Research Report: PICO, Search Strategy, and Article Appraisal Analysis

This report details the development of a PICO (Population, Intervention, Comparison, Outcome) framework focusing on the impact of standing desks on cognitive performance and health. It outlines a search strategy for identifying relevant research articles and provides a step-by-step guide for conducting a database search. The report then presents appraisals of two articles: a randomized controlled trial (RCT) and a systematic review. The RCT appraisal assesses the study's methodology, including randomization, blinding, and treatment effects, while the systematic review appraisal evaluates the review's focus, study selection, and quality assessment. The report concludes by summarizing the findings of each appraisal, highlighting the strengths and limitations of the research and its implications for workplace health and ergonomics.

PART 1: DEVELOPMENT OF PICO AND SEARCH STRATEGY PLAN, AND
EVIDENCE OF APPLICATION IN DATABASE SEARCH
1. Define your PICO (O) elements
Person/Population//Problem: Student or workers
Intervention/Interest: Standing desks
Comparison/Control: Sitting desks
Outcome: Concentration
Other: Health
2. Develop your PICO(O) question
e.g. For the working professionals, (P) does sit-stand work station (I), compared to sedentary mode (C) is
effective in increasing concentration (O) during working hours (O)?
3. Identify main and alternate search terms
Population Intervention Comparison
(not commonly used in
actual database search
strategy)
Outcome
(not commonly used in
actual database search
strategy)
Other
Main search term:
Students or
workers
Main search term:
Standing desks
Main search term:
Sitting desks
Main search term:
Concentration
Main search term:
Health
Alternative
search terms:
 employees
 Staffs
Alternative
search terms:
 High
adjustable
Alternative search
terms:
 Standard
desks
Alternative
search terms:
 focus
Alternative
search terms:
 wellbeing

PART 2a: APPRAISAL OF YOUR TWO ARTICLES – Randomised controlled
trial
1. Did the trial address a clearly focused issue?
Yes No Can’t tell
Justify your answer:
The aim of the article is to article is to examine the effect of the sitting Vs. standing position (via sit-stand desk) on the
cognitive performance under workplace setting. So in order to address the focused issue that is cognitive performance
of workplace sample, the study recruited 36 employees from the University of Tasmania (aged between 22 to 62
years) with a male: female ratio of 26 females and 10 males. All the selected group of participants were has their won
distinct professional roles and identified their work significantly as desk-based job (sitting) and has no previous
exposure to sit-stand desks. Thus the trial is clearly focused over a specific target group of population which aligns
with the scope of the research aim.
Consider: An issue can be ‘focused’ In terms of
 The population studied
 The intervention given
 The comparator given
 The outcomes considered
2. Was the assignment of participants to treatments randomised?
Yes No Can’t tell
Justify your answer:
Of total 36 participants selected, there was no selection bias. This is because, out of 36 participants 10 were male and
26 were female between the age group of 22 to 66 years. Among this 86.% were full-time employees and 13.9% were
part-time employee. The IQ score were both average and/or better. The baseline assessment of IQ or intellectual
capacity was tested via Wechsler Test of Ault Reading (WTAR). This helped in establishing validity and reliability of
the research without encountering any chances of selection bias.
Consider
 How was this carried out, somemethodsmay produce broken allocationconcealment
 Was the allocation concealed fromresearchers?
3. Were all patients, health workers and study personnel blinded?No Can’t tell
Justify your answer:
The participants of the study were not blinded. This inability of successfully implement the blinding procedure over the
experimental condition might have resulted in the generation of the biased test performance.
Consider
 Health workers could be; clinicians, nursesetc
 Study personnel – especially outcomeassessors
Randomised Controlled Trial
Appraisal Tool

