Use of Scientific Research to Determine the Most Effective Outcome - Essay Example

? Sports Research in motion An essay on How sport and exercise scientists support evidence based practice in different professional contexts through research And Critical evaluation of the methodological approach taken in the case study on “Effects of Acute Creatine Loading With or Without Carbohydrate on Repeated Bouts of Maximal Swimming in High-Performance Swimmers” by Theodorou, A.S. et al., (2005) By Submitted to (April 2011) Photo credit: Cover page: http://2.bp.blogspot.com/_GM4SVkO2ERg/TFt1pna2f8I/AAAAAAAAAVk/_s4rTdDIzbk/s1600/BFblog+(282).jpg Part 1: Critical discussion of how sport & exercise scientists support evidence based practice in different professional contexts Brief: Critically discuss the ways in which sport and exercise scientists support evidence based practice in different professional contexts through research. This part of the essay will be discussed under the following heads: 1. Introduction 2. Evidence based practice: concept and definition 3. EBP in sports & exercise context a. Swimming b. Cycling 4. Conclusion 1.1 Introduction 1.1 The concept Evidence-based practice (EBP) is refers to the “review and use of scientific research to determine the most effective outcome. The scientific evidence plays a central role, although clinical judgement and the athlete’s personal preferences and values must also be considered” (Dunford & Doyle, 2008, p.17). EBP is also refers to as the preferential use of mental and behavioural health interventions for which systematic empirical research has provided evidence of statistically significant effectiveness as treatments for specific problems. The University of Minnesota Libraries, which maintains a website on EBP states that “EBP is a thoughtful integration of the best available evidence, coupled with clinical expertise and enables health practitioners of all varieties to address healthcare questions with an evaluative and qualitative approach. EBP allows the practitioner to assess current and part research, clinical guidelines, and other information resources, clinical guidelines, and other information resources in order to identify relevant literature while differentiating between high-quality and low-quality findings” (University of Minnesota; Libraries , 2010). 1.1.1 Significance EBP is highly desirable to research as it leads to rigorous and systematic study of research questions, the answers to which are based on scientific evidence (Nelson, 2010). Gray & Gray (2002) explain that “because research findings are fundamental in forming recommendations, the quality of the research is very important in EBP (Dunford & Doyle, 2008, p.17). This in turn becomes fundamental to the development of the best practices in a variety of professions (Nelson, 2010). In recent years, professional organisations such as American Psychological Association, the American Occupational Therapy Association, the American Nurses Association, and the American Physical Therapy Association have been urging their members to carryout research in support or against specific interventions. Canadian equivalent of these organisations also stress on EBP. Other agencies such as the insurance providers have been known to deny insurance coverage to certain interventions due to lack of systematic evidences. 1.1.2 Applicability and areas of research The medical profession, in which treatments prescribed by doctors are based on the best evidence available so that the treatment is effective for the condition at hand, are not the only one to benefit from EBM. Other areas include psychology, psychiatry, rehabilitation, sports and physical activity research to mention a few. Many of these areas where lose bodies of knowledge were prevailing for generations without any empirical evidence are also now exploring application of EBM. Nevertheless, sports and exercise scientists perhaps are the most immediate beneficiary of EBM, next only to the medical profession. The succeeding sections of this part discuss how sport & exercise scientists support evidence based practice in different professional contexts. 1.2 EBM in different professional context A multitude of models of EBP are available and have been used in a variety of professional settings (Titler, 2008). The US Agency for Healthcare Research and Quality (AHRQ) delineates that promotion of adoption of EBPs can be seen from several perspectives depending upon how EBP affects the viewing person, such as the research scientists, or those who generate knowledge; the users of EBP information in practice; and those whose serve as a link between the knowledge generators and knowledge users. Figure 1: EBM from three perspectives- the knowledge generators, EBP knowledge users and the link between the two. Adapted from source: Titler, M.G., 2008. The Evidence for Evidence-Based Practice. Chapter 7. In R.G. Hughes, ed. Patient Safety and Quality: An Evidence-Based Handbook for Nurses. 