Critical Review: Evidence Informed Health Practice CMHL1005 Report

This assignment presents a critical review of a research paper concerning exercise interventions for individuals with Parkinson's disease to reduce falls. The review summarizes the study's primary results, including a 25% reduction in fall rates among participants in the exercise intervention group. It assesses the similarity between intervention and control groups at baseline, addresses potential risks of bias in participant allocation and outcome assessment, and comments on participant dropouts and their impact on findings. The review also delves into the operational definition and replicability of the intervention, potential measurement and performance biases, ethical considerations, and the validity and reliability of outcome measures. Furthermore, it includes a clinical recommendation section written for a layperson, summarizing the study's methods, results, and implications for a hypothetical friend or relative diagnosed with Parkinson's disease.

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CMHL1001 Evidence Informed Health Practice
Assessment 2
Student Name:
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Curtin Email:
Unit: CMHL1005 Evidence Informed Health Practice
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Due Date: Monday, 2nd August 2021 at 1pm
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degree or diploma at any university or other institute of tertiary education. I have filled out the
plagiarism checklist and I declare that information derived from the published or unpublished work
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Assessment 2 – Critical review
Questions with marking guide
DO NOT DELETE QUESTION TEXT AND MARK ALLOCATIONS
Part A: Critical Review (900 words, 30 marks)
1.) GENERAL (total 6 marks)
In no more than 250 words, summarise the two most important (primary) results of this
research paper in your own words. Where provided, your summary should make reference to
the following:
 The differences in the scores between the groups for the outcomes (dependent
variables of interest) and;
 The statistical significance of the final group scores.
Two most important primary results of this research paper were:
1. Incidence rate ratio for falls was identfied 0.68 during the period of intervention and
incidence rate ratio for falls during follow-up period was 0.74.
Primary results of this study helepd in understanding that there was 25% reduction in falls rate
among indviduals who followed exercise intervemntioon properly.
From the statistically significant results among differences in group it was observed that there
was difference in different kinds of groups but major difference was observed in different
groups such as Berg balance, recreational physical activity levels, and Falls Efficacy Scale-
International scores. Findings of this research paper were comparable to findings of recent
Cochrane review for identification of ways of preventing falls among elder people especially
among older people who reported and experienced high risk of falling. Exercise intervention
helped in reducing fall rate by approxiamtyl 25 percent among high risk of falling older people.
2.) SAMPLING & PARTICIPANTS (total 6 marks)
a. Using the statistical significance between groups (where available), discuss the similarity
between groups at baseline. In your answer, consider: (1) the number of participants in
each group; and (2) the characteristics of participants in each group. (2 marks)
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Statistical significance between two identified groups with similarities between their
baseline have been expaliend below:
First group is intervention group particpants, number of particpants in this group were 64
people Whereas, second group is control group particpants in which 66 number of people
were particpanting. Similarties between both the groups were that all the selected people
were those people who were suffering from parkinsons disease,had history of fall of 2 or
more than 2 falls last year and people who were able to mobilise independently.
b. Comment on the risk of bias in the allocation of participants to intervention vs. comparison
groups in your chosen study. (1 mark)
In order to minimize biasness risk within particpants allocation to intervention vs control
group all outcome assessments at secondary level were undertaken without provding any
kind of reference to past assessment data.
c. Comment on the number of participant dropouts from your chosen study (by group) and
how this has impacted on the findings (3 marks)
Seven of the total particpants did not complete the study as they did not complete the
follow upthat continued till June, 2009. Initially 343 particpants were chosen but out of
them 55 were not eligible for the study and 84 of them did not repoly. Sol from remaining
204 particpants. Out of these 204 particpants 74 of them denied and remaining 130 were
selected and asked to particpnte within study.
3.) DESIGN & METHODS (total 15 marks)
a. Describe the authors’ operational definition of the intervention (3 marks). Comment on its
replicability in a future study based on the description given (1 mark). (4 marks)
Intervention is a way though which number of falls of people suffering from Parkinson
disease can be controlled is known as intervention. Intervention comprised of 10 weekly
group exercise sessions with twice wekly home exercise. These intervention exercise can
be used in future studies as they were equally effective among people with PD. In future
studies these interventions can be used for studying their effectivity on broader population
and its effect should be observed for ap least an year.
b. Measurement/Detection Bias
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Using all the points below, discuss the risk of measurement/detection bias that may have
been present in your chosen research paper (3 marks)
 Number of outcome measures used (1 mark)
 Blinding of researchers to the outcome assessment (1 mark)
 Recall bias (if applicable) (1 mark)
Number of outcome measures: an unexpected fall results, Prospective baseline falls data,
primary outcome, secondary outcome.
Blinding of researchers to the outcome assessment: It was potential bias that lacked
association with lacking outcome of assessor blinding. In this primary outcome was majorly
self reported as it was not achieved, because it was difficult to blind participants asaresult
of intervention nature.
