NURSING ARTICLE CRITIQUE
This purpose of this paper is to critically appraise a research article titled ‘Promoting Urinary Incontinence in Women after Delivery: ’ by and (2002). This article was published in the British Medical Journal.
The reason why this research article is chosen is because urinary incontinence is a problem which patients often fail to discuss with physicians or nurses, making it a problem which is underreported and undertreated (, 2004). Urinary incontinence is one of the most common chronic medical conditions seen in primary care practice. It is more prevalent than diabetes, Alzheimer's disease, and many other conditions that receive considerably more attention. Incontinence is an expensive problem, generating more costs each year than coronary artery bypass surgery and renal dialysis combined (, 2005). Interventions designed to promote urinary continence are therefore very important in the medical field.
Nursing researches such as this one improves the practice of nursing and raises the standards of the profession. But not all findings in researches are properly done and can be used as a basis for nursing practice. Therefore there is a need to consider the worth of the study and the evidence provided in the study, thus critically appraising the study.
The title of the study, ‘Promoting Urinary Continence in Women after Delivery: Randomised Controlled Trial,’ clearly defines what the study is all about. The study population, the major outcome being measured, and a very brief description of the methodology with which the observations are to be measured are all included in the title. The study population here is the women experiencing urinary incontinence postpartum. The major outcome being measured is the promotion of urinary continence. A snapshot of the methodology used in the study is being shown in the words ‘randomised control trial.’
The aim of the paper is to test the effectiveness of a program – physiotherapy – for preventing urinary incontinence in women at three months after delivery. This purpose is feasible, interesting, new, and relevant. However, there is a question whether this is ethical or not. Researches dealing with human subjects need to have an approval first from an ethics committee before it can be performed. Yet this study, if ever it did seek for an ethics committee approval, did not mention in any part of the paper about ethical concerns. This is the first lack of the study that I have noticed at the very beginning of the paper.
The study provides an abstract or a summary which quickly provides the necessary information regarding the research activity. In the study, the abstract is divided into parts: objectives, design, setting, participants, main outcome measures, results, and conclusions. The abstract section is especially important for busy reviewers with very limited time allotted for going over the proposal. For expert reviewers, the abstract may be all that they need to read, aside from the budget and the study time frame, to enable them to decide on the acceptability of the research activity.
The next segment of the paper is the introduction. The most important purpose of the introduction is to define the question that is to be answered and to provide the reason for finding the answer to the question raised. This section is usually divided into parts consisting of background, rationale, and conceptual framework among many others. But for this particular paper, that is not so the case. The introduction is very brief and was not divided into parts. It did, however, provide the question that is to be answered and the reason for finding the answer to the question raised. The researchers reasoned out that although studies have proved that conservative treatment of urinary incontinence is effective, they could not find studies on preventing incontinence before its symptoms become evident.
The next should have been the review of literature which is an exhaustive summary of relevant information regarding the topic of the research. It provides information that justifies the need for the research to be conducted. However, this section is not found in this particular research paper. Except for the brief introduction, there are no other detailed information regarding the topic that could provide relevant information. It seems that the justification needed for the research to be conducted was already given by the authors in the Introduction section. Although the essence is still there, it did not follow the formal format of what a research paper should have.
The methodology section comes next. It explained the methods used, the design, the participants, the setting, and how the data was collected and analyzed. However, it did not give out reasons as to why this type of study design is used or why this type of intervention was used. It did not even explain why a randomized control trial was used and why the researchers believe that this would be appropriate for this paper. This may be okay if the researchers are sure that all the readers will be from the medical field and will therefore understand why such a design is used. But that is not so the case. Many readers will be wondering as to the appropriateness of the study design used without a thorough explanation.
In essence, the methodology section should chronologically describe the design, conduct and analysis of data collection for the purpose of providing answers to the specific objectives. For ease of review, it is recommended that the methodology section should have subparts with subheadings. It should include the study design, study setting, study population, maneuvers, and the plan for data analysis. In this particular paper, it did have subheadings yet they are different. However, it did provide a clear description of how data will be gathered and analyzed. The data collection process used in this study is one which is applicable to the kind of situation the research is involved. The rationale for following this procedure though is the one that the research lacks. Additionally, data analysis used which is logic regression was not thoroughly explained.
The results part of the paper presents the results and includes results of statistical tests if appropriate. It starts with an accounting of subjects from screening to enrollment into the study to final analysis. The characteristics of the final study population as a whole, and summary characteristics of comparative groups are reported. Results may be presented textually, in tables or with the use of various graphs. Attention to appropriateness and choice of graphs is strongly recommended.
From the given explanation above, the research paper seems to be able to reflect this. It gives the characteristics of the study population – 720 women with similar age, number of pregnancies, marital status and education in both control and intervention groups. It details how these women were selected and screened, and presents a final analysis also. The results were presented in text and in tables. This is good since the tables supplement what you could read in the text, and vice versa.
The next section on discussion is one of an exercise and discipline. In this section, the results are interpreted in the light of the study and assessed in the light of the general schema of current information or practice. These are those that are listed under the strengths of the study. It included in the study’s strength the use of randomized control design yet it did not explain why. Limitations to the study are likewise analyzed in this section. I have also noted that the discussion on the potential limitations of the study is more lengthy than the strengths of the study.
In the discussion section, results should have been compared with similar information from other reports and reasons for differences should be identified. Yet for this study, such is not the case and here we see another lack of the study. The implication of the results is discussed also and this one is helpful and clearly structured.
After the section on discussion, there was no section on conclusion. Ideally, the conclusion should be the last one in the study including the summary and recommendations sometimes. There is though a conclusion mentioned in the abstract at the start of the paper. Although brief, this conclusion did at least provide the final or summary answer to the research question.
The research on ‘Promoting Urinary Incontinence in Women after Delivery: Randomised Controlled Trial’ by and has its ups and downs. The authors of the research should provide a scholarly discussion of the research activity that they conducted in which the results indicate a mastery of the topic. In this particular paper, the authors did present a mastery of the topic researched. However, although the authors presented a mastery of the topic and the results are useful and could benefit the entire medical organization, the study in its printed from was not properly presented. It lacks many things that a formal research paper should have. Its redeeming point is only that it is very relevant to the medical community. All in all, this particular research is not bad, yet it could benefit from some improvement.