080043rd ed. Rockville, MD: Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services. P.2. The AHRQ has developed a model representing transfer of EBM knowledge generated by the knowledge generators. The model specifies a three stage process as (1) knowledge creation and distillation, (2) diffusion and dissemination, and (3) organisation and implementation. Figure 2: Stages and direction of EBM knowledge transfer and role of EBM knowledge generators Adapted from source: Titler, M.G., 2008. The Evidence for Evidence-Based Practice. Chapter 7. In R.G. Hughes, ed. Patient Safety and Quality: An Evidence-Based Handbook for Nurses. 080043rd ed. Rockville, MD: Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services. pp.1-49 The sports and exercise research scientists, being EBM knowledge creators support EBM in all the three levels in all the professional contexts they deal with. In the succeeding paragraphs, how sport & exercise scientists support evidence based practice in two different professional contexts are illustrated. 1.2.1 Swimming Swimming is an ancient sport considered as highly acclaimed sport in the modern times. Athletes participating in a wide variety of sports are known to use a variety of nutritional supplements of which Creatine is one of the most commonly used dietary supplements, as it has been shown to be beneficial in improving performance during repeated bouts of high-intensity anaerobic activity (Hopwood et al., 2006). Hopwood et al. (2006) explain that “Creatine (Cr) is an amino acid synthesized primarily in the liver and stored mostly in the muscle. The phosphorylated form, phosphocreatine (PCr) plays an integral role in anaerobic energy production in the muscle. PCr is directly involved in the formation of adenosine tri-phosphate (ATP) via the creatine kinase reaction: PCr + ADP + H+ - ATP + Cr For a normal healthy body the standard endogenous levels of PCr can maintain ATP production for only the 5-10 seconds of high intensity and explosive exercise. Since the supply of PCr is limited, once the initial supply depletes fatigue sets in on the athlete (Dawson et al., 1995; Greenhaff et al., 1993; Harris et al., 1992; cited by Hopwood et al., 2006.p.10. To provide recourse from this situation, sports and exercise scientists have been experimenting with exogenous creatine supplementation so that the intramuscular Cr and PCr levels can be maintained for extended period even during high intensity activity regimes such as swimming. As early as Harris et al. (1992) have observed that “commonly, total muscle Cr stores have been shown to increase by 20-30% following five days of Creatine supplementation and swim performance supplementation at a dose of 20g per day” (Hopwood et al., 2006, p.11). Ever since, sports and exercise scientists have been performing evidence-based practice to study how athletes respond to exogenous supplementation of creatine. There have been many important studies conducted on various aspects, various number of samples and with varying quantity of creatine supplementation. Hopwood et al. (2006) prepared two separate lists depicting how sports and exercise researchers have been trying to track the effect of creatine supplementation on swimming performance in two broad categories (1) on single sprint, and (2) repeated interval swim set. These copies of these lists are reproduced and placed in Appendix 1-A and 1-B respectively. The details of the research question and the findings can be found in the respective studies. However, one thing that emerges from all these studies that generation of this knowledge has been possible only due to evidence based practice. 1.2.2 Sprint Running Sprint running is another area where the sports and exercise scientists have been supporting EBP. A case in point is the study conducted by Paradisis et al. (2009) on “Combined Uphill and Downhill Sprint Running Training Is More Efficacious Than Horizontal”. The purpose of their study was to investigate the effect of sprint running training on sloping surfaces (30) on selected kinematic and physiological variables. Using fifty-four sport and physical education students selected randomly, the researchers allocated to one of two training groups (combined uphill–downhill [U+D] and horizontal (H)) and a control group (C). The researchers performed pre- and posttraining tests to examine the effects of 8 wk of training on the maximum running speed (MRS), step rate, step length, step time, contact time, eccentric and concentric phase of contact time (EP, CP), flight time, selected posture characteristics of the step cycle, and 6-s maximal cycle sprint test. The researchers observed that, MRS, step rate, contact time, and step time were improved significantly in a 35-m sprint test for the U+D group (P < .01) after