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Critical Appraisal of Research

Evaluation Table

Use this document to complete the evaluation table requirement of the Module 4 Assessment, Evidence-Based Project, Part 4A: Critical Appraisal of Research

Full citation of selected article Article #1 Article #2 Article #3 Article #4
  Hempel, S., Newberry, S., Wang, Z., Booth, M., Shanman, R., Johnsen, B., & Ganz, D. A. (2017). Hospital fall prevention: a systematic review of implementation, components, adherence, and effectiveness. Journal of the American Geriatrics Society61(4), 483-494.

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DiBardino, D., Cohen, E. R., & Didwania, A. (2014). Meta‐analysis: multidisciplinary fall prevention strategies in the acute care inpatient population. Journal of hospital medicine7(6), 497-503. Haines, T. P., Hill, K. D., Bennell, K. L., & Osborne, R. H. (2017). Additional exercise for older subacute hospital inpatients to prevent falls: benefits and barriers to implementation and evaluation. Clinical Rehabilitation21(8), 742-753. Spiva, L., & Hart, P. (2014). Evidence-Based Interventions for Preventing Falls in Acute Care Hospitals.
Conceptual Framework

Describe the theoretical basis for the study

 

None

 

multidisciplinary fall prevention interventions in acute care hospital None Inclusion of prospective controlled-design studies reporting the effectiveness of fall prevention programs in hospitals.
Design/Method Describe the design

and how the study

was carried out

 

Systematic review using a qualitative method Used qualitative method where the bibliographies of all systematic reviews and meta-analyses were hand searched a meta-analysis reviews Randomized controlled trial, subgroup analysis. Cluster randomized study
Sample/Setting

The number and

characteristics of

patients,

attrition rate, etc.

U.S. acute care hospitals

 

Acute care settings 5038 total participants. 1958 Male and 3080 Female. Patients of a metropolitan sub-acute/aged rehabilitation hospital Acute Care Settings
Major Variables Studied

List and define dependent and independent variables

Participants Studies reporting in-hospital falls for intervention groups and concurrent (e.g., controlled trials) or historic comparators (e.g., before-after studies). The belt, older people, Dependent – Falls, independent – exercise, Dependent- the relative risk of a fall per occupied bed day (RR(fall)) and independent – the relative risk of being a faller (RR(faller))
Measurement

Identify primary statistics used to answer clinical questions

Incidence rate ratios (IRR, ratio of fall rate post intervention or treatment group to the fall rate pre-intervention or control group) and ratings of study details. Electronic fall prevention tool kit which triggered automatic ordered interventions. multifactorial interventions including exercise to prevent inpatient falls in older adults The primary outcome was patient falls per 1000 patient-days adjusted for site and patient care unit. A secondary outcome was fall-related injuries.
Data Analysis

Statistical or

qualitative

findings

Meta-regressions analysis Effect sizes (odds ratios) and 95% confidence intervals were derived for individual studies and then combined across research reports using a random-effects meta-analysis. Intervention group participants in this subgroup analysis had a significantly lower incidence of falls than their control group counterparts (control: 16.0 falls/1000 participant-days, intervention: 8.2 falls/1000 participant-days, log-rank test: P = 0.007). However few differences in secondary balance, strength and mobility outcomes were evident. Hospitalization further increases risk of falls
Findings and Recommendations

General findings and recommendations of the research

Study shows better reporting of outcomes, implementation, adherence, intervention components, and comparison group information is necessary to establish evidence on how hospitals can successfully prevent falls. Fall prevention strategies have a significant but small effect on fall rates despite the use of complex, multidisciplinary interventions. Additional randomized trials are needed to examine the possible benefits of multidisciplinary fall prevention strategies in the acute inpatient setting. This exercise programme provided in addition to usual care may assist in the prevention of falls in the sub-acute hospital setting. The authors found that precautionary care including a falls safety champion reduced the occurrence of injurious falls by 58.3% (n=36).
Appraisal

Describe the general worth of this research to practice. What are the strengths and limitations of study? What are the risks associated with implementation of the suggested practices or processes detailed in the research? What is the feasibility of use in your practice?

