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Critical Appraisal of Research Articles

Develop skills in critically appraising two published research articles (one quantitative and the other qualitative) and to critically appraise the quality of reported information.

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Article: Qualitative Research Article
"Making decisions for people with dementia who lack capacity: qualitative study of family carers in UK. British Medical Journal, 341, p.c4184."

Section A: Are the results Valid?

1. Was there a clear statement of the aims of the research?

The research study that was conducted by Livingston, et al. (2010) presented clear objectives for which the research was conducted. It was quite clear from the abstract as well as the main paper that the aim of the research was identifying the common difficult decisions that are made by the family carer on the behalf of those individuals suffering from dementia. Furthermore, it was also evident that the study was aimed towards identification of the facilitators and barrier associated with such decision making as the researchers had aimed towards producing suitable information that would aid the family carers to overcome the barriers that are associated with the process. The study is relevant for those individuals who are associated with the carer professions and making the decisions for the adults who suffer from dementia as this study would provide them the opportunity to identify the major barriers that are associated with their profession and thereby develop suitable methods for overcoming the same based on the recommendations of the current study.

2. Is a qualitative methodology appropriate?

In the study conducted by Livingston, et al. (2010), the qualitative methodology that has been employed by the researcher is was based on conducting interviews through focus group. The research methodology that has been employed is appropriate for the research as the aim of the research is determining the major factors facilitating or causing barriers to the decisions making processes that are made by the family carer for the patients of high age and suffering from dementia. The qualitative method that has been employed by the researcher is one of the methods that can be employed for conducting these kinds of studies.For instance, the study that was conducted by Lord, Livingston and Cooper, (2015) was based on conducting evaluation of the different studies that have been conducted regarding the barriers and facilitators for the proxy decision making process that is employed by the family carers of the individuals with dementia. Therefore, it can be stated that the qualitative approach for the current study is appropriate.

3. Was the research design appropriate to address the aims of the research?

The research study that was utilized by the researchers in the current study is appropriate for addressing the aims of the research. The research design employed by the researcher was based on the qualitative study for delineating the decision areas employed by the family carers of elders with dementia. This has been achieved through the focus groups as well as complexity of the decision making amongst the individual interviews. This research design can be considered to be suitable for the current study, however, there are other methods and research designs that can be employed for conducting research in the area of focus, as the same in the current study. For instance, in the study conducted by Samsi and Manthorpe (2013) had interviewed dyads, that is, one carer and one individual with dementia for four times in the time span of one year for ascertaining the experiences of decision making and determining the changes with respect to the dynamics of the decision making process.

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4. Was the recruitment strategy appropriate to the aims of the research?

The recruitment strategy that was employed for the current research study was appropriate for the current context. The researchers had selected the participants from the community settings of London. Nearly 43 family carers of the old age individuals with dementia from focus groups were selected for the current study, and additional 46 carers were selected as the control as these were those individuals who had already made similar such decisions. This recruitment process has been appropriate for the fulfilment of the aims of the research as the participants had the necessary knowledge which is required for gaining the insight that are essential for the research. This recruitment process can vary as per the kind of research that is being conducted. For instance, Samsi and Manthorpe (2013) had recruited only 12 individuals for their interview and this comprised of dyad, while the study conducted by Lord, Livingston and Cooper (2015) was entirely based on the review of the existing literatures, thereby making its recruitment process entirely different from the current research topic.

5. Was the data collected in a way that addressed the research issue?

The data was collected in the manner that allowed the researchers to extensively evaluate it, which enabled the researchers in addressing the research issue. The settings in which the data were collected are justified as the same had provided the researchers to tap into the actual emotional or psychological state of the recruits and the same is crucial for the current research as the psychological state of the carer also play crucial role in the decision making process for the elderly patients with dementia. The researchers had also explained the selection of those recruits.In addition, the researchers had also provided a brief discussion regarding the recruits and their participation in the survey. Furthermore, the data were collected from focus group through interviews.

6. Has the relationship between researcher and participants been adequately considered?

The relationship between the participants and the researcher has not been adequately considered in the current research study. The researchers have not provided any kind of insights regarding their own role or the potential bias they can have on the research that has been conducted by them. Additionally, the influence of the researchers during any of the processes such as research question formulation or data collection processes, have not been explained by the researcher. In addition, the researchers have not provided any insight regarding their responses to the events associated with the study or the implications that have been considered by them regarding the changes associated with the research design.

