Evidence-Based Practice - Childhood Obesity - Coursework Example

Evidence Based Practice: Childhood Obesity Introduction Childhood obesity is a health concern of great magnitude. It is occurring in epidemic proportions is the world. Childhood obesity is a matter of concern because of the potential health problems it is associated with like hypertension and other cardiovascular problems, type-2 diabetes, respiratory ailments, orthopedic problems, trouble sleeping and depression. It has been estimated that 80% overweight adolescents continue to be obese in adulthood. Added to these problems, childhood obesity imposes huge health care costs on the nation (The Role of Media in Childhood Obesity, 2004). Hence it is very important to prevent and manage childhood obesity appropriately. Research has shown that increased physical activity is a useful intervention to prevent and manage. Whether such an intervention is appropriate or not can be ascertained by literature search and critical review of the articles. Making clinical decisions based on appropriate evidence is known as Evidence based practice. According to McKibbon (1998), " "Evidence-based practice (EBP) is an approach to health care wherein health professionals use the best evidence possible, i.e. the most appropriate information available, to make clinical decisions for individual patients. EBP values, enhances and builds on clinical expertise, knowledge of disease mechanisms, and pathophysiology. It involves complex and conscientious decision-making based not only on the available evidence but also on patient characteristics, situations, and preferences. " Literature search for EBP can be done effectively by creating appropriate question in PICO format. In this essay, the usefulness of increased physical activity in preventing and managing childhood obesity will ascertained through review of appropriate literature using suitable electronic databases. PICO Question "Does increased physical activity decrease childhood obesity?" Population- Children with obesity Intervention- Increase in physical activity Control- No increase in physical activity Outcome- Decrease in weight Literature Search The commencement of search in electronic databases was based on the inclusion/exclusion criteria and knowledge of the hierarchies of evidence. As Benton & Cormack (2000) mentioned, electronic databases are resourceful in presenting large amounts of recently published literature. To consider what articles must be included in the review to make the review more authentic and reliable, knowledge on the different levels of accorded studies is essential. The different levels of studies are called hierarchy. Hierarchy provides a confidence measure to the end-user (Evans, 2003). According to Evans (2003), random control trials can be considered of good standard and they are infact labeled as the gold standard of research for providing optimal research designs to answer pertinent questions. However, systemic reviews and meta-analysis have topped the hierarchy list. PubMed Search PubMed database was used first to retrieve articles. The search was started with the term "childhood obesity." This yielded 5388 results. The search was commenced without any limits for full text articles. Further on, the search was expanded by employing the term "physical activity." For this search, the search was limited to articles "published in the last 5 years" and also to "English". This yielded 528 results. The search was again conducted using limits for randomized control trial and meta-analysis. This yielded 38 results. The article selected from this database was "Effect of school-based physical activity interventions on body mass index in children: a meta-analysis" by Harris, Kuramoto, Schulze and Retallack, published in CMAJ in the year 2009. The author is a valid author and the journal is a reputed one. Google Scholar Search The next search was done in Google Scholar. The terms used for search in this data-base were "childhood obesity" and "physical activity". The search yielded 82,700 results. Google scholar is an enormous database and has connections to several global resources. Narrowing of the search is very difficult. The abstracts of the articles in the first 2 pages were reviewed. It was found that several articles in Google Scholar were also present in PubMed. The article "Short- and Long-Term Beneficial Effects of a Combined Dietary–Behavioral–Physical Activity Intervention for the Treatment of Childhood Obesity " by Nemet, Barkan, Epstein, Friedland, Kowen and Eliakim was selected for the study. The article has valid authors and was published in a reputable journal Pediatrics in the year 2005. CINAHL Search Search in this database was pursued after logging in and using the search terms "physical activity" and "childhood obesity". The search yielded 4800 results. "Full text" option was removed before commencing the search. The publication dates were narrowed down to 2005-2010 to retrieve the most recent articles pertaining to the PICO question. This yielded 68 results. The abstracts of the articles were scanned and the article "Physical activity to prevent obesity in young children: cluster randomized controlled trial" was selected for the study. The study was conducted by Reilly, Kelly, Montomery et al and was published in the year 2006 in the British medical Journal. The authors of the study are valid and the journal is a reputed one. It was noted that most search engines placed the results in a hierarchical order with the most relevant articles coming first or accorded higher star ratings. This search yielded valuable papers, all which have been identified in all the 3 databases. Finding Answer to the PICO Question To ascertain as to whether physical activity is an useful intervention to prevent and manage childhood obesity, 3 articles, one from each data-base were selected for evidence-based practice. The study by Harris et al (2009) was a meta-analysis. The objective of the study was to "determine whether school-based physical activity interventions improve children's body composition, as measured by BMI." Data for the study was extracted from valid electronic databases and the data was organized into four categories of data based on study