Pain Assessment and Relief Study, Research Paper Example

Introduction

Managing pain in acute care setting is a widely researched topic. The below review of mixed (qualitative and quantitative) research methods used by Adams. White & Beckett (2010), the qualitative study of Iqbal, Spaight & Siriwardena (2012), and Haller et al.’s  (2011) quantitative research.  The reviewed studies, focusing on measuring the effectiveness of different interventions on inpatients of acute care units used different research methodology to provide information for health care professionals on effective pain management methods. Based on the below assessment, the author found that the most effective method of providing easy to implement results for evidence-based health care is to support the findings of the quantitative research with qualitative data.

Comparison of Studies

The authors of the mixed study (Adams, White & Beckett, 2010) used a relatively large sample of participants to carry out the combined research; using quantitative and qualitative methods. The main purpose of the study was to find relationship between life quality and pain levels of patients and the implementation of massage therapy in pain management plans. The authors found a significant difference between pain levels before and after massage. Further, the research revealed that patients reported better quality of life, increased comfort level, and improvement of their emotional well-being.

The qualitative review of patient outcomes and perceptions created by Iqbal, Spaight & Siriwardena (2012) was based on patient interviews, using a sample of 17 patients, 13 ED clinicians, and 25 ambulance clinicians. One of the main findings of the study was that pain assessment of clinicians was often unreliable, and the actions taken did not match the expectations of patients. While the qualitative research was not focused on intervention methods, it was effective for measuring patient experience and outcomes, in order to identify development areas in the health care unit.

The quantitative review of Haller et al. (2011) study involved using a 40-item Picker Patient Experience questionnaire in order to measure patient experience with the hospital’s intervention methods for relieving pain and improving comfort.

Statistical Tests Used by Researchers

Adams,  White & Beckett (2010) used a large sample’s mean scores of patients before and after the massage therapy, while taking into consideration the standard variations.

The descriptive analysis of Iqbal, Spaight & Siriwardena (2012) used a interpretive phenomenological approach, without measuring results of the survey using a computer-based qualitative data analysis software (MAXQDA).

Haller et al. (2011) used P-scores to create a stratified analysis of the intervention effectiveness. The authors also compared patient characteristics before and after the implementation of a pain management program, which was a method of increasing validity.

Parametric and Nonparametric Tests Used

In the study of Adams, White & Beckett (2010) used a t-test on a relatively small population measuring Visual analog scales. The main information about the population characteristics was recorded, such as patients of medical, surgical, and obstetrics units within a community hospital, and demographic data was collected. It was a parametric study, as it used a paired t-test, to compare before and after means scores.

Iqbal, Spaight & Siriwardena (2012) used a non-parametric statistical analysis of qualitative data. Little was known about the population, and the authors did not make any assumptions regarding the patients and clinicians surveyed. The authors used the constant comparative method for data analysis, generally utilized for creating frameworks and theories, making assumptions, identifying common themes, or drawing consequences.

Haller et al.’s study used non-parametric research on a small scale, and used mean scores and variance as measures. The authors used chi-square test and binary logistic regression, after determining mean scores. This indicates that the researchers made assumptions in order to predict dichotomous outcome of the study. The analysis was completed using the Statistical

Package for Social Sciences software. The use of chi-square test signifies the fact that the deviation between the observed and expected results were measured.

Assessment of Research Designs

One of the main strengths of the mixed research (Adams, White & Beckett, 2010) was that it was designed to match the guidelines of the hospital, and approved by the management. Ethical considerations were also implemented in the research design, and participation was voluntary. Further, the selection criteria for inclusion was clearly defined. 65 patients were selected from a community, nonprofit hospital, who were offered to take part in massage therapy.  In many cases, the results of both methods are combined to support a hypothesis related to evidence-based health care approaches.

Iqbal, Spaight & Siriwardena’s (2012) adopted a constructivist view when designing the qualitative research study. Focusing on patient experiences and life quality improvement methods, the semi-structured individual interviews were created to measure patients’ and clinicians’ perception of the pain management approaches and methods, their effectiveness, and the responsiveness of designs implemented by the health care facility. The interviews were completed by clinicians, who were not practicing medicine at the time of the study. The research publication includes interview quotes from both patients and clinicians that can provide information for policymakers and health care unit managers with information how practice can be improved.

Haller et al. (202011) used a pre-designed questionnaire, which has already been approved by the Institutional Ethics Committee. Apart from patient demographic characteristics, the  study measured three different quantifiable variables: waiting time, receiving pain medication, and staff immersion to relieve pain.

