Evaluation of a multiprofessional community stroke team Essay

The study aims to conclusively evaluate how effective it is to employ a specialist community stroke team for the rehabilitation of stroke victims in a community based setting. This is clearly established at within the opening lines of the article. In the summary at the beginning of the article the author claims that the available evidence is inconclusive and his aim is to provide conclusive proof with regards to evidence based practise for the patient. A research article should state its’ aims clearly and should assume the audience has no previous background knowledge (Greenhalg, 2006). The literature reviewed in this article was from a variety of sources such as the Cochrane database and a selection of journal articles. On this basis the authors were able to deduce that previous research carried out provided contradicting reports. For example Roderick et al (2001) as cited by Lincoln et al (2004) found no significant difference in the effectiveness of rehabilitation which had taken place in the home to that which had occurred in a hospital setting. On the contrary Gladman et al (1993) as cited by Lincoln et al (2004) found a significant difference in a small group of younger patients. It was also suggested that there was a shift of focus from mainly hospital based rehabilitation to community based rehabilitation of stroke patients. According to Polger and Thomas (2008) a literature review should provide appropriate background information. That is, it should show the current knowledge level in that area of study. The author appears to have utilised much of his own previous work in the study and some are more than ten years old. This could possibly be an indication that indeed, there is a large gap in knowledge of this subject area. On the other hand it may indicate that the author has done a selective search of the literature. A quantitative approach was utilised in this study and the method used was a Randomised Controlled Trial (RCT). The articles’ methodology was well documented. According to Sim and Wright (2000) an analytic study attempts to quantify the relationship between two factors, that is, the effect of an intervention or exposure on an outcome. A term used to describe the design randomized controlled trial according to Greenhalgh (2006) is Parallel group comparison. This is when each group receives a different treatment and both are entered into the experiment at the same time. By comparing the groups an analysis is provided. In the Lincoln et al (2004) study Participants were divided into two groups, A and B with the former receiving routine care while the latter received the intervention – rehabilitation with the multi-professional community stroke team. The question posed by the authors could have been answered using a qualitative approach. The question could possible state; Evaluation of a multiprofessional community stroke team: a phenomenological study. SAMPLE Altman (1991) states that a study should have enough participants recruited in order to detect a significant effect if one exists. The sample group consisted of patients referred to the Nottingham Community Stroke Team who had suffered a stroke within the last two years, who were over sixteen years old and needed intervention from more than one multidisciplinary team member. Patients who lived outside the geographical area and/or had been treated by the community stroke team in the preceding two years were excluded. Four hundred and twenty eight patients were randomly selected at the start of the trial and randomly allocated to either Group A or Group B. An error resulted in seven people being recruited twice. This error was corrected by including only the outcome of their initial recruitment when the results were being analyzed. The target population of this study is relatively clearly defined (patients who have had a stroke within last two years, over the age of sixteen, etc†¦ ) and lends credence to the external validity of the study (Payton, 1994). According to Sim and Wright (2000) the accessible population is the portion of the target population that is available to the researcher and the sample is then taken from this accessible population. The groups are similar to each other with regards to gender and age distribution; this also increases the validity of the study as this similarity reduces the variables of the study. The overall population was a convenience sample which was then randomized to two groups. Six months after randomization all the patients were sent a letter asking them to consent to being in a study to evaluate the input of a community stroke team. According to Lincoln et al (2004) the consent forms and outcome questionnaires were sent this late so as to reduce bias. It was thought that group A which was receiving routine care would have lower expectations if confronted with the realization that the alternate group may receive superior care. Some would possibly insist on being referred to the specialist community stroke team The Local Research Ethics Committee granted ethical approval for this study to go ahead. This indicates that the value of the research undertaken outweighed any harm that this consenting method may have caused as patients in Group A were still receiving routine care. However, the department of health has issued guidelines which state that participants must be consented and all pertinent information given prior to the start of any study. Data was collected via a questionnaire comprising of the Barthel Index, Extended ADL, General Health Questionnaire 12 (GHQ-12) and Euroquol. The participants were also asked to rate their knowledge of the expected extent of recovery from their stroke, and their overall satisfaction with the services they received from the community stroke team. The use of a questionnaire for data collection has both negative and positive aspects. Greenhalgh (2006) states that a questionnaire is an instrument used to measure human psychology, so whilst sending the questionnaire via post proves to be cost effective as the alternative would be to hold face to face interviews with the participants as focus groups or individually, it raises concerns about the reliability of the study. This is because the researcher is not present to interpret facial expressions and body language when the participants answer the questions. The alternative of conducting face to face interviews with such a large number of participants would prove to be costly and time consuming. However, according to Oppenheim (2003) long questionnaires are sometimes off putting and may generate low response rates, conducting these questionnaires via the postal service could possibly increase the likelihood of a low response rate. The results were shown as a table and diagram, the Mann-Whitney U-test which was used to compare the groups showed no significant differences on independence in personal or instrumental activities of daily living or on the patients’ mood. There was also no significant difference between the groups in their knowledge with regards to the resources available to assist them in adjusting to life after a stroke. There was also no difference between the two groups with overall satisfaction or in satisfaction with the practical helped received. However, patients in the Community Stroke Team were significantly more satisfied with the emotional care they received. (Lincoln et al, 2004) According to Wright et al (2009) the Mann-Whitney U-test is used when one group from the sample is larger than the other and when both samples are from the same population, as is the case with this study. There was no significant difference in carers’ mood between the two groups. However, the strain on carers of patients seen by the community stroke team was significantly less than that of carers of patients randomized to the routine care group. The carers of patients in the community stroke team group were significantly more satisfied with their knowledge of stroke and had higher overall satisfaction than the carers of those in the routine group. By utilizing the randomized controlled trial design the author lends credence to its validity as this design allows for the eradication of systematic bias. (Sim et al, 2000) This was done through the sampling process of selecting the participants from the target population and randomly allocating them to Group A which received routine care or Group B those in the care of the community stroke team. The collection of data by using a postal questionnaire helps to â€Å"blind† the researcher as he cannot influence the participants’ response. Although some participants did not respond to the questionnaire, others responded with incomplete forms, some died and a few were recruited twice, the author is cognizant of this and incorporates it into his findings. Crombie (2000) states that if the withdrawals and failures to respond can be seen as being consistent between both comparison groups then the results of the research will not be negatively impacted upon. This is because the results show that these failures are random among both groups and not specific to one. However one major fault is the fact that the services received by Group A were not collected due to impracticalities and unreliable recollections of the patients. Critical appraisal is not just an exercise in fault finding, it is the analysis of these faults and the assessment of their potential impact on the research which allows the reader to come to a decision regarding the strength or usefulness of the article being critiqued. In order for the research results to be utilized in clinical practice its’ reliability and validity are essential aspects which need to be covered. (Polger and Thomas, 2008) This article shows a research that was methodically sound and well designed. The sample was representative of the population being examined and attempts were made to minimize bias. The author was aware of the shortfalls of this research and attempted to incorporate this in his findings however, most of the issues identified did not affect the results of the study. The study if repeated would provide comparable results. However, the author states that the study provides evidence supporting the use of a community based stroke team to assist in the rehabilitation of stroke patients because of the increased emotional support for patients and greater satisfaction and reduced strain on carers. This statement would have been better justified on results from a qualitative study as this type of study aims to interpret people’s emotional and psychological response to the intervention or interventions being employed. The results from such a study would be closer to the patients’ and carers true feelings as the methodology behind that study would be different.