training by 4.3%, 4.3%, ?5.1%, and ?3.9% respectively, whereas the H group showed smaller improvements, (1.7% (P < .05), 1.2% (P < .01), 1.7% (P < .01), and 1.2% (P < .01) respectively). There were no significant changes in the C group. The posture characteristics and the peak anaerobic power (AWT) performance did not change with training in any of the groups (Hopwood et al., 2006, p.229). Hopwood et al. (2009) concluded that up-hill + down-hill training method was considerable more effective in improving MRS and the MRS and the kinematic characteristics of sprint running than a traditional horizontal training method. The researchers believed that their study “provides further objective evidence substantiating the efficacy of the combined U+D training method for improving maximum horizontal sprinting speed, which is important in a range of sports, including athletics and a variety of major team games” (Hopwood et al., 2006, p.242). From the foregoing it is apparent that generation of this body of knowledge has certainly contributed to support EBP. 1.3 Conclusion Over the years, the knowledge generated by these EBP knowledge generators have been successfully transferred to the EBP knowledge users both directly and by the links between the two. Whether the swimmers and other athletes have been benefited from this knowledge may be a different research question altogether, but it is certain that the sports and exercise scientists have been contributing proliferation of knowledge through EBP. The bottom line is that the contribution of sports and exercise scientists towards adopting evidence-based practice is significant, as it leads to effective practices for the majority. Event though, the established best practices may not work in every context, but for the population as a whole, it is the best option (Nelson, 2010). Part 2: Critical evaluation of case study Brief: Critically evaluate the methodological approach taken in the case study on “Effects of Acute Creatine Loading With or Without Carbohydrate on Repeated Bouts of Maximal Swimming in High-Performance Swimmers” by Theodorou, A.S. et al., (2005) and Critically discuss the challenges of performing research in that particular professional context(results , sampling , doses of creatine, protocol of the study etc...)  The essay is discussed under the following heads: 1. Introduction 1.1. The article of review 2. Methodology 3. Evaluation 3.1. Evaluation of methodological approach 3.2. Evaluation of challenges of performing research in the particular context of 3.2.1. Sampling 3.2.2. Doses of creatine 3.2.3. Protocol of study 4. Conclusion 2.1 Introduction Gratton and Jones (2010) in their book “Research methods for sports studies” define “research as a systematic process of discovery and advancement of human knowledge” (Gratton & Jones, 2010, p.4). On the other hand, as Albert Szent-Gyorgyi interprets is “research is to see what everybody else has seen, and to think what no boy has thought” (Thomas et al., 2011, p.3). Both of these are true for sports and physical activity research, as they are for research in other areas. However, once a research is done, it becomes imperative to evaluate whether the research has been done in the manner in which it should have been undertaken and whether it serves the purpose to advance human knowledge. As Jim Collins in his acclaimed book “Good to Great” puts it, the objective of research is not to find the obvious, that every educational institution has classrooms, each classroom has furniture and so on (Collins, 2001); hence there is need to know whether the research effort has gone beyond finding the obvious. Besides, as Caldwell et al. (2005) state “… it is important that students are enabled to critique published research in order to determine the usefulness of that research in their chosen field of work. By ‘critique’ we mean the ability to critically appraise the strengths and weaknesses of the research and forming judgements concerning its overall quality and applicability” (Caldwell et al., 2005, p.46). Aveyard’ (2007) definition of critical appraisal as a structured process of examining a research with an aim to determining its strengths and limitations is also highly relevant. 2.1.1 The article of review Sports have always been an indicator of prosperity throughout history. From the Greek Civilisation to the present information civilisation, sports and consequently sports research have grown its stature and relevance. Application of newer techniques and supplements to enable the human machine to deliver at the time of test has always taken priority. From time to time, athletes have been trying to explore nutritional supplements that would benefit them the most. “Creatine is one of the most commonly dietary supplements, as it has been shown to be beneficial in improving performance during repeated bouts of high-intensity anaerobic activity” (Hopwood et al., 2006, p.10). In this regard the research conducted by Theodorou et al. (2005) has thrown considerable light on the subject. The purpose of this part the essay is to critically evaluate the research conducted by the researchers Appostolos S. Theodorou; Konstantinos Haventidis; Cathy L. Zanker; John P. O’Hara, Roderick F. G. J. King; Colin Hood; Giorgios Paradisis; Carlton B. Cooke. on “Effects of Acute Creatine Loading With or Without Carbohydrate on Repeated Bouts of Maximal Swimming in High-Performance Swimmers, published in the Journal of Strengths and Conditioning Research. 