design, population, intervention and outcome. The primary outcome of the study was mean change in the body mass index. Appropriate statistical analysis was used. The results of the study indicated that school-based physical activities did not cause improvement in the body mass index and that such interventions did not have a significant impact on the prevalence of childhood obesity. The authors opined that the "dose" of the physical activity in the schools were probably not significant enough to affect the body-mass index. Thus, from this study it is evident that despite an association between reduced physical activity and childhood obesity, there is no conclusive evidence that increase in school-based physical activity decreases childhood obesity. The level of evidence of this study is 1a (Oxford, 2001). It is easy to read and comprehend. The study by Nemet et al (2005) was conducted with an objective to examine "prospectively the short- and long-term effects of a 3-month, combined dietary-behavioral-physical activity intervention on anthropometric measures, body composition, dietary and leisure-time habits, fitness, and lipid profiles among obese children." The study was a randomized prospective study. The sample size of the study was appropriate and based on a previously reported interventional study for children with obesity. A larger weight-changed based study sample size was chosen for this study. Results of the study were analyzed using appropriate statistical software. From the results, the authors concluded that a multidisciplinary intervention involving diet, physical activity and behavior was essential to impact the body mass index in children with obesity. The level of evidence of the study was 1c (Oxford, 2001). The language in the article is easy to comprehend. The study by Reilly et al (2006) was a cluster randomized controlled single blinded trial with objective to "assess whether a physical activity intervention reduces body mass index in young children." The study design and sample size was appropriate for the purpose of the study. The main outcome measure of the study was body mass index. The data of the study was analyzed using a suitable statistical software. The study concluded that physical activity did not reduce body mass index in young children with obesity. The language of the study is easy to comprehend. The level of evidence of the study is 1c (Oxford, 2001). The validity of these studies may be evaluated using Duffy's Research appraisal method (Burns & Grove, 1997). There are 3 types of validity which need to be evaluated. They are construct validity, internal validity and external validity. Construct validity may be defined as the extent to which a scale measures a certain construct (Parahoo, 2006) in which the link between conceptual definitions and operational definitions is examined. In all the 3 studies, the essence of construct validity was intact. Internal validity is the extent to which the findings in the study reflect reality. It provides an effective measure in studies investigating causality (Burns & Grove, 1997). The factors attributed to internal validity are biases and confounders (Parahoo, 2006). The first study is a meta-analysis and the trials are randomized control trials and thus there is no source of bias. Some confounding factors which might have influenced the study are the "dose" of exercise, adherence to regimens, etc. External validity is a measure of the applicability of study findings and conclusions to other similar settings and populations (Burns & Grove, 1997). This aspect is important to know in the study because it gives an idea as to what extent the suggested causality is likely to hold true in other settings. The results of all the 3 studies can be generalized because they include a diverse population under study. From the 3 studies, it can be inferred that though decreased physical activity has been attributed to the development of childhood obesity, increase in physical activity in the form of enhanced physical activity in home school or nursery cannot be used to manage or prevent childhood obesity. On the other hand, when this physical activity is combined with dietary modification and behavioural changes too, then there is an increased chance of decrease in the body-mass index. Thus, the literature review has revealed the need for multidisciplinary intervention rather than only physical activity intervention to tackle the problem of childhood obesity. Conclusion Evidence based practice is essential to deliver the most appropriate treatment. While looking for evidence from research article, those with higher levels of hierarchy have better level of evidence. Addressing a clinical problem is possible through analysis of the problem in PICO format. Through such an evaluation it has been possible to ascertain that multidisciplinary approach to management of obesity is more effective than physical activity alone. References Benton, D.C. and Cormack, D.F.S. (2000). Reviewing and evaluating the literature: In: Cormack, D.F.S. (Ed.). The Research Process in Nursing. 4th Edition. Oxford: Blackwell Publishers Limited, 103 – 113. Evans, D. (2003). Hierarchy of evidence: a framework for ranking evidence evaluating healthcare interventions. Journal of Clinical Nursing, 12(1), p. 77 – 84. Harris KC, Kuramoto LK, Schulzer M, Retallack JE. (2009). Effect of school-based physical activity interventions on body mass index in children: a meta-analysis. CMAJ, 180(7), 719- 726. McKibbon KA (1998). Evidence based practice. Bulletin of the Medical Library Association, 86 (3), 396-401. Nemet, D., Barkan, S., Epstein, Y., Friedland, O., Kowev, G., and Eliakin, A. (2005). Short- and Long-Term Beneficial Effects of a Combined Dietary–Behavioral–Physical Activity Intervention for the Treatment of Childhood Obesity. Pediatrics, 115(4), e443- e449. Oxford Centre for Evidence-based Medicine. (2001). Levels of Evidence. Retrieved on 19th Feb, 20101 from http://www.cebm.net/index.aspx?o=1047 Reilly, J.J., Kelly, L., Montgomery, C., et al (2006). Physical activity to prevent obesity in young children: cluster randomised controlled trial. BMJ, 333(7577), 1041 . Retrieved on 19th Feb, 2010 from http://www.bmj.com/cgi/content/full/333/7577/1041 Read More