Supplemental Exercise for COPD Patients - Essay Example

? Critical Appraisal Introduction The article under scrutiny is d “A randomized study of the effects of supplemental exercisesessions after a 7-week chronic obstructive pulmonary disease rehabilitation program.” Just as this title suggests, the article primarily focuses on the influence of additional exercise on COPD patients after the first seven weeks of pulmonary rehabilitation (Linneberg, 2012). The researchers conducted this study by enrolling 140 patients in a rehabilitation program spanning over the mentioned duration of time. The COPD patients that successfully completed the program got divided into two groups in a random manner, and one was later subjected to extra exercise sessions, while the other was only subject to follow-up evaluations and no exercise. The two groups underwent constant evaluation over the subsequent 12 months and results documented. The study showed that the endurance shuttle walk (ESWT) depicted a significant increase from about 190 to 920s. Additionally, the score marked on the St George Respiratory Questionnaire (SGRQ) declined moderately to about 2.5 points. The researchers conclusively asserted that there was no significant disparity between the two groups in consideration of ESWT or even the quality of life (QoL). Discussion The article begins by briefly describing prior studies, which have been known to suggest that the impact of COPD techniques of rehabilitation tend to weaken over time. The article, therefore, has explicit focus on the effects of additional exercise sessions. It is also evident that the researchers sought to direct all their investigation on patients suffering from chronic obstructive pulmonary disease. This distinctive attention on the effect of supplementary exercise on the research subjects depicts study issue specificity. On the other hand, the scholars’ focus on COPD patients is a clear indicator of target population particularity. In regard to mode of investigation, the authors of this article clearly outline the methodology, which includes recruitment of research participants on the basis of their suitability and statistical analysis of the results after the examination period. For this reason, it is apparent that the outcomes, just like the subject matter, target population, and method of research, are highly specific. This is an aspect illustrated by the researchers’ discovery that, the conventional pulmonary rehabilitation program significantly improves QoL and ESWT of COPD patients, while there was no significant change over the additional exercise sessions. As mentioned earlier, the researchers randomized subjection of COPD patients to treatments. This happened after the initial rehabilitation period that took place for seven weeks. There were 118 COPD patients that accepted the invitation to participate in this second phase of the research. These patients were divided randomly into groups of 20 individuals. It is imperative to note that these groups largely fell under two principal categories, that is, intervention and control groups. The intervention groups underwent additional training exercises, such as those adopted during the seven week program, while control groups were not subject to any extra exercise. Additionally, individuals in control groups were not supposed to engage in any form of exercise at home and the two groups also went to evaluation sessions during different dates. In addition to being randomly assigned to the mentioned groups, other aspects were also accounted for in the randomization process. These factors include gender, whereby approximately 38% of men and 62% of women were present in both the control and intervention groups. The other base for randomization was age, and this had four categories including 60, 60 to 69, 70 to 79, and above 80 years age brackets. The researchers also took into consideration factors such as patients’ smoking tendencies and their forced expiratory volume (FEV). Clearly, Linneberg et al. (2012) accounted for virtually all factors relevant to the study of COPD patients. For instance, they take into consideration the gender aspect thus showing whether effects of supplementary exercise vary among the sexes. Additionally, the scholars account for tobacco smoking, one of the principal contributory factors to respiratory ailments, hence gaining the capacity to establish whether the habit has an influence on patients’ exercise response. Randomization on the basis of FEV makes it possible to determine, whether the lungs’ functioning capacity or severity of COPD illnesses affects patients’ response to supplementary exercise. However, in regard to age, these researchers primarily focused on elderly persons, giving the impression that COPD affects the old people only. It would have been advisable for the scholars to have participants within a younger age bracket, in order to clearly establish if effects of exercise vary across the age span. The article fully accounts for all individuals that agreed to participate in the trial. For instance, there is constant tracking of the subjects’ involvement and while 140 of them enrolled in the first rehabilitation program, 20 dropped out in this phase. This left 120 participants, and on placing the request for engagement in the supplementary phase, 2 research subjects failed to accept the invitation, leaving 118 willing participants. The article also clearly shows the number of participating individuals that withdrew from the research, at every level of intervention, for the groups subject to treatment, as well as, every evaluation interval for the control groups. This is a clear illustration that the researchers keenly followed-up on the patients’ progress throughout the study. However, rather than comprehensively discussing the effects of extra exercise on the basis of each baseline attribute used in randomization, the researchers principally focus on the participants as either intervention or control groups. This is evident from the general conclusion that two groups did not depict statistically substantial disparities in consideration of age, gender, lung function and smoking status. This is a clear indicator that this article’s authors largely focused on