Reliability and Validity

The most reliable data quality was provided by the study of White & Beckett (2010). The authors used a quantitative analysis of pain levels before and after the therapy. The sample size of 53 was relevant to the study.  Further, the qualitative assessment, based on patients’ perception and the impact of treatment on their overall life quality provided additional information for the impact of massage therapy on emotional well-being. The research design was relevant, as the surveys reflected 45 patients’ experiences, and the results could be implemented in health care delivery systems. As measuring pain levels using scientific methods, instead of patient reports is problematic, the research methodology was effective in measuring different potential benefits of implementing massage therapy in acute care units.

The research completed by Iqbal, Spaight & Siriwardena (2012) focused only on patients’ subjective opinion and perception, therefore, it was hard to eliminate bias and cultural differences. While the study was designed to help improving health care, the comparative investigation was not validated by qualitative data. As an example: the authors Iqbal, Spaight & Siriwardena, 2012, p. 10) stated that “inadequate analgesia also happened because patients were concerned about adverse drug effects”, but the number of cases is not stated, therefore, the only information available is that the above issue was present, but no data on the frequency of the occurrence was given.

The quantitative analysis of trials created by Haller et al. (2011) provided an analysis of a large data set. Taking into consideration the number of total participants within the trials researched by the article, data quality is likely to be high. However, the authors also state that the results of the systematic review are likely to be influenced by the data and research quality of the original trials. Further, the majority of trials assessed involved a small number of participants, and many lacked demographic data that is relevant to analyzing patient outcomes. Finally, some trials were sponsored by the drug’s manufacturer, which reduces the reliability of the data.

Applicability of Statistical Test and Alternatives

While parametric tests make assumptions and work with a large data set, using t-test, f-test, z-test, or ANOVA design, non-parametric tests have no initial assumptions. They use Mann-Whitney, rank-sum, or Kruskal-Wallis tests. Nonparametric tests do not have a knowledge about the population sampled, while Parametric tests use population information to make specific assumptions about them (Qualls et al., 2010). In the clinical setting, when authors are trying to create evidence based health improvement programs for a certain health care setting, parametric tests can provide more relevant information. According to Fagerland, Sandvik, & Mowinckel (2011), Welch U tests were providing better discrete numerical variables (number of events per individuals) than perform better than the ordinary T-test.

Conclusion– Implementation of Results in Evidence-Based Practice

The above review of literature confirmed that using statistical analysis taking into consideration the population’s characteristics, supporting the results of quantitative research with findings of qualitative surveys can help practitioners develop evidence-based health care interventions (Palinkas et al. 2013). As the authors (Palinkas et al. 2013, p. 12) confirm, the benefit of mixed research “lies in its ability to move beyond the confines of existing methodological approaches and develop innovative solutions to important and complex problems”.

Therefore, the author of the current study, based on the review of three health care research publications conclude that combining quantitative research with qualitative assessment can help improving data quality and validating results, leading to more information for health care professionals designing evidence-based intervention frameworks, used in the author’s current practice. The above review of literature provided an insight into both patient perceptions of pain relief methods and intervention implementation effectiveness.

References

Adams, MHA, BSW, LMT, R., White, MS, LMT, B., & Beckett, PhD, RNC-OB, LCCE, C. (2010). The Effects of Massage Therapy on Pain Management in the Acute Care Setting. International Journal Of Therapeutic Massage & Bodywork: Research, Education, & Practice, 3(1), 4-11. doi:10.3822/ijtmb.v3i1.54

Haller, G., Agoritsas, T., Luthy, C., Piguet, V., Griesser, A. C., & Perneger, T. (2011). Collaborative quality improvement to manage pain in acute care hospitals Pain medicine, 12(1), 138-147.

Fagerland, M. W., Sandvik, L., & Mowinckel, P. (2011). Parametric methods outperformed non-parametric methods in comparisons of discrete numerical variables. BMC medical research methodology, 11(1), 44.

Iqbal, M., Spaight, P. A., & Siriwardena, A. N. (2012). Patients’ and emergency clinicians’ perceptions of improving pre-hospital pain management: a qualitative study. Emergency           Medicine Journal, emermed-2012.

Palinkas, L. A., Horwitz, S. M., Green, C. A., Wisdom, J. P., Duan, N., & Hoagwood, K. (2013). Purposeful sampling for qualitative data collection and analysis in mixed method      implementation research. Administration and Policy in Mental Health and Mental Health Services Research, 1-12.

Qualls, M., Pallin, D. J., & Schuur, J. D. (2010). Parametric versus nonparametric statistical tests: the length of stay example. Academic Emergency Medicine, 17(10), 1113-1121.