2014) has specified about
recruitment strategy, method of approaching participants and sample size too. For instance,
purposive sampling technique was employed to recruit participants and their sample size
was determined after confirming data saturation. Participants has face-to-face interview
which were recorded and transcribed. Hence, by the use of this strategy, about 30 nurses
were selected for the study. Purposive sampling strategy is a non-probability sampling
technique and it is found useful when the aim is to collect data from target sample quickly.
This kind of sample may not be representative of the whole population, however it is found
useful when population is very large (Etikan, Musa & Alkassim, 2016). Abedini et al.,
(2014) wanted to get wide range of individual experience and perception, so they recruited
participants based on diverse criteria such age, gender, work experience, marital status,
different degree of pain and positions. Use of such heterogeneous purposive sample is

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commendable because it helped in getting diverse range of cases, related to risk perception
of nurses regarding LBP (Robinson, 2014).
The quality of qualitative research paper is understood when the author gives clear
idea regarding each strategy taken and the rational for it. Quality and trustworthiness of
research also becomes evident when clinical reality is appropriately analyzed (Mantzoukas,
2008). Abedini et al., (2014) work is also found to be high quality evidence on the basis of
these criteria because the authors were explaining the reason for any strategy whenever it
was mentioned in the article. For instance, the main inclusion criteria for sample selection
was one year experience in nursing, however the author justified why wide range of
samples were taken. However, the author did not give wide explanation around recruitment.
Instead, the discussion mainly centered around questions used for interview and ethical
requirements before recruiting samples for the study.
Method of data collection
According to COREQ checklist, a quantitative research articles must have details on
interview guide, repeat interviews, method of collecting data, duration, field notes, data
saturations and return of transcripts by participant. Abedini et al., (2014) provided detail on
development of interview guide, however no repeat interviews were carried out. The study
was conducted in Bandar Abbas, but the author gave no detail regarding the setting. Despite
the above mentioned shortcomings in the article, the strength of the data collection section
is that the researcher has explicitly covered the method of conducting interview. For
instance, the process used to prepare interview guide was discussed and it was based on

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protection motivation theory. This theoretical basis was useful to effectively evaluated risk
perception.
Semi-structured interview was conducted and interview data were converted into
audio transcripts. Another important aspect that was considered by the researcher was
saturation of data. All such discussion makes reviewer clear about the method of collecting
data. However, there were no such instances of repeat interview and return of transcripts.
The researcher did not clarified regarding the duration of interview too (Abedini et al.,
(2014). Hence, method of data collection that is conducting interview to collect data was
found useful because it had the potential to directly address the aim or research question.
Minor shortcomings were present, however this had negligible impact on study result.
Relationship between researcher and participants
The validity of any qualitative research is understood when author demonstrate self-
reflexivity in data collection and data analysis process. This means while formulating
research question and sample recruitment strategy, the author examines their role in
contributing to biasness (Borbasi, Hengstberger-Simis & Jackson, 2008). In case of the
study by Abedini et al., (2014), the authors focused on minimizing biasness during
formulation of questions for interview. This can be said because questions were not
independently framed by researcher. Instead, great rigor was seen in preparing interview
guide because literatures related to LBP, protection motivation theory and other qualitative
approach was reviewed before preparing interview question. In addition, the questions are
finalized only after taking feedback from health education and behavioral specialist. This
process validated the research and eliminated chances of biasness too. However, the same