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Section B: What are the results?

7. Have ethical issues been taken into consideration?

Sufficient details regarding how the research was explained and conveyed to the participants have been provided in the research study. Furthermore, the researchers had ensured that all the necessary ethical considerations are followed so as to ensure that none of the ethical aspects are violated throughout the research that has been conducted. The required approvals and permissions have been obtained by the researchers, prior to conducting the research so as to ensure that none of the ethical considerations are violated.

8. Was the data analysis sufficiently rigorous?

The data analysis processes that have been employed by the researcher has been sufficiently explained in the research paper. The various analytical software as well as the measures that have been employed by the researchers in analysing the acquired data have been sufficiently explained, thereby ensuring that any reader would be able to gain knowledge regarding the different kinds of analytical processes and tools that are available for qualitative data analysis. The data analytical process that has been employed by the researcher is quite different and other kinds of approach of data analysis can also be employed for analysing these kinds of data. For instance, the study that was conducted by Samsi and Manthorpe (2013), the researchers had employed thematic analysis of the interview transcripts and the qualitative interviews were conducted in the homes of the participants.

9. Is there a clear statement of findings?

The findings that have been presented by the researchers, provide sufficient insight regarding the association between the obtained data and the manner in which certain people conduct the evaluation processes. The researchers have included the credibility of the findings and how the same links with that of the objectives. The presence of adequate discussions on the evidences for as well as against the initial arguments against ensured the creditability of the findings of the research that have been obtained through the study that were conducted by the researcher. Furthermore, the findings have also been discussed with respect to the original research questions, thereby making the findings even more valid for the discussions that have been conducted.

Section C: Will the results help locally?

10. How valuable is the research?

The research that has been conducted by the conducted significantly contributes to the existing understandings as well as knowledge that are associated with the area in which the current study was conducted. It can be determined through the current study that there are various approaches that can be taken by the carers, doctors, and other individuals assisting all the elderly individuals with the case of dementia and decision-making processes that are associated with the same. The researchers have provided detailed review regarding the insight that has been gained through the present research study. In addition, the potential strategic approach that can be considered for conducting similar researches in the future have also been completed. Therefore, it can be stated that the study conducted by the researchers are appropriate for gaining information regarding the area in which the study has been conducted.

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Article 2: Quantitative Randomized Controlled Trial Research Article

"Effect of tai chi versus aerobic exercise for fibromyalgia: comparative effectiveness randomized controlled trial. British Medical Journal, 360, p.k851."

Section A: Are the results of the trial valid?

1. Did the trial address a clearly focused issue?

The trails that has been conducted by Wang, et al. (2018) has clearly addressed focused issues. The population that has been studied has been explained as to why that population has been selected. Furthermore, the setting that has been conducted for obtaining information from the participation and so on. The aim of the current research study have been aimed towards determining the efficiency of the interventions of Aerobic exercise as an existing core standard treatment in the patients with the health condition of fibro amygdala as well as for testing if the efficiency of tai chi is dependent on its duration or dosage availed by the patients. The comparators of the current research study have also been provided in the research that has been conducted.

2. Was the assignment of patients to treatments randomised?

The assignment of the patients to the treatments were randomised in the study that was conducted by the researcher in the current research study. The treatments were randomised for 52 weeks through a single blind comparative efficiency trial. The assignment of the participants was made randomly, and they were either assigned to supervised aerobic exercised for 24 weeks and was conducted twice every week. The rest of the participants were assigned to one of the four classical Yang style supervised tai chi intervention groups for 12 or 24 weeks and were conducted once or twice in a week. The participants were rigorously encouraged in person as well as via telephone to ensure that none of the participants quit the process. Similar approach has also been identified in the study that was conducted by Wang, et al. (2015), whereby the researchers had subjected the participants to similar interventions of Tai Chi and aerobics and for almost about the same duration of time for the interventions. However, in the study that was conducted by Collado-Mateo, et al. (2017) had focused the participants into 2 groups, namely exercise group and non-exercise group and the study duration was for a total of 8 weeks. This implies that different randomisation and testing processes can be applied with respect to the current research study.

