Exercise Training During Hemodialysis Improves Dialysis Efficacy and Physical Performance - Coursework Example

Critical Appraisal for Research Method Unit: “Exercise Training During Hemodialysis Improves Dialysis Efficacy and Physical Performance” Critical appraisal of a research work is a complex process that involves “the assessment of evidence by systematically reviewing its relevance, validity and results to specific situations”: any competent critical appraisal should take into account both the strength and weakness of the research, focusing on the research process, quantitative and qualitative aspects of the research and the results of the study (Slide 3, Critical Appraisal Defined). The research article by Parsons, Toffelmire, and King-VanVlack (2006), entitled “Exercise Training during Hemodialysis Improves Dialysis Efficacy and Physical Performance” is chosen for the purpose of the critical appraisal. This paper seeks to evaluate and analyze the strengths and weaknesses of the research paper by employing the various components of the research appraisal methodology; the various components of the research such as its title, abstract, introductory part, methods, results, discussion part, and the conclusions drawn are critically evaluated in this critical appraisal for research method unit. Title and Abstract The title of the research paper is self-explanatory. In fact, the title brings to the mind of the reader the conclusion of the study itself-that exercise training during Hemodialysis improves dialysis efficacy and physical performance. As such the title is capable of grabbing the attention of the readers. Similarly, the abstract part of the research paper is equally interesting, concise and clear. The Abstract of the paper clearly states the objective of the study, the research design, the setting, participants’ information, the intervention programs employed in the study, the main outcome measures, results and conclusions of the research. In short, the reader can very well grasp the sum and substance of the research paper just by having a glance at the abstract and this is most likely to stir the curiosity and motivation of anyone who is interested in the topic under consideration. Introduction and Literature Review As the researchers have not devoted a separate section for the literature review in the paper, the introduction and literature review are taken as a single whole for the purpose of critical appraisal. A good piece of research should incorporate specific research questions or hypotheses, and should offer a sound rational for the study; the background information, and the scope and significance of the study are also to be made clear at the introductory part of the research ( Slide 6, Introduction). In the given article, the introductory part provides clear cut background information of the End- Stage Renal Disease (ESRD) and the three common forms of renal replacement therapy, namely, kidney transplant, peritoneal dialysis, and hemodialysis. The authors make use of the reliable previous research statistics from the Canadian Institutes of Health Information to show the effectiveness of the treatment: “In 2000, approximately 45% of the 25,000 Canadians with ESRD underwent HD, the fastest growing subpopulation of ESRD patients” (Parsons, Toffelmire, and King-VanVlack, 2006, p. 1). The researchers carefully brings out the scope and significance of the present study by pointing out with the help of previous studies the possible common ramifications of the uremic syndrome and how these syndromes could be lessened by exercise training in ESRD. The purpose as well as the hypothesis of the study is clearly stated towards the end of the introductory part; the purpose of the study is to determine the impacts of a 20 week intradialytic exercise program on dialysis efficacy and physical performance and the hypothesis is that “intradialytic exercise will increase dialysis efficacy, which will in turn, be significantly correlated with improvements in physical performance and QOL” (Parsons, Toffelmire, and King-VanVlack, 2006, p. 2). Thus, it can be concluded that the study has got a specific hypothesis and rational, and research is very much significant as the results of the study would benefit patients as well as health professionals. Methods The methods employed by the researchers also deserve attention as they are able to “tell the reader exactly what was done, how it was done, why the approach was chosen and with whom the research was conducted” (Slide 9, Method). The design of the study was one group repeated measures and the sample taken for the study consisted of a convenience sample of 13 self-care HD patients who were stable on dialysis for a minimum of 6 months and were medically screened for significant cardiac, pulmonary, and/or musculoskeletal pathology that would preclude exercise. The ethical issues connected with the study were resolved by making sure that all the participants were above 18 years old and that they all signed the consent form approved by the Research Ethics Board. The protocol of the exercise program began with the baseline measures prior to the 20 week exercise program. Later, “spKt/V was measured every 4 weeks of the exercise program while 6MWT and KDQOL were measured at weeks 10 and 20 of the exercise program” (Parsons, Toffelmire, and King-VanVlack, 2006, p. 2). The outcome measures included the calculation of a single-pool model of urea kinetics (spKt/V) and the percentage reduction of urea (PRU) using the set formulae, and after