Combination of Treatment of Depression With Physical Activity - Case Study Example

Critical Analysis Introduction Based on the data released by the Mental Health Council of Australia (MHCA), the number of patients diagnosed with depression has significantly escalated in the recent years (MHCA 2013). Over the years, a considerable number of studies have used different approaches to examine various interventions that can be used as treatment for patients with depression. Some studies have looked into the efficacy of non-drug based forms of therapy as an alternative or adjunct treatment for depression alongside drug therapy (Chalder et al., 2012; Haase et al, 2010; Mead et al., 2009). Although many studies have looked into various forms depression treatments, the approaches used and the results established vary significantly. As a result, there is still no consensus on which treatment interventions are most suitable for addressing the needs of patients with depression. Nevertheless, some studies have provided invaluable insight on the effectiveness of various interventions when it comes to the treatment of depression. A good example of such a study is one conducted by Chalder et al (2012). In this study, Chalder et al (2012) investigate the effectiveness of facilitated physical activity as an adjunctive treatment for adults with depression. Using the CASP (Critical Appraisal Skills Programme) critique tool, this paper will critically analyse the study carried out by Chalder et al (2012). Foremost, it will provide a summary of the study. Secondly, using the CASP tool it will explore the validity of the results established in this study. Thirdly, this paper will discuss the results established through this study. Subsequently, it will explore the applicability of the findings established by Chalder et al (2012) to the practice setting. Overview/Summary of the study In their study Chalder et al (2012) investigate the effectiveness of facilitated physical activity as an adjunctive treatment for adults with depression presenting in primary care. In order to realise the objectives of the study they employ a pragmatic, multicentre, two arm parallel randomised controlled trial. In this case they recruit 361 adults between the ages of 18 to 69 years who had presented symptoms of depression as assessed using the Beck depression inventory score. Subsequently, participants in the intervention group were subjected to TREAD (Treatment of Depression with physical activity) mainly involving a total of three face to face sessions and 10 telephone sessions with a professional physical activity facilitator for a period of eight months. Their depressive symptoms were then compared with the group subjected to the usual care using the Beck depression inventory score. Following this study Chalder et al (2012) did not establish a positive correlation between physical activity and depression improvement. Their study did not establish any evidence that the adoption of physical activity improved patients’ mood and overall depression during the trial period (Chalder et al , 2012). Although this study provided invaluable insights on the effectiveness of physical activity as a treatment for depression, it also had several limitations that may have affected the validity of the findings. For instance, the retention of participants was lower (80%) than what is outlined in the protocol. Moreover, despite the fact that the baseline comparability of participants in the two treatment groups was done accordingly, the fact that the study relied on self-reported outcome data indicates the possibility of bias. The responses of the participants could have been significantly influenced by the level of knowledge on their treatment allocation (Chalder et al, 2012). Validity of Study Results Overall, Chalder’s et al (2012) study is very specific particularly in relations to its objectives, population studied, intervention given and the outcome considered. In this study, Chalder et al (2012) investigate the effectiveness of facilitated physical activity as an adjunctive treatment for adults with depression presenting in primary care. Firstly, the population studied are 361 adults between the ages of 18 to 69 years. Secondly, in their article it is clearly stated that the intervention given involved usual care combined with treatment of depression with physical activity mainly involving a total of three face to face sessions and 10 telephone sessions with a professional physical activity facilitator for a period of eight months. Chalder et al (2012) note that this intervention was grounded on theory and largely focused on providing patient-cantered support and encourage in physical activity engagement (Chalder et al 2012). This study was conducted as a random controlled trail (RCT). Although the model of random sampling that was employed is not specified, based on the selection criteria it is assumable that the method was simple random sampling. According to Krauth (2000), a random controlled trail is a type of clinical experiment that is commonly used to evaluate the effectiveness of an intervention by randomly assigning or placing individuals in either a control group or an intervention group. A number of studies show that, RCT are very effective methods for testing the effectiveness of clinical interventions within a patient population (Krauth, 2000; Solomon, Cavanaugh& Draine, 2009). Since this study sought to examine the effectiveness of facilitated physical activity as an adjunctive intervention for adults with depression, the use of a RCT was suitable for achieving its objectives. The allocation of participants to intervention and control groups was completely random. Nevertheless, the authors do not clearly indicate which methods were used to balance the randomisation. The authors also do not report any differences between the participants in the intervention and control groups. Chalder et al (2012) observes that due to the nature of intervention used in this study, the clinicians, researchers, participants and the practitioners who took part in