the impact of intervention measures on the basis of whether individuals received treatment or not. They simply used the baseline features to denote why there might have been slight disparities in statistics. It would, therefore, have been advisable for the researchers to provide deeper insight into the reaction of individuals falling under the mentioned categories. For instance, it would be highly instrumental for a person utilizing information from this research paper, to comprehend or distinguish between the response of smoking and nonsmoking COPD patients to extra exercise. The same applies to patients with low lung functioning capability, in comparison to those with relatively stable lung functionality. Overall, for comprehensive patients’ analysis, the scholars should have been more specific to randomization attributes. Blinding in research work is usually done with the aim of ensuring that, research participants’, as well as, researchers’ expectations, in regard to the experiential treatment, do not influence the results of the study. There are two categories of studies, on the basis of blinding, the first being a single-blinded research. In this case, research subjects have no knowledge of whether they fall under the control or experimental group. The other class is referred to as a double-blinded research, and under this category both researchers and participants do not know which subjects fall under control or treatment groups. In this case, neither the research subjects nor the researchers were blinded. This implies that both groups were aware of the classification of subjects. Even though the subjects had full awareness of their status in the experiment, measures were taken to avoid possibility of information impartiality. For instance, control and intervention group evaluation sessions occurred during different days. As shown by the random division of research participants on the basis of distinctive attributes, it is rather evident that the two groups, intervention and control, were not similar during the trial’s commencement. The groups had several distinguishing factors such as gender, smoking habits and lungs’ functioning capacity, as indicated by the COPD patients’ FEV. The authors attributed the insubstantial statistical disparities to these distinguishing features. Other attributes that have the potential to affect research outcome include subjects’ residential environment, social or economic status, and work environment, among others. In regard to a subject’s area of residence, living conditions may predispose him or her to additional respiratory problems, negating the crucial role of exercise. The same applies to the work environment, since these places could be damp or have chemicals that negatively affect the respiratory tract. In consideration of socio-economic status, there may be COPD patients that can afford to engage in productive exercise schedules and gain access to proper medical care, whereas others may be limited from achieving the same by their finances. Also accounting for social status, COPD patients with committed caregivers and close family or friends, may have sufficient motivation not only for customary rehabilitation, but also for home-based supplementary exercise. This, however, may not apply to subjects that have no caregivers, family or friends. The groups in this study received equal treatment, in consideration of intervention and evaluation measures. However, these two groups were required to attend evaluation or treatment sessions during different times, to avoid bias, as mentioned previously. In addition, the intervention group had to record their home-based exercise schedules in a diary, which was later examined by researching nurses. This provided a basis for recommendation of extra training, where it was found to be necessary. Further, the two groups underwent ESWT measurement, as well as, filled out QoL questionnaires during the trial’s commencement, at week seven and during the other evaluation sessions. Diary keeping, however, was not required of the control group, since the individuals were not subject to extra exercise. It is common knowledge in research work that, the sample size should be adequate, in order to fully represent the population under scrutiny and at the same time give relevant results. In a typical study, calculation of the population sample size can be done using the confidence interval (CI) and margin of error. The latter enables one to determine if the results reflect the population’s view, while CI enables a researcher to be sure of the sample’s accuracy. For instance, in a population of 100, a 1% margin of error and confidence interval of 95% would yield a sample size of 88. Even though this was not explicitly outlined in the research article, the sample size of 140 is sufficiently representative of the COPD patients in this region. The statistically calculated results are presented in a table, showing the value for autonomous samples after t-test comparison at an insignificant value of 0.718. Additionally, the average SGRQ score, for both groups declined considerably by 2.5. Overall the results showed that there was no substantial difference observed in COPD patients following the year long supplementary physical training (Linneberg, 2012). Conclusion The research article conclusively asserts that supplemental exercise for COPD patients is of limited benefit. The paper even proves this assertion statistically thus confirming its validity. Even though the paper seems to suggest that extra exercise is not important for COPD patients, it is necessary to promote continuity of therapy among them, however, insignificant. If I were to carry out a similar study on COPD patients, it would cover patients from a wider age bracket, and examine their capacity to afford medical care. The study would also examine each distinctive aspect individually, in order to get comprehensive results relevant to pulmonary therapy. Reference Linneberg, A., Rasmussen, M., Buch, T., Wester, A., Malm, L., Fannikke, G., & Vest, A. randomized study of the effects of supplemental exercise sessions after a 7-week chronic obstructive pulmonary disease rehabilitation program. Clinical Respiratory Journal, 6, 112–119. Read More