Recall bias: In this research it was not applicable.
c. Intervention/performance bias
Using all the points below, discuss the risk of intervention/performance bias that may have
been present in your chosen research paper (6 marks)
 Contamination & blinding of participants (1 mark)
 Co-intervention (1 mark)
 Timing of intervention (Discuss the appropriateness of: (1) length of the
intervention, (2) the frequency of the measurements) (2 marks)
 Site of treatment (1 mark)
 Different examiners/therapists (1 mark)
Contamination & blinding of participants: Blinding of participants was a potential bias as in
this to blind participants was not possible due to nature of interventions.
Co-intervention: not other cointerventiosn were focused upon in this study related to
health.
Timing of intervention: 10 weeks wasthe length of intervention period and 10 week
followup period.
Site of treatment: At home as wellas at hosptials
Different examiners: no other examiner was involved.
d. Comment on the validity and reliability of one of the measures reported in Question 1. You
will need to provide references to previous studies conducted on the measure used. (2
marks)
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Difference in score of bot the groups cannot be relied upob because in this outcomes were
self- reported by particpants and none of the partipants were binded to study because of
natur of intervention.
4.) ETHICS (total 3 marks)
Comment on any ethical considerations from your chosen paper. In your answer touch on all
the points below:
 informed consent;
 ethics approval; and
 any potential conflicts of interest
Each participant was asked to provide written consent before completing baseline
assessments.
Ethics approval for the trial was taken by the Devon and Torbay Local Research Ethics
Committee
To estimate your word count, highlight from Qn 1 to the end of your answer in Qn 4. Subtract 366 words from the indicated
word count.
Word Count for Part A:
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PART B Clinical Recommendation (500 words, 20 marks)
Answer the following question in relation to your chosen journal article:
You are a newly graduated evidence-based practitioner that works in the health field. Your
friend/ relative has been diagnosed with the condition mentioned in your paper. He/she is
interested in the intervention that the paper reports about. In a language that is
understandable to them, write a 500-word (11/3 pages) abstract summarising the following
points under their respective headings:
 Introduction: (2 marks)
o Why the study was needed (1 marks)
o What the study aims were (1 mark)
 Methods (How the researchers conducted the study): (10 marks)
o Which level of evidence this study design sits at (1 mark). Comment on the
strength of the design based on where it sits on the level of evidence it sits at.
(1 mark)
o Discuss 2 main strengths and 2 main weaknesses of the study design (what they
are and why you think they are important). (8 marks)
 The results (5 marks)
o State the results of the study concisely (2 marks)
o Interpret these results in light of the points you have addressed in methods (2
marks)
o Comment on the risk of Type I and Type II error (1 mark)
 Discussion: (3 marks)
o Make a decision here on what you think the results mean:
 Did the study support the intervention of interest in the study? (1 mark)
 How trustworthy are the results? (Discuss this in light of your
interpretation earlier) (1 mark)
o What the findings mean for your friend.
 Should they pursue the intervention/ explore it further/ avoid it? Who
should they pursue that discussion with? (1 mark)
 Make references to 2 credible websites / articles within the public
domain that your friend can access for further information with regards
to the information. (deductions apply – see above)
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The study was needed because approximately 70 percent of people with Parkinson’s
disease experience falls every year and its consiquences impact paitnet, their families,
socialcare organzations etc. The main aim of this study was comparision of effectiveness of
exercise intervention for people with PD (Goodwin & et. al., 2011).
This study was conducted in conducted in South West England and is based upon
pragmatic research design parallel group randomised controlled trial. Main strength of this
design in siting on the level of evidence was that it helps in evaluating therapy used in normal
practice. One of the main strength of this study is that it does provide adequate amout of
connection between thoughts and actions. It alsorests on excellent internal validity. One of the
mainweakness of this design that it does not proide adequate account of whatrelationship is
about. Another wekanessis that its results might not always mimic real life treatment
situation
Results of this study clelry helped in understanding that incident ration of fall during
intervention period was 0.68, whereas incident rate ratio during the follow-up period was
0.74. results of this study also helped in understanding that there was Statistically significant
among differences within groups observed within Falls Efficacy Scale-International scores, Berg
balance and recreational physical activity levels. pragmatic research design clearly helped in
interpreting results and helped in evaluating differet exercise interventions used in normal
practice. In this study type 2 error was deteted which is of false negative conclusion. This stusy
did not rule out type 2 error.
The study did support the intervention of interest in the study but its effectiveness
with accuracy was not foused upon much. The resutlswere not completely trustworthy
because in this stuy particpants were not not blindeddue to nature of interventions. There are
two credible anduseful websites that can provide information about Parkinson disease, ways
in which fall due to Parkinson disease canbe controlled: first is healthdirect is a government
website (https://www.healthdirect.gov.au/falls) that can provide prevention strategies from
falling in parkinsondisease. Second website is nt.gov.au
(https://nt.gov.au/wellbeing/emergencies-injuries-and-accidents/fall-injury). It is another
Australian government website that can provide all kinds of required details for prevention
from falling in parkinson disease. Both of these websites would also provide health isues that
can be created due to fall and critera on the basis of which patients should consult a doctor.
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Reference List
Insert reference list here.
Goodwin, V.A., & et. al., 2011. An exercise intervention to prevent falls in people with
Parkinson's disease: a pragmatic randomised controlled trial. Journal of Neurology,
Neurosurgery & Psychiatry, 82(11), pp.1232-1238.
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