Acupuncture for Chronic Headache in Primary Care

Acupuncture for Chronic Headache in Primary C beenquiry CritiqueIntroductionResearch involves the use of taxonomical military operations to answer an inquiry. It involves data collection, synthesis and analysis in the light of the question or inquiry and formulation of conclusions and recommendations, (Badke, 2004). General types of enquiry include experimental studies which argon used to test the effect of a treatment or intervention, (Peat, 2001, p. 16). Clinical trails fall under the broad category of experimental trials. Clinical trials argon controlled experiments with patients, which range from studies to prevent, detect, diagnose, control and treat health problems to studies of the psychological impact of a health problem and ways to improve peoples health, comfort, functioning, and quality of disembodied spirit, (Brooten, 2006, p.86). Generally, clinical trials stack be categorised into either randomize trials or non- randomise trials.This paper get out try to evaluate the scientific research conducted by Vickers and colleagues (2004), authorise Acupuncture for chronic concern in primary care large, pragmatic, randomised trial, which was published on 15 March 2004 at the British Medical Journal. This incident guinea pig was selected due to its relevance to this field of study. Numerous insights from this field of study and valuable best practice information in quantitative research methods can be gained from undertaking this critiquing task. This critique will be carried out using the research framework for critiquing health research formulated by Caldwell and co-workers (2005), which provides a citywide set of criteria against which the elements of the research word by Vickers and colleagues (2004) can be appropriately measured. This paper will first evaluate the overview of the study, including the abstract, literature review and the methodology used. Next, it will critically analyse issues concerning research ethics, data protection and research funding. Then, it will evaluate the reliability, legality of the research results, including the sampling methods employed. It will then identify the special(prenominal) strengths and weaknesses of the research hold. Finally, the concluding judgement about the research article will be presented.Below are the definitions of selected important terms used in the research articleAcupuncture pertains to the technique of traditional Chinese medicine, in which a number of very fine metal needles are inserted into the skin at specially designated points, (Acupuncture, 2007).ANCOVA stands for analysis of covariance which is a statistical treatment that combines analysis of variance (ANOVA) and degeneration whereby the predictable component of the individual differences can be removed with regression analysis, (Anderson, 2001, p. 283).Chronic all impairments or deviations from normal that have one or more of the following characteristics are permanent leave residual balk are caused by nonreversible pathological alteration drive special training of the patient for rehabilitation or may be expected to require a long period of supervision, observation or care, (Sidell, 1997, p. 1)Negative binomial regression is one of a class of mixed Poisson models that mix a second source of variance with the Poisson variance to account for overdispersion, (Cohen, et al., 2003, p. 531).Outcome measures reflect patient health status at either the individual or the totality (population) level, (Stommel Wills, 2004, p. 234).Randomised trial A randomised trial is a clinical trial that pertains to an experiment in which therapies under investigation are allocated by a chance mechanism, (Brooten, 2006, p.86).Sham Treatment is the experimental treatment that has no effect and which subjects cannot distinguish from the active treatment (Peat, 2001, p. 20).Critical AnalysisIn March 15, 2004, the BMJ Publishing Group Ltd, a wholly owned subsidiary of the British Medical As sociation, published the research article in its medical exam journal, the British Medical Journal (BMJ). Its print BMJ has been published continuously since 1840, and now appears in four weekly editions, varying only in their advertising content. Together, their circulation totals about 122 000 copies, of which 10 000 are distributed outside Britain, (BMJ, undated). Its weavesite provides the full text of everything published in the print journal since 1994, as well as much material unique to the web, (BMJ, undated).These make the BMJ Publishing Group Ltd. an influential and authoritative source of medical articles.The authors are recognized medical practitioners with different fields of specialisations. Andrew Vickers is an assistant attending research methodologist at the Integrative Medicine Service, Biostatistics Service, Memorial Sloan-Kettering Cancer Center in smart York Rebecca Rees is a research officer at the Evidence for Policy and utilization Information and Co-ordi nating Centre (EPPI-Centre), Social Science Research Unit in London Catherine E Zollman is a general medical practitioner from Montpelier wellness Centre in Bristol Rob McCarney is a research officer at the Department of Psychological Medicine, Imperial College in London Nadia Ellis is lecturer Department of health and Social Sciences, Coventry University in Coventry and both Peter Fisher, who is the director of research and Robbert Van Haselen who works as the deputy director of research are from Royal London Homeopathic Hospital. Thus, based on their qualifications, the authors have the credibility, needed intimacy and expertise to engage in an extensive scientific study such as the article being evaluated.The article is appropriately titled as Acupuncture for chronic headache in primary care large, pragmatic, randomised trial, since it fundamentally focussed on the effectiveness of the use of acupuncture to relieve chronic headache. Moreover, the title expressly implies that t he methodology utilizes a large sample in the randomised trial. The abstract appears to be concise and complete. In a few paragraphs, the essential research components were summarised in the abstract, namely (1) the research objective (2) setting (3) participants (4) interventions (5) main number measures (6) results and (7) conclusions. The abstract provides the complete key information that the readers need to fully understand the article. The introduction explained the health costs related to headache, which is the main topic of the article, including the need to cave in other approaches in its treatment, particularly, acupuncture. The introduction also provides the main aim or rationale of the study, which was to estimate the effects of acupuncture in practice in general and to determine the effects of a policy of use acupuncture on headache, health status, days off sick, and use of resources in patients with chronic headache compared with a policy of avoid acupuncture, in par ticular, (Vickers et al., 2004). However, the literature review