Introduction
Analysis of a specific theme is always associated with the search for sources that meet the necessary criteria. However, in addition to direct investigation, the critical assessment of the found material is essential. This process is important in the context of the health sector and various medical articles. They often describe various methods of treating diseases, and inaccuracies in these data can lead to severe consequences. Therefore, papers of this kind should be written as clearly as possible. The purpose of this paper is to critically assess a systematic review of non-pharmacological pain management in the elderly to assess whether the paper meets the necessary quality criteria for this type of work.
Critique
Problem Identification and Research Question
This paper by Tang et al. (2019) focuses on exploring a variety of pain management techniques that fit the theme of this report. Many people in old age suffer from daily pain, but pharmacological treatment is associated with specific side effects. Therefore, the main problem with the paper is the need to find non-pharmacological remedies for pain that are effective, suitable for use by the elderly in the community, and sustainable (Tang et al., 2019). This problem is not directly stated in the text, but its analysis is possible from the title and the “Background” section.
On the other hand, research questions in this paper are displayed in a separate block at the end of the “Background.” Since the text does not directly state the problem, it is difficult to assess how accurately the problem and the questions are related. However, the list of questions addresses three different components of the problem: the need for effective techniques, suitability for the elderly, and sustainability (Tang et al., 2019). Unfortunately, none of the three questions meet the criteria for the PICO (T) format. In all three cases, the parts of the question are rearranged: Intervention is brought to the first place, followed by the desired Outcome, and Population is included at the end of the question (“PICO (T),” 2021). Nevertheless, the questions, the problem, and the general theme are relevant for nursing, as they touch upon a necessary topic of pain management.
Literature Search and Figure
The literature search for this systematic review is described in great detail. The authors used consulted search terms across five databases, which are well-known sources of medical and nursing articles, especially PubMed, so they can be considered appropriate. Using the deduced inclusion and exclusion criteria, special software, and the help of third-party experts, authors came up with a list of 10 articles on which they continued to work (Tang et al., 2019). As an initial selection criterion, a compiled search query was used. However, the wording “pain treatment” is found in two places, reducing its quality.
The authors also used the PRISMA technique, which can be seen from the checklist attached to the article and the graph included in the text. This flow chart reflects the process of selecting articles, indicating a precise number of works and a strategy for selecting texts, including the inclusion and exclusion criteria. However, as the authors themselves note in the “Limitations” section, some of these criteria may have led to selecting only ten articles for the final analysis. Such details do not allow concluding that the final sample of studies was strong enough.
Study Quality Evaluation
Nevertheless, the collected articles were subjected to a study evaluation procedure. This procedure has not received much attention in the text of the article. According to the authors, the study evaluation was carried out using the Jadad scale, and three out of four researchers were involved in this process. In addition, a table was compiled illustrating the assessment results. It is noted that the researchers reached an interrater agreement, and interrater consistency of 0.66 was observed (Tang et al., 2019). However, since the entire assessment process was limited to the Jadad scale, the level of evidence was not assessed during the study. The tool used is a relatively simple methodological assessment method widely used in various kinds of research. However, some researchers believe that it focuses too much on the blinding component, which increases the risk of bias (Halpern & Douglas, 2005). This factor somewhat reduces its credibility, especially given the fact that no additional measures were used.
Literature Review Table
Two tables, reflected in the text of the article, fall under the category of tables devoted to the materials considered in the article. Table 1 is a list of authors categorized by type of therapy, reflecting the authors of the article, the title of their work, goals, duration and type of intervention, as well as the presence of a follow-up assessment (Tang et al., 2019). The second table is a visual demonstration of the application of the Jadad scale. The information presented in the tables is concise and clear, which allows comparing the works following the available criteria: the type and duration of intervention for the first table and the presence of corresponding Jadad scale elements for the second. However, these sources lack vital elements, so they cannot be considered full-fledged literature review tables. Despite the clarity of this presentation, it is of little value to the reader.
Although these tables provide a general idea of the investigated papers, the reader cannot draw the same conclusions as the authors due to the absence of the summary columns. In the following sections, the authors refer to some additional table S1, which the reader does not have direct access to. Therefore, it is impossible to assess the validity of the conclusions and the usefulness of this study for practice based on the available data tables.
Synthesis of the Evidence
The description of the data synthesis process is complicated since the authors do not comment on how it occurs. According to the article, the selected articles were categorized, scored, and then the authors summarized the results of all ten papers (Tang et al., 2019). However, the following section can confuse the reader because although it is titled “Summary of evidence,” the following text traces the details of data synthesis. Authors highlight links to several different sources simultaneously, combine the results of several articles and form a general conclusion (“Synthesis,” n.d.). Nevertheless, they do not mention the method they use for this process, so there is no way for the reader to know if meta-analysis or meta-synthesis is being used. Thus, the authors confuse the concepts of summary and synthesis, despite the significant differences between them.
In addition, most of the text lacks specific quotes, which makes it challenging to understand where information was taken from. This problem is possibly related to the lack of a conclusion and results column in the literature review tables. Moreover, this makes the conclusions drawn by the authors seem unfounded and unconvincing. Since the analysis process and its methodology have not been demonstrated to the reader, one cannot be sure that the information extraction process was complete and the analysis credible.
Conclusion of Evidence
The conclusion section summarizes the entire article, as the authors mention what they examined and put forward a hypothetical solution. The text highlights three main research questions related to effectiveness, suitability, and sustainability (Tang et al., 2019). Accordingly, the authors rate the quality of the articles studied following these three criteria. However, almost no attention is paid to the quantity and consistency of the evidence, which reduces these findings’ value. In addition, due to the lack of full-fledged data synthesis, the conclusion is weakly associated with this category, due to which the reliability of this section decreases even more.
On the other hand, the authors point out their work’s limitations, consisting of an insufficient number of researched works and possible search queries and criteria errors. In addition, they note the lack of proper categorization and consideration of the impact of different medical interventions. Finally, Tang et al. (2019) combine their shortcomings and their findings in inviting subsequent researchers to further develop the topic of non-pharmacological pain management following the outlined guidelines. Thus, the authors connect their work with medical practice, bringing a little more specificity into it.
Conclusion
Conducting a critical review of an article by Tang et al. allows concluding about the quality of the text as a whole and the importance of a full-fledged analysis in this area. Throughout the study, difficult moments were noted that reduced the quality of the article and interfered with its perception. There were serious gaps in the study towards the middle and the data collection sections of the study. Although the authors ultimately recommend the investigated methods for practical application, the degree of elaboration of this issue raises doubts about conclusions’ reliability. Thus, this study cannot be called complete and used as a practical guide. In addition, the investigated errors make it possible to more effectively assess the importance and necessity of adhering to all the details of the systematic analysis to create a high-quality work that can be used in the future.
References
Halpern, S. H., & Douglas, M. J. (Eds.) (2005). Appendix: Jadad scale for reporting randomized controlled trials. In Evidence-based obstetric anesthesia (pp.237-238). Blackwell Publishing.
PICO(T): Definitions and examples.(2021). Claude Moore Health Sciences Library.
Synthesis. (n.d.). UAGC Writing Center.
Tang, S. K., Tse, M. M. Y., Leung, S. F., & Fotis, T. (2019). The effectiveness, suitability, and sustainability of non-pharmacological methods of managing pain in community-dwelling older adults: A systematic review. BMC Public Health, 19(1), 1–10.