3. Were all of the patients who entered the trial properly accounted for at its conclusion?

All the patients who had entered the trial had been properly accounted for at the conclusion of the study that has been conducted by Wang et al. (2018). The researchers had ensured that all the participants of the study remain a part of the study till the completion of the research so as to avoid any kind of complications associated with the data analysis processes, thereby making the same, more valid. Furthermore, the patients have been analysed as per the groups into which they were initially randomised and the same had been maintained until the completion of the entire study.

4. Were patients, health workers and study personnel ‘blind' to treatment?

The study that was conducted by the researcher in the current research was single blind and the research study nurses, sponsor staff and the physical function assessors who had been the part of the baseline as well as the follow ups evaluations, were blinded for the process of treatment allocation. However, the patients were not blind to the treatment and were fully aware of the treatment processes that they were subjected to. In the study that was conducted by Collado-Mateo, et al. (2017), the researchers had employed the process of single blind in their study as well. This signifies that the process of single blind can also offer significance results and may provide insights that would be favourable for the study that is being conducted by the researchers.

5. Were the groups similar at the start of the trial

The individuals who were above the age of 21 years were enrolled for the research study by the researchers and it was ensured that the participants fulfilled the preliminary diagnostic criteria for fibromyalgia that has been detailed by American College of Rheumatology 1990 and 2010. However, no other details regarding the similarities between the groups have been detailed in the research article such as gender, age, social class and so on. Although there were other criteria associated with the exclusion of the participants so as to ensure that the study is not affected in any manner. In the study that was conducted by Wang et al. (2015) similar criteria were used, implicating that this is one the selection or inclusion criteria that are considered by the researchers associated with this area of research.

6. Aside from the experimental intervention, were the groups treated equally?

Apart from the experimental interventions, the groups of the participants were subjected to similar treatments in other aspects. All the participants were encouraged in the similar manner and were kept motivated for the entire duration of the research that has been conducted by the researcher. These participants were also provided with sufficient motivation as to why their participation is significant for the study and why they are expected to remain with the study till the completion of the same.
Section B: What are the results?

7. How large was the treatment effect?

The treatment was then later followed by FIQR (revised fibromyalgia impact questionnaire) scores amongst all the five groups that have been segregated at the initial stage of the research study. The scores were measured at the end of the 24 weeks. Based on the results of the scores the extent of the improvements that have been observed with respect to each of the focus or intervention group have been determined. The primary outcomes of the research study have been clearly identified and specified and the outcomes were measured based on the similarity with the FIQR scores. At the end of each outcomes, the results associated with the aims and objectives of the research were acquired. The results from each of the group were evaluated to identify the best outcomes from the intervention groups and identify the intervention that is most suitable.

8. How precise was the estimate of the treatment effect?

The estimate of the treatment effect was precise to a large extent. It was identified that the groups that received tai chi for the 24 weeks presented with more improvements than those with the intervention availed for 12 weeks. Furthermore, it was also identified that the groups with similar interventions and intensities of tai chi and aerobics presented that the individuals from tai chi had better and improved results as opposed to the individuals who received the intervention of aerobics.The effects of tai chi were maintained to be consistent across all the instructors so as to maintain a homogeneity with respect to the treatment that were provided to the different groups.
Section C: Will the results help locally?
9. Can the results be applied to the local population, or in your context?

The results that have been obtained from the research study that was conducted as per the article, has presented with positive results that appear to be suitable to be applied for the individuals with similar health issues in the localised geographies. The application of the intervention or the treatment can be applied only to those individuals who qualify all the criterion that has been mentioned in the current research study, apart from having just the disease conditions. This would ensure that positive results are acquired through the application of the intervention in the real-life context.

10. Were all clinically important outcomes considered?

In the study that was conducted by the researchers, all the clinically significant outcomes have been considered in an appropriate manner. It has been ensured by the researchers that all the significant details are addressed during the development of the outcomes of the research and the same have been considered such that the interventions can be applied on other patients in the future, although under all kinds of supervisions that are required and expected from such treatments and interventions. It is required to be considered that all the processes that were described in the interventions of the researcher are included in the real life context as well.

11. Are the benefits worth the harms and costs?
As such no harms have been identified with respect to the interventions that have been described by the researchers in the current research study. Hence it can be stated that the inventions and treatments that have been suggested are suitable and does not comprises of any kind of harm to be inflicted upon the users or patients. With respect to the cost aspect, it can be stated that the expenses that are associated with the process are confined to the treatment and interventions, that is, the tai chi classes and sessions that the patients would be required to undertake. Apart from that no other expensive costs can be determined.

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