2.2 Methodology As Trochim (1998) stated, methodology is the study of methods available for undertaking a particular research. As for research, for critical evaluation of research too, researchers have been developing methods over the years. Some of them are designed for qualitative studies, while a few others are suitable for quantitative studies and yet some of them cater to both types of studies (Aveyard, 2007). The author studied a few of them and identified three frameworks that are particularly suitable for the present evaluation. These are (1) Bray & Reefs (1995) method; CASP (2005) critical appraisal framework and the framework developed by Caldwell et al. (2005). The three frameworks are placed in Appendix 2-A, 2-B, & 2-C. The framework developed by Caldwell et al. (2005) was found to be particularly suitable and is reproduced below. The present evaluation will use some of the components of this framework. A discussion of the rationale is placed in the succeeding paragraphs. The Caldwell et al. (2005) framework is place in the figure below. Figure 3: Caldwell et al. (2005) framework for critical evaluation of published research works Source: Caldwell et al. (2005), p.50. 2.3 Evaluation Effects of Acute Creatine Loading With or Without Carbohydrate on Repeated Bouts of Maximal Swimming in High-Performance Swimmers by Theodorou et al. (2005). 2.3.1 Evaluation of methodological approach The researchers in their study had the purpose to compare swimming performance assessed as mean swimming velocity over repeated maximal intervals, in high-performance swimmers before and after an acute loading regimen either creatine along (Cr) or combined creatine and carbohydrate (Cr + CHO). The researchers believed that a greater increase of mean swimming velocity over repeated bouts of maximal swimming would be observed in high-performance swimmers after combined dietary creatine and CHO loading than after creatine loading alone. To test their hypothesis, the researchers employed a quantitative experimental research method. Berg (2001) stated that “…quantitative orientations are often given more respect”, as it “…may reflect the tendency of the general public to regard science as related to numbers and implying precision” (Berg, 2001, p.2). Berg (2001) further quotes Bogdan & Taylor (1975) and stated that “research methods on human beings affect how these persons will be viewed. If humans are studied in a symbolically reduced, statistically aggregated fashion, there is danger that conclusions although arithmetically precise – may fail to fit reality (Mill, 1959; cited by Berg, 2001, p.7). Trochim on the other hand states that the experimental designs are usually considered as superior to all other research design and even touted as the most “rigorous” or the “gold standard” amongst all the research designs (Trochim, 1998, p.211). Sports and physical activity research frequently use both quantitative experimental research methods. In the present study under evaluation the researchers Theodorou et al. (2005) recruited human object (international level swimmers comprising of both males and females) and randomised into two groups. The researchers than ingested each swimmer 5-g doses of creatine for 4 days, with the Cr + CHO group also ingesting ? 100 g of simple CHO 30 minutes after each does of creatine and measured performance on five occasions. This is a standard research method of experimentation in such these types of research hence is justified. 2.3.2 Evaluation by using Caldwell (2005) framework As per the Caldwell et al. (2005) framework, quantitative studies need to be tested for evaluation to satisfy seven conditions. These conditions and their brief evaluation are placed in the table below: Condition 1: Is the study design clearly identified and is the rationale for choice of design evident? Yes. As discussed in the above, use of the present study design is justified, however, the article did not clearly identify the rationale for choice. Condition 2: Is there an experimental hypothesis clearly stated? As Trochim (1998) states, a hypothesis is a specific statement of prediction that describes in concrete (rather than theoretical) terms what a researcher expect will happen in your study. In the present study, the researchers