4. Were the groups similar at the start of the trial?
Yes No Can’t tell
Justify your answer:
The groups were similar at the start of the trail. The study generally tested the effect of sitting and standing on the
cognitive performance of same group of working professionals. However, since the population was selected randomly
they differed by age, sex and workplace experience. But the amalgamation of the traits of the focused group was
same. This helped the researcher to non-biased response.
Consider:
 Other factors that might affect the outcome such as age, sex, social class, researchers and participants?
5. Aside from the experimental interventionwere the groups treated equally?
Yes No Can’t tell
Justify your answer:
All the participants were tested for their IQ level via WTAR and were also screened to detect the clinical level of
anxiety or depression which may hamper the cognitive performance. This assessment was based on Hospital anxiety
and Depression Scale (HADS). The self-reported levels of workplace activity were generated via employing
Occupational Sitting and Physical Activity Questionnaire (OSPAQ).
However, 52.8% of the participants reported a 30-minutes of physical activity for 5 days per week and this might lead
to the generation of biased response.
6. Were all of the participants who entered the trial properly accounted for at its
conclusion?
Justify your answer:
Yes. The trial was not stopped early and was conducted till the pre-scheduled time. Patients were randomly assigned
to one of the two conditions that is either standing or sitting during the first week of testing. The overall condition
pattern assignment was comprehensively counter-balanced.
Consider:
 Was the trial stoppedearly?
 Were patients analysed in the groups towhichthey wererandomised?
7. How large was the treatment effect?
Justify your answer:
The primary outcome of the study is the measured of the cognitive performance. For the measurement of the cognitive
ability of the participants MANOVAs were conducted. MANOVAs were used to measure information processing
speed, attention, working memory and overall work performance. The measurement of the cognitive performance
revealed that there is no significant change in the work-based performance while standing. Thus the primary outcome
was clearly specified and results of the statistical analysis were tabulated in an ordered manner. There are also valid
evidences in the discussion section for the selective reporting of the outcomes.
Consider
 What outcomes were measured?
 Is the primary outcome clearly specified?
 What results were found for each outcome?
 Is there evidence of selective reportingofoutcomes?
8. How precise was the estimate of the treatment effect?

Justify your answer:
There are discrete mention of the confidence limit in the study and statistical significance from the grounds of the
confidence limit cannot be determined.
Consider: What are the confidence limits? Were they statisticallysignificant?
9. Can the results be applied in your context? (or to the local population?)
Yes No Can’t tell
Justify your answer:
Yes. Because, the selection criteria of the focus group was diverse. The target group of participants included both
male and female between the age group of 22 to 62 years. This is a very diverse yet common pool of participants and
thus can be easily applied in other related studies. Moreover, the participants also had moderate to normal level of IQ.
Consider:
 Do you think that the participants covered by the trial are similar enough to the participants to whom you will
apply this?
 If so, in what way?
10. Were all (clinically) important outcomes considered?
Yes No Can’t tell
Justify your answer:
All the clinically important outcomes were considered in the study. As the study covered all the aspects of
measurement of the cognitive skills like selective attention, sustained attention, visual grapho-motor processing
speed, working memory, short-term memory and overall work performance via cognitive assessment battery.
The need of this trial was also clearly mentioned. It was said that it was the first every RCT study to investigate the
effect of standing on the cognitive functions and the overall work performance. The larger sample size and refined
techniques of measurement of the cognitive skills helped to get a clear picture of the relationship between the work-
performance/cognitive skills with the standings. This initiative was unique and was not conducted before.
Consider:
 Is there other information you would like to have seen?
 Was the need for this trial clearly described?
11. Are the benefits worth the harms and costs? Yes Can’t tell No
Justify your answer:
There was no harm conducted to anyone in this study. The overall cost required to undertake the study was also
justified as it helped to establish the actual picture of the relation of cognitive skills with the standing posture and
whether standing posture is helping in increasing the work-performance. The elucidated result will help to break the
myth behind the use of use of sit-stand work station to improve the individual work performance.
Consider:
 Even if this is not addressed by the trial, what do you think?

