Summary
Multiple searches across several databases may be required when searching for relevant articles to support research with evidence to address the PICOT question criteria. Randomized controlled trials have the highest level of evidence, and they remain the focus of the search. The goal of this week’s task is to select five relevant journal articles to search for evidence on the PICOT topic. The MEDLINE database was used to search for relevant articles.
Search Tracker
PICOT Question Organizer
Search Tracker
Databases Utilized
The MEDLINE database was used to search for relevant literature on the PICOT topic. OVID/MEDLINE is a database containing literature on nursing, medicine, dentistry, allied health, and the biological and physical sciences (Rutgers University, 2019). The output of articles was relevant because strong terms were used; no other database was searched. To personalize the search, a search filter was set to only available full-text articles. In order for the articles in the search results to be up-to-date, the interval of the last five years was chosen.
APA-Formatted References, Abstract, and Level of Evidence
Bates, A., Furber, S., Tiedemann, A., Ginn, K., van den Dolder, P., Howard, K., & Sherrington, C. (2018). Trial protocol: Home-based exercise programs to prevent falls and upper limb dysfunction among community-dwelling older people: study protocol for the BEST (Balance Exercise Strength Training) at home, randomized, controlled trial.Journal of physiotherapy, 64(2), 121-136. Web.
Abstract
Bates et al. (2018) are investigating specific exercise programs that will help reduce the risk and frequency of falls among older people. Home exercise programs are liked by some older adults because of their convenience (Bates et al. 2018). This study aimed to determine the effectiveness and cost-effectiveness of a home exercise program for the lower limbs compared to an exercise program for the upper limbs at home. The study is randomized and controlled, which ensures its reliability. The study included 576 community residents from the Illawarra and Shoalhaven regions of New South Wales and Australia (Bates et al. 2018). Participants are randomized to do home exercises for the lower limbs or home exercises for the upper limbs. Participants will take part in three group sessions to learn and improve the exercises and will be instructed to do the exercises at home three times a week for 12 months (Bates et al. 2018). If successful, the trial will provide a model of upper and lower-limb exercise programs that can be done at home and scaled up for the elderly.
Level of Evidence
Since the study provides only a literature review and a description of the proposed intervention, the level of confidence can be no higher than VI. The study provides an analysis of the previous literature and explains the need for intervention. The above data follows the validity of the study. Since the participants were carefully selected and the sample is sufficient, it can be assumed that the conclusions of the study will be relevant.
Liu-Ambrose, T., Davis, J. C., Best, J. R., Dian, L., Madden, K., Cook, W., & Khan, K. M. (2019). Effect of a home-based exercise program on subsequent falls among community-dwelling high-risk older adults after a fall: A randomized clinical trial.Jama, 321(21), 2092-2100. Web.
Abstract
Liu-Ambrose et al. (2019) highlight the lack of studies on the effect of exercise on subsequent falls in high-risk older adults who have already experienced a fall. A single-blind, randomized clinical trial was conducted on adults aged at least 70 who had fallen within the past 12 months (Liu-Ambrose et al., 2019). Participants were randomized to receive conventional care and a home-based strength and balance exercise program administered by a physiotherapist and a conventional care group consisting of fall prevention care provided by a geriatrician (Liu-Ambrose et al., 2019). The groups were 173 and 172 people, respectively (Liu-Ambrose et al. 2019). Among 345 randomized patients, a total of 236 falls occurred among participants in the exercise group versus 366 falls among participants in the usual care group (Liu-Ambrose et al., 2019). Thus, the study proves that participants who exercised significantly reduced the frequency of falls. This study provides strong evidence for the effectiveness of exercise in older patients.
Level of Evidence
This study achieves II level of evidence because it is randomized and controlled. The data obtained during the study can be considered relevant and practically negligible since the study was long and the control group was significant. Both groups were extensively monitored throughout the study, which increased the validity of the findings. The research can be broadly applied to develop a set of exercises to reduce the number of falls among the elderly population.
Moreland, B., Kakara, R., & Henry, A. (2020). Trends in nonfatal falls and fall-related injuries among adults aged ≥ 65 years — United States, 2012–2018.Morbidity and Mortality Weekly Report, 69(27), 875-890. Web.