hypothesised that “a greater increase of mean swimming velocity over repeated bouts of maximal swimming would be observed in high-performance swimmers after combined dietary creatine and CHO loading than after creatine loading alone”. The experimental hypothesis is clearly stated, and therefore, this condition is satisfied. Condition 3: Are the key variables clearly defined? The key variables are not clearly defined. However, they are implicit in study. Condition 4: Is the population identified? No. Though the population has been clearly identified in the research, but it is clearly quantified. Quantification of the population is essential for determination of the size of the sample. Condition 5: Is the sample adequately described and reflective of the population? Trochim (1998) stated that “sampling is the process of selecting units (e.g., people, organizations) from a population of interest so that by studying the sample we may fairly generalize our results back to the population from which they were chosen” (Trochim, 1998, p.59). In the present experiment, the demography of the research included ten international calibre swimmers (n=10) with two physical criteria in (1) age group of 17.8 years ± 1.8 years (SD), and (2) body mass (72.3 ± 6.8 kg) respectively. Sixty per cent of the samples were men and the remaining 40 per cent were women. Most of these swimmers were British National Team. It is evident from the study that the researchers used non-probabilistic purpose convenient sampling method. Non-probabilistic sampling is considered to be prone to errors (Trochim, 1998), however, for the present study, recruiting international standard players in sufficient numbers for the study though not impossible, but certainly is not an easy task. Hence, the sampling method is justified. However, the basis on which the size of the sample was determined has not been clearly articulated in the paper. Condition 6: Is the method of data collection valid and reliable? Reliability and validity are two important aspects often determine the usefulness and generalizability of the study. The OECD Glossary of Statistical Terms defines reliability is the “closeness of the initial estimated value (s) to the subsequent estimated values” (OECD, n.d.). and validity error “is an occurrence of the value of a data item which is not an element of the set of permissible codes or values assigned to that data item” (OECD, n.d.). Statistically validity means, making a statement that the researcher can have confidence in the means that establishes validity. Therefore, the essential features of reliability and validity (placed in table below) need to be satisfied by the present research. Table 1: Comparison between reliability and validity issues Reliability Validity Production of consistent, replicable outcomes Production of outcome that meets objective Substantiation based on past data Substantiation based on future events Use of limited number of objective variables Use of a broad number of diverse variables Minimisation of judgement Integration of judgement Avoidance of the possibility bias Acknowledgement of the reality of bias Source: http://www.uxmatters.com/mt/archives/2006/09/images/8s06_tension-btwn-reliability-validity.JPG Further, it also need to satisfy Trochim’s (1998) target metaphor on validity and reliability (placed in figure below) and in Appendix B-4. Figure 4: Trochim's (1998) target metaphor on reliability and validity Source: Trochim, W.M.K., 1998. Research Methods. Electronic Edition ed. Trochim, William M.K., p.109. The researcher believes that both the method of data collection is both reliable and valid. Condition 7: Is the method of data analysis valid and reliable? Yes. From the study it is apparent that the method of data analysis qualifies all the three types of reliability tests namely, (1) inter-rater, (2) internal consistency, and (3) test-retest conditions. Moreover, as the data has been collected under direct supervision of the researchers, hence, there is no scope for any of these types of errors. It is also apparent that the analysis and the instruments would qualify both internal validity and construct validity scrutiny. However, to qualify the external and criterion validation, more such cross-sectional studies or waves of data collection on a longitudinal survey would be necessary. 2.3.2 Doses of creatine The researchers have stated that the selected dosages of creatine regimens were based upon those prescribed in the study conducted by Green et al. (1996) on “Carbohydrate ingestion augments creatine retention during creatine feedings in humans”. Further verifications from this study could not be undertaken. 2.3.3 Protocol of study The test-retest protocol of the study has been conducted with adequate forethought. Bibliography 1. Aveyard, H., 2007. Doing a literature review in health and social care : a practical guide. New York: Maidenhead: Open University Press. 