PART 2b: APPRAISAL OF YOUR TWO ARTICLES – Systematic review
1. Did the review address a clearly focused issue?
Yes No Can’t tell
Justify your answer:
The systematic issues clearly address a focused issue. The issue is time spent in sitting in the workplace is a
significant contributor to the overall sedentary risk. Thus, installation of the height-adjustable workstations is proposed
via several trials as the most feasible way for reducing the overall occupational sitting time within working hours. In
order to address the clearly focused issue, the authors of this systematic review have aimed to provide an overview of
controlled trials that have measured the effects of height adjustable workstation intervention under workplace settings
among the office workers. The main population which was considered for the study include studies published till 2014.
In order to identify unpolished studies, the list of references of relevant official or scientific websites was also checked.
Both RCT and non-RCT studies are included in the search. Among an initial yield of 8497 studies, five studies with a
total of 172 participants were included in the final analysis of the effectiveness of the height-adjustable workstations.
HINT: An issue can be ‘focused’ In terms of
 The population studied
 The intervention given
 The outcomes considered
2. Did the authors look for the right type of papers?
Yes No Can’t tell
Justify your answer:
The time frame that was selected for the selection of the articles includes 200 to 2014. The reason for the selection of
this time frame is also provided by the authors. According to the authors, there are no significant published trials on
this topic before 2009. The main data bases that were used for the selection of the articles include Medline,
PsycINFO, EMBASE, PEDro and CENTRAL. The main inclusion criteria was studies that aimed to decrease the
overall sitting time of the adult workers via installation of the height-adjustable workstation as a single or multi-
component intervention. Both the randomised and non randomised controlled trials where the placebo groups were
not provided with height adjustable workstation were also included. The reason for the inclusion of the non-RCT
studies was also cited by the authors. According to Tew et al. (2015), the non-RCT studies were included because of
the paucity of ECTS. They excluded single arm studies. The strength of the RCT studies were evaluated via Cochrane
Collaboration Handbook.
HINT: ‘The best sort of studies’ would
• Address the reviews question
• Have an appropriate study design (usually RCTs for papers evaluating interventions)
3. Do you think the important, relevant studies were included?
Yes No Can’t tell
Justify your answer:
Systematic Review
Appraisal Tool

The databases which were used to search papers included Medline, PsycINFO, EMBASE, PEDro and CENTRAL.
However, the keywords that were used for the search of the articles were not mentioned in the study. It is mentioned
thattwo reviewers screened the search results for eligible studies. The studies which have represented data via
primary outcome, cardiovascular events, mental health and musculoskeletal health were included in the systematic
review. Both RCTs and non-RCT studies were included in the systematic review. No-language restriction was applied
in the literary search but no papers were selected that required translation. All the papers were reviewed via Cochrane
Risk of Bias tool in order to measure its validity and strength. Upon Cochrane Risk of Bias tool analysis, the papers
were rated as “low’, “unclear” and “high risk”. The entire search process and the final search results was clearly
represented via PRISMS diagram.
Figure: PRISMA Diagram
(Source: Tew et al. 2015)
HINT: Look for
 Which bibliographic databases were used
 Follow up from reference lists
 Personal contact with experts
 Search for unpublished as well as published studies
 Search for non-English language studies
4. Did the review’s authors do enough to assess the quality of the included studies?
Yes No Can’t tell
Justify your answer:

In order to select high-quality study, the researchers used several strategies. Two independent researchers were used
to search the literary articles from the electronic databases. After removal of the duplicate studies, 8417 articles were
screened for the abstract and title. Among these 8358 were excluded and only 59 were accessed for eligibility via
Cochrane Risk of Bias tool Upon analysis 54 articles were excluded dur to improper study design and irrelevant
intervention. Finally the authors included 5 articles for the systematic review.
HINT: The authors need to consider the rigour of the studies they have identified. Lack of rigour may affect the studies’ results. (“All
that glisters is not gold” Merchant of Venice – Act II Scene 7)
5. If the results of the review have been combined, was it reasonable to do so?
Yes No Can’t tell
Justify your answer:
The five studies that were selected for the review were clearly represented in the tabular format via mentioning the
study details, the setting of population, interventions, comparator, the duration of the study and the follow-up points
and the proper elucidation of the funding along with conflict of interest. The second table, included the objective
measures of each of the five studies. The third table contained risk of bias ratings for each study. Table 4 contained
the summary of the results of the primary outcome of the study. Table 5 provided summary of results of secondary
outcomes. Upon separately stating the outcome of each of the five selected study, the author provided a summative
conclusion. Thus the results of all the included studies were clearly displayed and the analysis of the different studies
showed there were large variability in the interventions and the outcomes. The reason for the variations included
different sample size different risk of bias.
HINT: Consider whether
 The results were similar from study to study
 The results of all the included studies are clearly displayed
 The results of the different studies are similar
 The reasons for any variations in results are discussed
6. What are the overall results of the review?
Justify your answer:
The overall results of the review highlighted that height-adjusted workstation interventions help to reduce the sitting
time in workplace among the office workers. However, the authors failed to draw firm conclusion because the the
sample size of each of the study was small with high risk of bias. The results of the main study were expressed in
words with no tabular representation. However, the results of each of the five selected articles were represented in a
tabular format via stating all the details clearly in a succinct manner.
HINT: Consider
 If you are clear about the review’s ‘bottom line’ results
 What these are (numerically if appropriate)
 How were the results expressed (NNT, odds ratio etc)
7. How precise was the estimate of the treatment effect?
Justify your answer:
There were no confidence intervals given in the systematic review thus, how the precise was the estimate of the
treatment effect con not be determined.
HINT: Look at the confidence intervals, if given