the outcome assessment could not be blinded. Evidently, this is one of the limitations of this study. The fact that the study relied on self-reported outcome data leaves room for bias. The responses of the participants could have been significantly influenced by the level of knowledge on their treatment allocation (Chalder et al, 2012). A critical look at the conclusion of this article, it is evident that not all the participants who entered the trial were accounted for at the end of the trial. Although this study involved 361 participants at the end of the four month follow up only 257 participants could be accounted for. Chalder et al (2012) indicate that some participants were lost in the course of follow up, others withdrew from the exercise, and some were no longer contactable. During the follow up, the participants were reviewed within equal time intervals in all the groups they were allocated. The results of the study were categorically collected at three different time points which include; four month time point, eight month time point and twelve month time point. The data was also collected homogeneously through administering questionnaires. (Chalder et al 2012). Discussion of Results The authors of this article have presented the results established in this study concisely in two main ways. They have taken into account the proportion of people experiencing several outcomes/ risk. For instance, they have taken into account the proportion of people in education, employed, married, smoking and receiving counselling. Additionally, the results presented in this study are presented as mean differences, percentage and ratio measurements. Following this study Chalder et al (2012) found that as compared to participants in the usual care group, by the fourth month follow-up period, there was no evidence that participants subjected to facilitated physical activity exhibited improvement in mood. Using the Beck depression inventory score they found that by the fourth month follow-up period participants in the intervention group reported slightly lower scores. Group difference in mean score was found to be -0.54(95% confidence interval −3.06 to 1.99; P=0.68). Moreover, by the twelfth follow-up period there was still no evidence that that participants subjected to facilitated physical activity exhibited improvement in mood. There was also no evidence that as compared to participants in the usual care group, participants subjected to facilitated physical activity reported reduced use of antidepressant. Chalder et al (2012) found that in the course of this random trial the adjusted odds ratio was 0.63, 95% confidence interval 0.19 to 2.06; P=0.44. Although the retention rate in this study was slightly lower than what was initially expected in the protocol, the data set that Chalder et al (2012) used was sufficiently large enough to measure the confidence intervals. This study is considered to be one of the largest trials to have taken place in primary care that measures the correlation between physical activity and depression. Bottom-line the findings of this trail established that facilitated physical activity does not improve depression outcome. Applicability of the Findings to the Practice Setting From the point of view of a clinician or a mental health practitioner, the findings established through this study can be helpful when it comes to advising patients on suitable interventions for addressing depression. Based on these results, clinicians or mental health practitioners within their various practice settings can advice patients that increase in physical activity does not necessarily help in improving depression. Nevertheless, since this study found that TREAD intervention increased self reported physical activity. This intervention can be implemented within the National Health Service so as to increase physical activity levels and address other health issues such as obesity, diabetes, and cardiovascular diseases. (Chalder et al 2012). Conclusion The findings of this study indicate that physical activity intervention neither improves depression outcomes nor reduce the use of antidepressants. Nonetheless, it was established that the TREAD intervention increased self reported physical activity. The facilitated physical activity intervention in this study not only focused on giving advice but also supported behavioural change as far engagement in physical activity is concerned. Clinicians should therefore advice patients with depression that increasing physical activity does not improve possibility their recovery. However, physical activity might have benefiting effects to one’s overall health. Nevertheless, due to the limitations associated with this study especially in terms of blinding participants and the use of self-reported outcome data, future studies should critically examine the underlying mechanisms that can link physical activity to mood in order to establish suitable approaches of treating depression using physical activity. References Chalder, M., Wiles, N.J,Campbell, J., Hollinghurst, S.P, Haase, A.M, Taylor, A.H,et al. (2012). “Facilitated physical activity as a treatment for depressed adults: randomised controlled trial”. British Medical Journal 344, 1-13. Haase, A., Taylor, A., Fox, K.R, Thorp, H. & Lewis, G. (2010). “Rationale and development of the physical activity counselling intervention for a pragmatic trial of exercise and depression in the UK (TREAD-UK)”. Mental Health and Physical Activity 3, 85-91. Krauth, J. (2000). Experimental Design: A Handbook and Dictionary for Medical and Behavioural Research. London: Elsevier Mead,G.E, Morley. W., Campbell, P., Greig, C.A, McMurdo, M. & Lawlor, D. A. (2009). “Exercise for Depression”. Cochrane Database of Systematic Reviews 3 (9), 1-157 Mental Health Council of Australia (MHCA) (2013). Statistics of Mental Health. Retrieved August 8 2014 from Solomon, P.L., Cavanaugh, M.M. & Draine, J. (2009). Randomized Controlled Trials: Design and Implementation for Community-Based Psychosocial Interventions. New York: Oxford University Press. Read More