was limited to only one source of published work the Cochrane review of 26 randomised trials. This would be very insufficient in terms of the extent of evaluating available sources of information related to the topic of the study. Moreover, it does not provide a comprehensive military rating of scholarly work from which the rationale of the study could be based.The study is a quantitative research, since the data obtained are represented in the form of numbers and statistical treatment was employed to interpret the data gathered (Grinnell Unrau, 2005, p. 62). Despite the lack of implicit statement of the hypothesis, the audience or reader can obtain a general notion or idea of what is being tested (the effectiveness of acupuncture in the treatment of chronic headache). However, the variables were not trenchantly defined. Nevertheless, the procedures employed in the methodology were intricate and systematic. The parti cipants were clearly identified and adequately described in the study. In the accrual of patients, several stages were established to facilitate the flow and recruitment of participants. regard 1 in the appendix illustrates the flow of participants in the study. Moreover, ethical principles were upheld during the conduct of participant recruitment. Since most legal instruments expressly prohibit the use of human subjects for medical research, the researchers obtained written informed consent from the participants.The researchers implemented a system to ensure randomization of the study through a password protected database, thereby eliminating the emf for bias and subsequently improving the quality of the results. As Peat (2001, p. 28), explains in randomised controlled trials, the quality of the evidence is improved if measurement bias, such as observer or reporting bias, is reduced by using objective outcome measurements and if observers are blinded to the group status of the s ubjects. The method of data collection proves to be valid and reliable, as evidenced by the relatively high number of treatments (12 treatments) employed over a sufficient length of time (3 months). Moreover, a follow-up procedure was implemented to generate a global estimate of current and baseline headache severity, (Vickers, et al., 2004). This further enhanced the validity of the results. The large sample coat helped ensure the reliability of the results. Additionally, the use of measurable outcomes such as the Likert scale of headache severity helped eliminate bias by extending common measurement criteria for the respondents. The article correlated its results with the findings in prior literature on acupuncture, (Vickers, et al., 2004), suggesting a high degree of validity of results generated.The presentation of results was systematic and at the same time, clear and comprehensive. The results portion explained the process of participant recruitment including the flow of part icipants through the trial, patient compliance and dropout rate and their characteristics. It also provided a clear explanation of data that were obtained with accompany tables and graphs. Thus, the audience can easily comprehend the results obtained. In the discussion, the results generated were translated into the main findings of the study which were stated in a clear, yet simple manner. Moreover, the strengths and the limitations were identified and discussed clearly.The strengths of the research article are anchored on its methodology, such as in the recruitment of participants with a large sample size, the implementation of a system to conceal the randomization and the precise follow-up procedure one year after the experiment. Such procedures helped ensure that the research findings are reliable and valid. On the other hand, one of the limitations of the study is the absence of sham acupuncture for the participants, thereby failing to consider the potential placebo effects. Additionally, the participants were not blinded in the study thereby raising the possibility of bias in terms of the participants assessments of their headache scores. In terms of the literature review, the article failed to provide an objective evaluation of a sufficient body of literature related to the topic of the research. Thus, it failed to address the gaps in knowledge related to acupuncture and chronic headache due to the lack of an extensive evaluation of available literature.ConclusionIn the concluding analysis, the research article serves as an additional source of authoritative and credible information regarding the use of acupuncture for the relief of chronic headache. The findings of the study strongly incarnate available scientific evidence. The weaknesses of the research article discussed above can serve as important considerations for researchers who are planning to engage in a correspondent undertaking they must evaluate a substantial body of literature to gai n insight into the currently available information and subsequently identify knowledge gaps. Moreover, future randomised clinical studies in acupuncture should include a sham treatment to be able to consider potential placebo effects and eye-popping of participants must be observed to eliminate bias.BibliographyAcupuncture. (2007). In The Columbia Encyclopedia (6th ed.). New York Columbia University Press.Anderson, N.H., 2001. Empirical Direction in Design and Analysis. Mahwah, NJ Lawrence Erlbaum Associates.Badke, W.B., 2004. Research strategies Finding your way through the information fog. (Second Edition). New York iUniverse, Inc.British Medical Journal. Undated. Available from http//resources.bmj.com/bmj/about-bmj. Accessed 18 April, 2008.Brooten, D., 2006. Clinical Trails. In Encyclopedia of Nursing Research (Second Edition). Joyce Fitzpatrick and Wallace, J.J., (Eds). New York Springer Publishing Company.Caldwell, K., Henshaw, L., Taylor, G., 2005. Developing a framework for critiquing health research. Journal of Health, Social and Environmental Issues, 6(1), 45-54.Cohen, J., Cohen, P., West, S.G. and Aiken, L.S., 2003. Applied Multiple Regression / Correlation Analysis for the behavioral Sciences. Hillsdale, NJ Erlbaum.Grinnell, R. M., Unrau, Y. A., (Eds.), 2005. Social Work Research and Evaluation Quantitative and Qualitative Approaches (7th ed.). New York Oxford University Press.Peat, J. K. (Ed.), 2001. Health Science Research A Handbook of Quantitative Methods. Crows Nest, N.S.W. Allen Unwin.Sidell, N. L. , 1997. big Adjustment to Chronic Illness A Review of the Literature. Health and Social Work, 22(1), 5+.Stommels, M., Wills, C.E., 2004. Clinical Research Concepts and Principles for Advanced Practice Nurses. Philadelphia Lippincott Williams and WilkinsVickers, A.J., Rees, R., Zollman, C.E., McCarney, R., Smith, C.M., Ellis, N., Fisher, P., 2004. Acupuncture for chronic headache in primary care large, pragmatic, randomised trial. Available from http//www.bmj.com/cgi/content/full/328/7442/744. Accessed 15 April 2008.AppendixFigure 1Flow of Participants Through the TrialSource Vickers, et al., 2004