8. Can the results be applied to the local population?
Yes No Can’t tell
Justify your answer:
Yes. Because the sample population of each of the selected studies mainly included working class who have a
sedentary working culture and is between the age group of 18 to 65 years (approx)
HINT: Consider whether
 The participants covered by the review could be sufficiently different to your population to cause concern?
 Your local setting is likely to differ much from that of the review?
9. Were all important outcomes considered?
Yes No Can’t tell
Justify your answer:
Both the detailed primary and the secondary outcomes of all the selected studies were included in the study along
with the intervnetions
HINT: Consider
 Is there other information you would like to have seen?
10. Are the benefits worth the harms and costs?
Yes No Can’t tell
Justify your answer:
This systematic review is cost effective as a new RCT study would cost a significant amount of energy, time and
money. However, while conducting the systematic review, a lot of time was spent in looking for the relevant papers.
No long term results were provided. According to the author, firm conclusions could not be drawn because of the
number of the selected articles for the final review was less (5) and the sample size of each of the selected papers
were also less. Moreover, the non-RCT studies which were included in the review have high rate is risk bias along
with blinding bias. Thus definite conclusion cannot be drawn from the review.
HINT: Consider Even if this is not addressed by the review,what do you think?

PART 3: SYNTHESISING THE EVIDENCE
Write a summary of approximately 300 word summarising the quality of the evidence of each paper
and then make an evidence-based decision on whether you can rely on the evidence to answer your
research question. You need to write this in simple language as if you were explaining the rationale
for your decision making to a layperson.
The aim of both the papers was slightly different but the basic idea of each of the paper was same.
The aim of the RCT study the aim was to investigate whether sit-stand workstation helps affects the
cognitive performance. The aim of the systematic review is detect the effect of the height adjusted
workstation in the reduction in the sedentary mode of the desk work. These two studies was selected
because the amalgamation of both the results will help to elucidate the importance of height-adjusted work
station on the sedentary mode of professional life of the working professionals and whether this height
adjusted workstation has any affects on the cognitive performance.
The RCT study which was selected for the review, helped to provide a detailed insight about how
sit-stand workstation has no significant effect on the cognitive performance of an individual. The study also
stated that sit-stand work-station might be helpful for the improving of the performance of a team as it
promotes ease of communication. However, it has no significant amount of benefits over the cognitive
performance and attention of an individual. The study however, has sudden amount of limitations like short
time frame of the study, the inability to implement the blinding approach and short duration of exposure. All
these limitations might tamper the final outcomes as it may increase the overall bias responses. So
comprehensive relying on the data elucidated by study is not permissible.
The aim of the systematic review does not coincide with the PICO question of the study. This is
because, it aim to measure the affect of height adjusted working stations on the sitting time of the working
professionals and not on their cognitive performance and concentration. Moreover, this systematic review is
also associated with numerous limitations like small sample size (only 5 selected articles). Moreover, the
articles selected for the systematic review score high on the bias response and also included non-RCT
trials which further decreased the strength of the final findings.
In the end, it can be concluded that RCT study selected for the review can be used to answer the
PICO question. However, further research in this domain is required to be undertaken in order to succinctly
answer the PICO question of the study.

References:
Russell, B.A., Summers, M.J., Tranent, P.J., Palmer, M.A., Cooley, P.D. and Pedersen, S.J., 2016. A randomised
control trial of the cognitive effects of working in a seated as opposed to a standing position in office
workers. Ergonomics, 59(6), pp.737-744.
Tew, G.A., Posso, M.C., Arundel, C.E. and McDaid, C.M., 2015. Systematic review: height-adjustable workstations to
reduce sedentary behaviour in office-based workers. Occupational Medicine, 65(5), pp.357-366.