Critique of the Study’s Introduction
Research Problem and Purpose
The researchers concisely stated the problem they intended to investigate. The provided problem statement is clear, significant, and congruent with the study’s purpose. It contains a comprehensive description of the study’s background, pertinent variables, target populace, and an elucidation of the setting. Henskens et al. (2017) included a clear delineation of the research’s primary purpose in the article. They aimed to ascertain MRC’s efficacy in enhancing better QoL and ADL performance of patients with mild-to-severe dementia.
The study contains a clear and testable hypothesis; it is appropriately worded and consistent with the problem statement and the research’s overall purpose. Henskens et al. (2017) hypothesized that MRC would maintain or slow down the deterioration of ADL independence and QoL in patients with moderate-to-severe dementia compared to those receiving routine care. The above-mentioned postulation predicts the relationship between MRC intervention and QoL and ADL independence. Contrarily, the researchers did not include research questions for this particular survey.
Independent Variable and Dependent Variables
The study’s independent variable is the intervention administered to patients with mild-to-severe dementia. The research’s dependent variable is the outcome to be measured – the treatment’s impact on the aforementioned patients’ ADL and QoL. However, the researchers did not provide a clear delineation of the above-mentioned variables in the article. Contrarily, they identified demographic variables; this includes continuous (age), nominal (gender and type of dementia), and ordinal (severity of dementia) variables.
Theoretical or Conceptual Framework
The researchers did not provide a conceptual or theoretical framework for their study. Henskens et al. (2017) should have developed a conceptual framework based on a pertinent scientific theory. According to Adom et al. (2018), the model mentioned above is instrumental in identifying, describing, and defining the relationship between conceptions and variables. It also helps investigators link variables to conceptualizations using a well-developed conceptual diagram.
The researchers did not include a literature review section in the article. Therefore, it is impossible to ascertain its comprehensive nature, its contents’ relevance to the study, the type of sources used and their pertinence to the research, and whether it contains information from recent research.
The researchers used a quasi-experimental research design with a convenient sample and two parallel groupings. The aforementioned study design relates to an empirical intervention model used to ascertain the causal effect of a treatment on a target populace without random allocation (Handley et al., 2018). Under the hierarchy of evidence, quasi-experimental studies are classified as level III pieces of evidence. These surveys are typically well-designed; however, they lack the randomization aspect, which, in turn, limits the investigators’ ability to control external factors, which may impact the study’s results.
Sample and Setting
The researchers used the convenience sampling methodology to select the study’s participants. Henskens et al. (2017) used a small convenience sample comprising 61 nursing home residents living in a control location. Thirty-seven subjects were assigned to the treatment cohort and twenty-four to the placebo group. The researchers performed a sample attrition analysis: out of the 61 subjects, only forty-four participants completed the study. There are a few drawbacks of the chosen sampling technique. It constrains the study outcomes’ generalizability and could result in an under/over-representation of a subgroup in the selected sample leading to biased outcomes. It is difficult to ascertain the sample size’s appropriateness and its efficacy in minimizing type I error since the researchers did not conduct a power analysis.
Inclusion and Exclusion Criteria
The exclusion and inclusion criteria were adequately elucidated in the study. The inclusion criteria included patients diagnosed with dementia, those living in a nursing home (NH) for at least three weeks, and individuals aged sixty-five and above. The authors excluded participants with psychotic symptoms, extreme dementia, bad vision, contraindications for physical activity, and poor mental state determined by a mental health scale. The inclusion and exclusion criteria can minimize selection bias and random errors and improve a study’s external validity (Patino & Ferreira, 2018). Therefore, this approach helped the researchers minimize the aforementioned shortcomings and enhance better validity.
The selected statistical tests were appropriate for this particular study. The Pearson’s chi-square tests, Mann-Whitney U tests, and t-tests were done to analyze variations in demographic characteristics and outcome measurements between the study groups (Henskens et al., 2017). Because the data in this study were hierarchical, the linear mixed model (LMM) use to examine the effect of MRC on study participants was appropriate. The LMM is often utilized when there is non-independence in data. The initial model evaluated the intervention’s impact independent of time, while the other one evaluated the treatment’s effect at every time interval.
The type and level of the selected measures were also appropriate for the study. The qualidem, a questionnaire used in the study, was utilized to measure the participants’ QoL levels. There was moderate evidence regarding the validity and reliability of qualidem and Barthel index for the DP and functional disability analysis, respectively (Henskens et al., 2017). The researchers also addressed the reliability of the statistical tools. For the baseline characteristics and outcome variables, the alpha level was set at.05 (Henskens et al., 2017). Henskens et al., (2017) utilized Bonferroni correction to rectify or adjust alpha inflation (p<.005). The researchers also determined and reported confidence intervals and regression coefficients.
Results and Discussion
The data collected during the survey did not support the researchers’ hypothesis. There was no significant difference between the demographic characteristics of the treatment and control grouping – both the treatment and placebo grouping had p scores of >.005 on the Barthel index (Henskens et al., 2017). Regarding MRC’s effect on participants, there was no statistically significant variation between the above-mentioned groups (Henskens et al., 2017). The intervention category scored 16.94 on the Barthel Index and >.005 on the qualidem, while the control one attained a 16.32 and >.005 outcome, respectively (Henskens et al., 2017). However, the findings revealed a significant statistical variation in the positive self-image variable in the intervention category.
The investigators’ findings revealed MRC’s insignificant impact on the study’s dependent variables. Henskens et al. (2017) theorized that the reason behind MRC’s efficacy in enhancing better QoL in patients is because of its inability to improve participants’ independent functioning. According to the investigators, ADL independence is a major predictor of QoL; since MRC could not increase the respondents’ functional independence, its positive effect on patients’ QoL was also constrained. Contrarily, the survey’s outcomes regarding the intervention’s impact on self-image are relevant because DPs struggle with self-esteem issues, including feeling worthless for depending on others for ADL support (Emmady & Tadi, 2020). Therefore, practitioners working in nursing homes can utilize the MRC to improve the self-value of dementia patients. Although Henskens et al. (2017) did not link the research outcomes to the conceptual framework, they provided a comprehensive discussion of the review’s findings and related them to past studies. They postulate that the inconsistency of their results to past studies can be attributed to differences in treatment fidelity. The conclusion fits the survey results; the researchers inferred that MRC does not improve QoL or ADL independence.
The ultimate goal of any healthcare intervention is to improve the QoL of patients. However, enough evidence must be warranted to rationalize the administration of a specific treatment plan. This study is significant to nursing practice since it contributes to the body of evidence-based literature related to MRC’s effectiveness in improving ADL independence and QoL in DPS. Although the researchers adopted a nonrandomized approach to obtain the research findings, the evidence is reliable and can be used to justify practitioners’ clinical decisions. Given that dementia’s prevalence is expected to rise, this survey’s outcomes are beneficial; they highlight MRC’s inefficiency in improving the target population’s health outcomes. Nurses can therefore opt for more effective interventions to enhance these patients’ health outcomes. However, they may integrate the above-mentioned treatment approach to better DPs’ self-image.
The study is well-designed and based on logical scientific conceptions. The survey’s purpose is clearly outlined, procedures have been described in detail, and the flaws in procedural design have been identified by other researchers. The analysis techniques are sufficient and appropriate for this research; they reveal the data’s validity and reliability. Furthermore, conclusions are tied to the facts derived from the study’s findings. However, the findings cannot be generalized because the sample was small, and investigators used the convenience sampling approach. Additional randomized clinical trials should be conducted to establish how MRC can be effectuated for this patient population.
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