Adherence methodologies are of specific significance for long haul changes A broad eligibility criterion was incorporated in the study and questions were clearly reviewed and addressed. Participants had their balance, strength and mobility assessed upon referral for the exercise programme and then again prior to discharge. The use of a fall prevention tool kit in hospital units compared with usual care significantly reduced rate of falls.
General Notes/Comments N/A

 

N/A N/A N/A

Levels of Evidence Table

Use this document to complete the levels of evidence table requirement of the Module 4 Assessment, Evidence-Based Project, Part 4A: Critical Appraisal of Research

Author and year of selected article Article #1 Article #2 Article #3 Article #4
  Hempel, S., Newberry, S., Wang, Z., Booth, M., Shanman, R., Johnsen, B., & Ganz, D. A. (2017

 

DiBardino, D., Cohen, E. R., & Didwania, A. (2014). Haines, T. P., Hill, K. D., Bennell, K. L., & Osborne, R. H. (2017). Spiva, L., & Hart, P. (2014).
Study Design

Theoretical basis for the study

 

Systematic review using a qualitative method

 

systematic reviews and meta-analyses Randomized controlled trial, subgroup analysis. Cluster randomized study
Sample/Setting

The number and

characteristics of

patients

U.S. acute care hospitals.

Information on number of fallers, number of falls, fall rate (per 1,000 patient days), and number eligible to fall.

Sample sizes were not reported but the number of 1,000-patient days in treatment groups ranged from 4.3 to 160.3. 5038 total participants. 1958 Male and 3080 Female. Comparing patient fall rates in 4 urban US hospitals in units that received usual care (4 units and 5104 patients) or the intervention (4 units and 5160 patients).
Evidence Level *

(I, II, or III)

 

Level V Level VII Level 1 Level 1
Outcomes

 

A critical analysis of the qualitative studies surrounding the use of interventions placed to reduce the number of elderly falls in the hospital. Fall prevention strategies had a statistically significant but small effect on fall rates despite the use of complex, multidisciplinary interventions. Provides a meta-analysis

from randomized controlled

trials involving exercise

The review addressed a clear question and used broad eligibility criteria.
General Notes/Comments N/A

 

N/A N/A N/A

* Evidence Levels:

· Level I

Experimental, randomized controlled trial (RCT), systematic review RTCs with or without meta-analysis

· Level II

Quasi-experimental studies, systematic review of a combination of RCTs and quasi-experimental studies, or quasi-experimental studies only, with or without meta-analysis

· Level III

Nonexperimental, systematic review of RCTs, quasi-experimental with/without meta-analysis, qualitative, qualitative systematic review with/without meta-synthesis

· Level IV

Respected authorities’ opinions, nationally recognized expert committee/consensus panel reports based on scientific evidence

· Level V

Literature reviews, quality improvement, program evaluation, financial evaluation, case reports, nationally recognized expert(s) opinion based on experiential evidence

Outcomes Synthesis Table

Use this document to complete the outcomes synthesis table requirement of the Module 4 Assessment, Evidence-Based Project, Part 4A: Critical Appraisal of Research

Author and year of selected article Article #1 Article #2 Article #3 Article #4
  Hempel, S., Newberry, S., Wang, Z., Booth, M., Shanman, R., Johnsen, B., & Ganz, D. A. (2017

 

DiBardino, D., Cohen, E. R., & Didwania, A. (2014). Haines, T. P., Hill, K. D., Bennell, K. L., & Osborne, R. H. (2017). Spiva, L., & Hart, P. (2014).
Sample/Setting

The number and

characteristics of

patients

Same as above Same as above Same as above Same as above
Outcomes

 

Studies had to report on the outcome of inpatient falls. Fall prevention help should be considered along patient’s cultural differences. Properly implemented fall prevention strategies and interventions are important for older adults Falls cause injury and death for persons of all ages, but risk of falls increases markedly with age.
Key Findings

 

Meta-regressions showed some evidence of the importance of adherence levels to reduce falls Fall prevention strategies have a significant but small effect on fall rates despite the use of complex, multidisciplinary interventions.

 

This exercise programme provided in addition to usual care may assist in the prevention of falls in the sub-acute hospital setting The analysis of this study show that fall prevention strategies according to risk category and insufficient to prevent falls, especially low risk patients.
Appraisal and Study Quality

 

Population control study Random control study Cohort review study True experiment evidence from the RCT
General Notes/Comments Feasibility of the entire study through examination of recruitment, Eligibility,

Protocol, adherence and

missing data

 

Comprehensively reviews literature thus efficient in

boosting the knowledge of

clinical experts on about the

Clinical issue. Generally

ineffective unless supported by other sources

Comprehensively reviews literature thus efficient in boosting the knowledge of clinical experts on about the clinical issue. Being a level one evidence with favourable outcomes, it

helps to solve the clinical question and provides a

comprehensive answer to the study question

Critical Appraisal Tools Worksheet Template

 

 

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