Background and Clinical Scenario
A 67-year-old man was admitted at the Residential Aged Care facility. The resident has a history of constant pain, constipation, falls, and memory loss and has recently been diagnosed with dementia. The man has been prescribed the following medication; vitamin D, calcium, and regular analgesics. The resident next of kin mentions during the man’s admission that the resident was part of an exercise group in the community before he was diagnosed with dementia. Prior to the resident’s admission, the family had read about exercise such as high intensity exercise for people with dementia in reducing fall and fall related injury. The resident and family asked if there is an exercise group or class the resident they can commence.
Population: Residential Aged care resident with dementia
Intervention: Exercise (High-Intensity Function)
Comparison: Control Group (Normal seated exercise)
Outcome: Reduction in falls incidence and fall related injury in residential aged care facility/Nursing homes.
Answerable Question.
In residents living in residential aged care facility/nursing, what will be the effect of exercise high-intensity exercise compared to control exercise in reducing fall and fall related injury.
Article
Original Study
The Effects of Exercise on Falls in Older People with Dementia Living
in Nursing Homes: A Randomized Controlled Trial
Please use the article provided to answer the following questions below.
write a critical appraisal of the article you selected in Research Portfolio A.
Assessment Two Task Questions ALL section MUST be Answer
Section A: Is the basic study design valid for a randomised controlled trial?
1. Did the study address a clearly focused research question?
CONSIDER:
Was the study designed to assess the outcomes of an intervention?
Is the research question ‘focused’ in terms of:
• Population studied
• Intervention given
• Comparator chosen
• Outcomes measured?
2. Was the assignment of participants to interventions randomised?
CONSIDER:
• How was randomisation carried out? Was the method appropriate?
• Was randomisation sufficient to eliminate systematic bias?
• Was the allocation sequence concealed from investigators and participants?
3. Were all participants who entered the study accounted for at its conclusion?
CONSIDER:
• Were losses to follow-up and exclusions after randomisation accounted for?
• Were participants analysed in the study groups to which they were randomised (intention-to-treat analysis)?
• Was the study stopped early? If so, what was the reason?
Section B: Was the study methodologically sound?
4. • Were the participants ‘blind’ to intervention they were given?
• Were the investigators ‘blind’ to the intervention they were giving to participants?
• Were the people assessing/analysing outcome/s ‘blinded’?
5. Were the study groups similar at the start of the randomised controlled trial?
CONSIDER:
• Were the baseline characteristics of each study group (e.g. age, sex, socio-economic group) clearly set out?
• Were there any differences between the study groups that could affect the outcome/s?
6. Apart from the experimental intervention, did each study group receive the same level of care (that is, were they treated equally)?
CONSIDER:
• Was there a clearly defined study protocol?
• If any additional interventions were given (e.g. tests or treatments), were they similar
between the study groups?
• Were the follow-up intervals the same for each study group
Section C: What are the results?
7. Were the effects of intervention reported comprehensively?
CONSIDER:
•Was a power calculation undertaken?
• What outcomes were measured, and were they clearly specified?
• How were the results expressed? For binary outcomes, were relative and
absolute effects reported?
• Were the results reported for each outcome in each study group at each
follow-up interval?
• Was there any missing or incomplete data?
• Was there differential drop-out between the study groups that could affect the results?
• Were potential sources of bias identified?
• Which statistical tests were used?
• Were p values reported?
8. Was the precision of the estimate of the intervention or treatment effect reported?
CONSIDER:
• Were confidence intervals (CIs) reported?
9. Do the benefits of the experimental intervention outweigh the harms and costs?
CONSIDER:
• What was the size of the intervention or treatment effect?
• Were harms or unintended effects reported for each study group?
• Was a cost-effectiveness analysis undertaken? (Cost-effectiveness analysis
allows a comparison to be made between different interventions used in the care of the same condition or problem).
Section D: Will the results help locally?
10. Can the results be applied to your local population/in your context?
CONSIDER:
• Are the study participants similar to the people in your care?
• Would any differences between your population and the study participants alter the outcomes reported in the study?
• Are the outcomes important to your population?
• Are there any outcomes you would have wanted information on that have not been studied or reported?
• Are there any limitations of the study that would affect your decision?
11. Would the experimental intervention provide greater value to the people in your care than any of the existing interventions?
CONSIDER:
• What resources are needed to introduce this intervention taking into account time, finances, and skills development or training needs?
• Are you able to disinvest resources in one or more existing interventions in order to be able to re-invest in the new intervention
APPRAISAL SUMMARY: Record key points from your critical appraisal in this box. What is your conclusion about the paper? Would you use it to change your practice or to recommend changes to care/interventions used by your organisation? Could you judiciously implement this intervention without delay?
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