Abstract
Moreland et al. (2020) emphasize the importance of studying falls as it is the leading cause of injury in people over 65 years of age in the US. Data from the Behavioral Risk Factors Surveillance System was analyzed to describe the percentage and frequency of non-fatal falls by age group, as well as demographics and trends in falls and fall-related injuries over time (Moreland et al., 2020). In 2018, 27.5% of older people reported a fall at least once in the past year. The percentage of older people reporting falls increased between 2012 and 2016 and decreased slightly between 2016 and 2018 (Moreland et al., 2020). Screening older patients for risk of falling, assessing modifiable risk factors, and recommending interventions to reduce this risk can prevent older people from falling (Moreland et al., 2020). The data obtained from this study can be used to identify risk factors for falls and design a relevant exercise program to address these risks.
Level of Evidence
This study is a systematic descriptive review and therefore achieves level V of evidence. Researchers are seeking to categorize the information obtained from the database to identify factors that increase the incidence of falls and to analyze at-risk groups in the population. The study is well applicable as it allows the development of a risk-addressing strategy to reduce the frequency of falls. The study could be strengthened by identifying specific fall reduction strategies for each of the risk groups.
Papalia, G. F., Papalia, R., Diaz Balzani, L. A., Torre, G., Zampogna, B., Vasta, S., & Denaro, V. (2020). The effects of physical exercise on balance and prevention of falls in older people: A systematic review and meta-analysis.Journal of clinical medicine, 9(8), 2595-2615. Web.
Abstract
The aim of the systematic review and meta-analysis by Papalia et al. (2020) was to evaluate the effect of exercise on static and dynamic balance in the elderly and analyze the number of falls. A systematic literature search was performed using PubMed-Medline, Cochrane Central, and Google Scholar to select randomized clinical trials (Papalia et al., 2020). Meta-analysis showed improvements in dynamic balance (p = 0.008), static balance (p = 0.01), participants’ fear of falling (p = 0.10), balance confidence (p = 0.04), quality of life (p = 0.08) and physical performance (p = 0.30) in patients who performed physical exercises (Papalia et al., 2020). An analysis of the total number of falls showed a decrease in the likelihood of falls in patients who participated in physical activity programs (p = 0.0008) (Papalia et al., 2020). There was a significant decrease in the number of patients who fell at least once in the intervention group (p = 0.02) (Papalia et al., 2020). Exercise is an effective means to improve balance and reduce falls in the elderly. This study provides a strong evidence base for the effectiveness of exercise as a therapy for helping the elderly.
Level of Evidence
This study is a systematic review and meta-analysis of relevant randomized controlled trials and therefore achieves I level of evidence. The study provides strong evidence to justify the use of exercise as an effective measure to reduce falls in the elderly population. The study used robust tools to select peer-reviewed articles and search multiple databases. Articles have been carefully reviewed for relevance, so the findings of the study can be considered valid and applicable.
Seymour, K. C., Pickering, R., Rochester, L., Roberts, H. C., Ballinger, C., Hulbert, S., & Ashburn, A. (2019). Multicenter, randomized controlled trial of PDSAFE, a physiotherapist-delivered fall prevention program for people with Parkinson’s.Journal of Neurology, Neurosurgery & Psychiatry, 90(7), 774-782. Web.
Abstract
The aim of the study by Seymour et al. (2019) was to evaluate the effect of a physical therapy program for people with Parkinson’s disease. The study was randomized, and controlled, with a predetermined subgroup analysis. 474 people with Parkinson’s disease were enrolled in the study, 238 were enrolled in the physical therapy program, and 236 were in the control group (Seymour et al., 2019). The intervention group had an individually tailored, progressive home-based fall prevention strategy training program with balance and strengthening exercises. By 6 months, 116 (55%) in the control group and 125 (61.5%) in the intervention group reported recurrent falls (controlled OR 1.21, 95% CI 0.74 to 1.98, p = 0.447) (Seymour et al., 2019). Secondary subgroup analysis showed different responses to the intervention between the moderate and severe disease groups (Seymour et al., 2019). The results of the study can be used in further work to prove the need for medical personnel to intervene in the control of exercise.
Level of Evidence
This study presents data from a well-designed, randomized, controlled trial, reaching the II level of evidence. The results of the study were inconsistent due to insufficient control over the intervention group of subjects. The higher number of subjects who reported a sustained number of falls in the controlled group may be associated with greater reflexivity over their health compared to the uninstructed group. Research results may have been more relevant if the number of subjects is increased to minimize randomness.