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thing cannot be said regarding the use of purposive sampling strategy. This is because
purposive sample is taken based on judgment of researcher; hence there is increased chance
of selection bias (Robinson, 2014).
The alertness of researcher to reduce potential bias and influences is also understood
when they effectively respond to unpredictable events during the study. This is also
reflective of the reliability of the study because such explanations clearly show that the
researcher is taking note of all changes that can affect the study results. The study by
Abedini et al., (2014) lacked all such discussion because at no point the researcher
explained about any changes in research process due to unpredictable events. However, the
author focused on establishing relationship with participant by informing them about
research purpose, rational for recording the interview and voluntary participation process
(Tong, Sainsbury & Craig, 2007). This helped in getting appropriate response from
participants during the research.
Consideration of ethical issues in research
While conducting qualitative research, researchers have the responsibility to fulfill
certain ethical requirements before starting the research. This includes maintaining
anonymity and confidentiality of client information and taking informed consent from
participant. Abedini et al., (2014), also maintained ethical standards in research by giving
all information to participants related to research purpose, voluntary participation and
confidentiality of participant’s identity. Besides this, they were also made aware about the
how research will be conducted by informing about data collection method and reasons to
record the interview. Hence, by the above justification, it becomes clear that confidentiality

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and informed consent requirements were maintained. Despite this, one very important and
vital aspect of ethics was missing in the research which was taking approval from the
Research Committee regarding conducting the research. Missing such important point can
give a bad impression to reviewers.
Critique of data analysis
The validity of the study is finding is determined by the way data is analyzed. In
case of interview with nurse regarding LBP, data collected from the interview records were
analyzed. The text transcribed in the Microsoft Office Word was also transferred into a
qualitative data analyzing software, MAZQDA10 version 10. This software analyzes and
categorize qualitative data in a systematic manner. Deductive content analysis of data was
done by extracting key concepts assigning primary codes to each sentence. By this way of
primary coding, main category and sub-category was analyzed (Abedini et al., 2014).
Hence, it can be inference that thematic analysis was followed which helps in in-depth
exploration of data. The researcher also focused on reducing bias by maintaining the
accuracy of verbal cues. For instance, this was done by comparing the audio tapes. This is
also revealed the process by which data collected from original sample were analyzed. On
comparison of the article according to the COREQ checklist, it can be said that coding was
used and themes were derived. Appropriate software was also used to manage the data,
however participants feedback on findings was not present. Despite taking only 30 samples,
the data can be sufficient because diverse range of participants were recruited to make the
sample inclusive.
Statement of findings

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With respect to the original research question, the subcategories were developed on
the basis of perceived severity and perceived vulnerability. The key subcategories emerging
in perceived severity includes impact of LBP on confronting challenges in profession,
inefficiencies in job performance, physical and psychological consequences and financial
problems. Subcategories under perceived vulnerability included challenges in hospital’s
working system and nature of nursing job (Abedini et al,. 2014). The main conclusion from
the finding is that nurses mainly have the perception that LBP negative affects their life and
disrupts personal nursing performance. Some categories were found consistent with past
studies, however some new subtopics such as affect on married life also emerged which
was not covered in past studies. Although the themes were linked back to research question,
however the quality of article is evident from the utilization of triangulation method to
validate the findings. Many themes were cross-verified from more than two sources (Carter
et al., 2014). Besides this, use of direct quotation from nurses helped to enhance the
credibility of data.
Importance of research
The outcome of the study by Abedini et al., (2014) will have great implications on
nursing practice and key policy makers. This is because the findings were also analyzed in
relation to current practice and on this basis several flaws in work environment and nature
of working profession was found which contributed to LBP. Therefore, to effectively
implement interventions related to work environment and rules and regulation for research,
the study gave direction for future research ideas too. This includes doing more research on
work related factors contributing to LBP in nurses. By giving this statement, the researcher

9EVIDENCE BASED NURSING RESEARCH
gave the idea that the research can be used to improve the quality of nursing care and
address the problem of LBP.
Conclusion
From the critical appraisal of the article by Abedini et al., (2014), it can be said that
the evidence is a good quality qualitative research articles as it adopted suitable research
process and data analysis process to get answer to the original research questions. Although
certain shortcomings were found in the article according to the COREQ checklist (such as
no participant feedback, transcript returned, duration of interview, detail of setting and
personal characteristics of interviewer), however these were negligible mistakes that would
have little impact on study results. The research gave wide area regarding risk perception of
nurses regarding LBP, hence the recommendation of narrowing down the research with
work related LBP in future was a commendable advice by the researcher.

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