2. Berg, B.L., 2001. Qualtitative Research Methods of Social Sciences. 4th ed. Singapore: Allyn and Bacon. 3. Bryman, A. & Bell, E., 2007. Business Research Methods. London: Oxford University Press. 4. Caldwell, K., Henshaw, L. & Taylor, G., 2005. Developing a framework for critiquing health research. Journal of Health, Social and Environmental Issues, 6(1), pp.45-54. 5. Collins, J., 2001. Good to Great: Why Some Companies Make the Leap.And Others Don't. 1st ed. New York: HarperCollins Publishers Inc. 6. Dunford, M. & Doyle, J.A., 2008. Nutrition for Sport and Exercise. Belmont, CA: Thomson Wardsworth. 7. Fitzpatrick, J., 2007. Finding the research for evidence-based practice - Part two: Selecting credible evidence. [Online] (1 May, 2007) Available at: http://www.nursingtimes.net/nursing-practice-clinical-research/finding-the-research-for-evidence-based-practice-part-two-selecting-credible-evidence/201888.article [Accessed 29 April 2011]. 8. Gratton, C. & Jones, I., 2010. Reserach methods for sports studies. 2nd ed. New Yourk: Routledge. 9. Hopwood, M.J., Graham, K. & Rooney, K.B., 2006. Creatine Supplementation and Swimm Performance: A Review. 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Appendix 1-A Appendix 1-B Appendix 2-A Critique framework of Bray and Rees 1. Focus The topic or theme of the article 2. Background The local problems, the importance and reasons that the researchers did the study 3. Terms of references The aim or a statement of purpose to summarize the overall goal of the study 4. Study design An experimental, descriptive or qualitative design. 5. Data collection tools The method of data collection has been used 6. Ethical considerations The harm verse benefit towards the participants, informed consent, ethical committee approval. 7. Sample The target population 8. Data presentation The forms, tables or figures 9. Main findings The results related to the terms of reference. 10. Conclusions and recommendations The hypothesis is accepted or rejected. 11. Readability Easy to read and understand 12. Implication for practice The application of the research to local population. Appendix 2-B The CASP Framework (2005) 1. Did the review ask a clearly-focused question? 2. Did the review include the right type of study? 3. Is it worth continuing? 4. Did the reviewers try to identify all relevant studies? 5. Did the reviewers assess the quality of the included studies? 6. If the results of the studies have been combined, was it reasonable to do so? 7. How the results presented and what are the main results? 8. How precise are these results? 9. Can the results be applied to the local population? 10. Were all important outcomes considered? 11. Should policy or practice change as a result of the evidence contained in this review? Appendix 2-C Caldwell et al. (2005) Framework Source: Caldwell, K., Henshaw, L. & Taylor, G., 2005. Developing a framework for critiquing health research. Journal of Health, Social and Environmental Issues, 6(1), pp.50. Appendix B-4 Trochim’s (1998) Target Metaphor for testing reliability and validity Trochim (1998) explains that the centre of the target can be thought of as the concept that is being measured. Imagining that for each person being measured, the researcher takes an aim and shoots at the target; if the researcher is able to measure the concept perfectly for one person, in such a case, he/she is able to hit the centre of the target. If the researcher is not able to do that, it means, that bulls eye (centre) is missed. The more the researcher is off for that respondent, the farther the results are from the centre. Trochim (1998) provides four possible situations as mentioned below: Situation Description Outcome Interpretation Reliable but not valid The researcher is able to hit the target continuously, but is missing the bull’ eye. The researcher is consistently and systematically measuring the wrong value for all respondents. This measure is reliable, but not valid (that is, it's consistent but wrong). Valid but not reliable Hits that are randomly spread across the target. The researcher seldom hit the centre of the target but, on average, he/she is getting the right answer for the group (but not very well for individuals). In this case, the researcher gets a valid group estimate, but he/she is inconsistent. Therefore, reliability is directly related to the variability of your measure. Neither reliable nor valid Hits are spread across the target and you are consistently missing the centre. The measure in this case is neither reliable nor valid. Neither reliable nor valid. Both reliable and valid Hits are consistently at the centre of the target. The measure is both reliable and valid. Both reliable and valid. Adapted from source: Trochim, W.M.K., 1998. Research Methods. Electronic Edition ed. Trochim, William M.K., p.109. Read More