obtaining the data a second-generation logarithmic equation established by Daugirdas is employed by the researchers. Besides a six minute walk test was administered on the patients, and based on the findings of the study a Kidney Disease Quality of life Questionnaire was prepared to assess the 8 generic and 12 disease specific subscales. Similarly the blood samples were constantly used as a means of monitoring. To conclude, the researchers have successfully employed both qualitative and quantitative approaches to the study. The qualitative approach is mainly employed in the introductory part whereas quantitative analysis forms core of the methodology and the data analysis. Quantitative techniques such as mean, standard deviation, repeated measures analysis, Bonferroni post hoc test and correlational analyses are very effectively used in the research design and data analysis. However, the size of the sample does not sound convincing enough for such an important study as the sample selected is very small. Similarly, the complexity of the methods employed make it difficult for an average reader to understand the scientific terms and concepts employed in the paper. Results The striking results of the research are summarized in Table 1: Demographic Profile of the Study Group (N 13). There is sufficient clarity in the reported results of the study and from the given table one can easily understand the major results brought out by the research. The limitations of the research also are elaborately dealt with in the results section of the article. Even though there were 20 selected participants in the beginning of the exercise program, 7 of them had to be eliminated for one reason or other. Table 2 shows the Predialysis Serum Chemistry Values, Table 3 deals with the Serum Urea Clearance (in spKt/V) and clearly depicts the changes in the variables from the baseline to week 4, week 16 and week 20, and Table 4 makes possible a highly useful comparison of Disease-Specific KDQOL Subscales and makes contrastive study between the current study and the normative Data From a Hemodialysis Population in the United States. Thus, it can be inferred from the results presentation that the figures and tables are self-explanatory and helpful and leaves no sorts of ambiguity in the minds of the readers. Discussion Having critically appraised the results part of the article, it is necessary to evaluate how far the present study results are in tune with the previous literature and what implications and recommendations for future research are offered in the discussion part of the article. It is also necessary to evaluate how well the research findings are interpreted in the discussion part and also to know whether the researchers have come across any major limitations of flaws in the study and how do they plan to rectify them in the future. The study clearly revealed that intradialytic exercise program resulted in a noticeable increase in dialysis efficacy. The findings of the study point out that exercises of a duration of 60 minutes or more performed during HD are most likely to enhance urea removal and that this would in turn improve dialysis efficacy. However, one of the major limitations of the study was that “little information was provided by the above studies with respect to the timing of the exercise during the dialysis session and the exercise intensity, making it difficult to interpret these results in terms of a standardized exercise protocol” (Parsons, Toffelmire, and King-VanVlack, 2006, p. 5). The researchers also make special efforts to compare their findings with the previous studies done in the same field. For instance, the current study could not find any noteworthy association between the improvement in dialysis efficacy and a corresponding improvement in self-reported QOL. This prompts the researchers to compare and contrast their studies with the previous studies done by researchers like Painter. Thus, one can come to the conclusion that the strengths of the study outweigh its limitations and no doubt the study findings will be highly useful for further researches in this regard. Conclusions and over all considerations The conclusions of the study pinpoints that “a low intensity, intradialytic exercise program resulted in a significant improvement in urea clearance perhaps due to the acute increases in blood flow to working muscle” (Parsons, Toffelmire, and King-VanVlack, 2006, p. 7). The researchers conclude by highlighting the need and significance for further studies in the area so that one could braw a better picture of the various mechanisms that can be used to improve urea clearance and further research on intradialytic exercise program can even develop the exercise programs as adjunctive therapies to HD. Commenting on the over all worth and significance of the study, it can be said that the current research is a worthwhile project that has great amount of implications for the concerned patients and the health care professionals all over the world. The study undoubtedly adds to the existing discipline of health care and the article is of great value to researchers and scholars all over the world. Bibliography Parsons, Trisha L., Toffelmire, Edwin B., and King-VanVlack, Cheryl E. May 2006. “Exercise Training During Hemodialysis Improves Dialysis Efficacy and Physical Performance”. The American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation. Arch Phys Med Rehabil Vol 87. MSc SES Research Methods and Design: Critical Appraisal. Slide Show: PowerPoint presentation. Read More