Effectiveness of Early Physiotherapy to Prevent Lymphoedema after Surgery for Breast Cancer - Research Paper Example

Effectiveness of Early Physiotherapy to prevent lymphoedema after surgery for breast cancer, randomised, single blinded, Clinical trial. Why and Howto Appraise Literature Critical appraisal of literature forms a vital part of research. Critical research appraisal is imperative to help in the identification of most-relevant studies in clinical practice. Research appraisal assesses the relevance of the research question to the field of work. The study topic is of central importance in adding new knowledge in the field of work. Most scientific research studies aim to create new knowledge based on existing literature or latest discoveries (Greenhalgh & Taylor, 1997, p. 2). An appraisal determines the extent to which a research study adds substantive new knowledge to existing concepts. Research appraisal determines whether it extends validity of previous studies or introduces a new idea in the field of study. In most research studies, there exist biases that may cause possible deviation of results. Choice of most-appropriate study methods is imperative to avoid instances of bias in research (Greenhalgh, 1997, p. 3). A research appraisal determines the type of question posed by the author (s). Proper research studies should have well-developed questions. Study questions should identify the study population, applicable parameters, and relevant outcomes. Research appraisal ascertains accuracy of tests used in the study. Studies should test all the stated hypotheses. Statistical testing of study hypotheses forms a critical part of research studies (Greenhalgh, 1997, p. 2). Through research appraisal, it is possible to ascertain the relevance of hypothesis testing techniques applied in the study. Appraisal of research by Lacomba et al., 2010 How good or bad is the research? Lacomba et al., 2010, launched a study to ascertain the efficacy of early physiotherapy during post cancer surgery. An appraisal of the study reveals proper application of interventions. The study by Lacomba et al., 2010, is imperative in enhancing prevention of secondary lymphoedema after surgery using early surgery. Though the study was a success, it was subject to limitations of recruitment in a single hospital. Single hospital recruitment may be a cause of systematic variations in care provision between the hospital and other regions. Systematic differences are a source of bias in the study that may influence validity of its results. Introduction Introduction of the research is appealing to readers. Lacomba et al., 2010, applied sentences in the first paragraph that attract readers attention. The introduction also presents an extensive explanation of the terms of study. It meets the standards of research in nursing care. Lacomba et al., 2010, provide a clear definition of secondary lymphoedema in the first paragraph. The description provides readers with the direction and scope of study. Lacomba et al. 2010, also points out the method of approaching the research question. Contrary to providing a concise introduction, the limitations of the introduction are evident. The research has not indicated the studys focus in introduction. It has raised various issues in the introduction creating confusion on the researchs main objective. It has not presented the studys stance on the effectiveness of physiotherapy in lymphoedema (Lacomba et al., 2010, p. 1). Methodology The research has applied an effective method in studying the effectiveness of physiotherapy in prevention of lymphoedema. It has involved a reasonable number of participants in the study. One hundred and twenty (120) women with experiences in surgery in axillary Limp nodes have participated in the study (Lacomba et al., 2010, p. 1). Besides, the study entailed observation of participants within an appropriate period. The women had the surgeries between 2005 and 2007. However, the study has not used participants of varying health status. Using participants with different health conditions would increase the accuracy of the study results. The methods used in conducting the study are also effective. The study involved using physiotherapy programmes to test their effectiveness in the respondents. Besides, the methodology involved application of a variety of physiotherapy programmes such as scar tissue massage, shoulder exercises, and lymph drainage undertaken manually. The variety of programmes gave the research a wide scope of study and confirmed their effectiveness. In addition, the method incorporated the use of a control group. The control group helped provide a basis for reference during the research. On the other hand, the methodology used in the study did not elaborate on the method of analyzing data collected. Despite highlighting methods used in collecting data, it did not explain method of data analysis. Consequently, it has created a problem in correlating the data to the study topic (Lacomba et al., 2010, p. 2). Critical Analysis of Reducing the Risk of Secondary Lymphoedema Measurement of arm circumference within the year of surgery is effective during critical analysis of secondary lymphoedema development after surgery in women with breast cancer. Results obtained from circumferential measurements showed a clear indication of secondary lymphoedema development after cancer surgery in women than questionnaires such as postoperative assessments involving measurement of BMI. Use of circumferential measurements shows more accuracy as it is indicative of actual change in volume ratio of the arm fluids. On the contrary, collecting data using questionnaires on the medical assessment would not reflect real results of the actual secondary lymphoedema condition as patients might be secretive. The study was more relevant in its usage of circumferential measurements as it represented actual medical conditions about the subject. The study indicated that those subjects with significant secondary lymphoedema had an arm circumference increment of 2 centimeters when contrasted with the unaffected arm (Lacomba et al., 2010, p. 5). Study Design The literature used appropriate research designs in collecting data from the evidently from the study groups such as early physiotherapy and educational strategy. The quantitative study embraced use of systematic review design in collecting information regarding the effectiveness of early physiotherapy for preventing secondary lymphoedema development. It was a good study design as subjects for the study groups were randomly selected for clinical trial with a control group singly blinded present. Such design constituted the requirements of a randomized controlled trial study design. The subjects were randomly assigned to specific treatment with a single blinded control. Follow up studies were later made on both the groups after a gold standard treatment for testing efficacy of therapy. All these procedures are reflective a perfect single blind study (Lacomba et al., 2010, p. 3). Interpretation of Results Results indicate that the use of early physiotherapy is effective in reducing the risks of secondary lymphoedema. The results support the hypothesis that 116 women subjected for early physiotherapy showed a confidence level of 95 percent. 95 percent confidence level shows that out of 100 patients with possible risks of secondary lymphoedema, 95 of them survived while only 5 developed the risks. The risks involved in early physiotherapy and dissection of axillary lymph nodes are also minimal to about 5 patients out of 100 used in the study (Lacomba et al., 2010, p. 4). Acceptance of Evidence Evidence from this research is adequate in understanding and providing a solution to secondary lymphoedema. Lacomba et al. show secondary lymphoedema as one of the vital chronic impediment after conducting surgery on breast cancer with dissection of axillary lymph nodes. Conducting rehabilitation after surgery in real time is essential in improving shoulder mobility and functional capacity, but the process has no adverse effects (Lacomba et al., 2010, p. 5). However, this post-surgery rehabilitation is not a way of preventing secondary lymphoedema. The study shows how incorporating early physiotherapy and educational approach help in lowering the risks of secondary lymphoedema twelve months after conducting surgery for breast cancer with axillary dissection. The incorporation is practical and efficient compared to educational strategy alone . Practical Aspect of the Evidence Evidence from this research can be applicable in health institutions to inform the practitioners on the significance of conducting physiotherapy in good time in efforts to manage secondary lymphedema. However, the practicality of the evidence is still questionable considering the control environment set for the study (Lacomba et al., 2010, p. 6). The evidence is basing on results, which is not reflective on general terms of different levels of health facilities. The research evidence is basing on the nature of services in one level hospital, but the conditions do not hold for all health facilities. The physiotherapists forming part of the research result are trained experts limiting the application of the evidence withdrawn from the analysis to only cases where such experts are available. Conclusion Research appraisal forms a critical aspect in evaluating its relevance and contribution to the field of study. An appraisal determines the relevance of research question and its methodology. It also entails an enquiry of the relevance of hypothesis testing. Lacomba et al., 2010, launched a successful research study that enhances prevention of secondary lymphoedema after surgery using early surgery. Introduction of the study is satisfactory. It is appealing to readers and provides an overview of the study. It also explains the terms of study in the research. The introduction has also explained the direction and scope of study. Methodology of the research was effective in collecting data necessary in answering the research question. It involved use of a variety of physiotherapy programmes on 120 patients who had undergone surgery between 2005 and 2007. It also entailed a control group that provided a basis for reference. It is imperative that women who have undergone cancer breast surgery attend early physiotherapy within the first year of treatment. Such treatment strategy helps in the prevention of potential risks of secondary lymphoedema development. Conducting the post-surgery physiotherapy early, enough incorporating with education on best self-management is the best remedy in limiting chance of secondary lymphedema. Acceptance of the result cannot hold a generalized application as the control environment for the research is not similar in all health service facilities. The research study by Lacomba et al., 2010, is effective in enhancing knowledge of managing secondary lymphoedema among women after undergoing breast cancer surgery and promoting recovery. Bibliography Greenhalgh, T. & Taylor, R., 1997. How to read a paper: Papers that go beyond numbers (qualitative research). British Medical Journal 315, 740–743. doi:10.1136/bmj.315.7110.740 Greenhalgh, T., 1997. How to read a paper: Assessing the methodological quality of published papers. British Medical Journal 315, 305–308. doi:10.1136/bmj.315.7103.305 Torres Lacomba, M., Yuste Sánchez, M.J., Zapico Goñi, A., Prieto Merino, D., Mayoral del Moral, O., Cerezo Téllez, E., Minayo Mogollón, E., 2010. “Effectiveness of early physiotherapy to prevent lymphoedema after surgery for breast cancer: randomised, single blinded, clinical trial”. British Medical Journal 340, b5396. Read More