UB015-6 Appraisal On Effects Of Multicomponent Frailty Prevention Program Assessment 1 Answer

Answer :

Introduction 

The method of deliberately and consistently reviewing the results of scientific study (evidence) to determine its authenticity, validity and significance in a given context is critical assessment (Marcus, 2018). Critical assessment evaluates the manner in which research is carried out and evaluates variables such as internal validity, generalisation and significance. Critical appraisal is of crucial importance as it helps in choosing evidenced-based practices that are critical for public health (Roberts et al., 2018). Also, the ageing population is at increased risk of health disorders and conditions such as falls so it is important to assess the interventions and prevention methods to help the ageing population reduce the effect of morbidities. This assessment aims at highlighting the research article conducted by Yu et al. (2020) on “Effects of a multicomponent frailty prevention program in prefrail community-dwelling older person”. Also, the CASP tool is used for the appraisal of the article to know its validity, applicability and reliability.

Critical Appraisal of the Article

The Critical Appraisal Skills Programme (CASP) is the checklist used for apprising the randomized control trails research articles. The checklist is subdivided into three sections which include the analysis of validity, applicability and reliability of the article (CASP, 2018). Mainly the checklist contains multiple-choice questions and the answer is given as either yes or no. In total there are 11 questions as per the recent checklist and this does not have scoring as other appraisal tools (CASP, 2018). Hence for the scoring purpose, the score for yes will be 1, maybe yes 0.5 and no will be 0. The high-quality score is between 8 and 11, the moderate quality between 4-7 and low quality will be based on the score 0-3.

Section A: Validity

1. Did the trial address a focused issue?

Yes, the article addresses the clearly articulated issue and examines the effects on multicomponent frailty for the older individuals suffering from prefraility. Next, adults aged 50 and above are included in the study based on the simple frailty questionnaire.  The multicomponent intervention includes cognitive training, board game activities and exercise. The combined objective and subjective frailty measures include muscle endurance, gait speed, balance and grip strength. Considering the interventions and population yes the issues are of prime importance and authors have identified and defined the primary and secondary outcomes (Hopkins, 2017). Hence, it gets a score of 1.  

2. Was the assignment of patients to treatments randomised?

Yes, the assignment of the patients to the treatments was randomized using block sizes. Participants were randomly allocated to the control and intervention group after agreement and achievement of the standard review by computer-generated random statistics of block sizes of 4 (Yu et al., 2020). To gain comparable sample sizes within and intervention group during the study phase, block randomization was performed. Autonomous of selecting participants and evaluation, the group distribution schedule was created and controlled by an investigator. FitzPatrick, (2019) states that a key benefit of blocked randomization is that treatment groups would be comparable in length and will likely to be allocated evenly by baseline characteristics related to the outcome. . Hence, it can be given 1 score for this criterion. 

3. Were all of the patients who entered the trial properly accounted for at its conclusion?

Yes, the patients entered the trial properly accounted the intervention program was for 12 weeks and the program completed for the mentioned given period and only with the selected participants. The trail had no interfering factors and all the participants given their consent and completed their trail except for 7 participants who left willingly and the rest of the study was conducted with 61 in the control group and 66 in the intervention group were analysed (Yu et al., 2020). Further, pair t-tests for constant variables or Wilcoxon or McNemar signed-rank tests for descriptive statistics were used for the improvement in outcome measures from baseline to week 12. Hence for this element also the article gets a score 1. 

4. Were patients, health workers and study personnel blind to treatment?

At baseline and week 12, result tests were carried out by qualified research assistants who've been blinded to the group distribution of the patients and independently of integrative investigators (including the fitness instructor and the fitness assistant) who provided therapies. Based on both subjective and quantitative dimensions, outcomes were assessed (Roever & Oliveira, 2016). Although it meets criteria of blind treatment for all three categories that are patients, study personal and health workers. But the authors state that the declines in FRAIL scores can also be partially clarified by the unblinding of group assignment including the use of block randomization. Hence it can be said “can’t tell” and it gets a score of 0.5. 

5. Were the groups similar at the start of the trial?

In terms of age, ethnicity, degree of frailty and other relevant facts about their health, both care groups were identical at baseline, which may have a positive effect on the study result. This also increases the validity of the article.  According to Grady et al. (2017), the important aspect of the validity of a research article is that the groups are similar until the end of the completion of the trail. Hence, this gets a score 1.  

6. Aside from the experimental intervention, were the groups treated equally?

According to the author's Yu et al. (2020), there were no significant disparities in age, ethnicity, marital status, educational qualifications, jobs, living conditions, discretionary cash, physical activity, smoking, alcohol consumption, body weight, frailty and physical measurements (FRAIL portion subscores, grip power, muscle capacity, coordination, gait speed), cognitive measurements, correlation of the baseline characteristics and the treatment outcomes (Yu et al., 2020). Also, the two got the same of trails and intervention sessions which showcases the equality between the two groups hence it gets a score 1 for this element (Manzini et al., 2020). 

Section B reliability 

1. How large was the treatment effect?

The frail total score was the primary outcome of the study and baseline characteristics including balance, muscle endurance, gait speed and grip strengths were their secondary outcomes. There was a significant frail score difference seen in the control group and intervention group 1.3% and 1.5%.  After 12 weeks of intervention, the frail score reduced to -1.3 for intervention group but for the control group, it increased by 0.3% (Yu et al., 2020). Life satisfaction and quality of life improved for both intervention and control group. Further, the intervention group reported the improvements in baseline characteristics three times more than the control group. Balance and muscle endurance showed improvement by 3.5 that is for of the older adults included in the study by 95%. Although there were no improvements or adverse effects seen in the gait speed and grip strength. So this criteria meets the standards only to a moderate extent and is given a 0.5 score (Stack et al., 2020). 

2. How precise was the estimate of the treatment effect?

The analysis found an incident rate ratio of 0.68, with 95 per cent confidence that the overall average for treatment intervention will range between 0.49-0.99. The large confidence interval and the similarity of the greater confidence interval value (0.99) to 1 indicate that the accuracy of the predicted procedure is unknown and that the findings of the trial should be viewed with caution. Since the accuracy of the predicted treatment result is uncertain, this problem will be assigned a 0.5 score.

Section C applicability 

1. Can the results be applied to the local population, or in your context?

Participants were enrolled into the sample using specific guidelines for participation and exclusion, were correctly randomised into different care groups and were comparable in terms of relevant baseline health characteristics and results showed significant improvements in the treatment group. However, the research sample was not sufficiently large, thus the reported broad confidence interval, which undermines the applicability of the results of the study. So, it cannot be applied to the large population and based on the different local population (Buti & Zaheer, 2019). Hence, it can be given a score of 0.5.

2. Were all clinically important outcomes considered?

Yes, the article sufficiently describes all the clinical outcomes in terms of baseline characteristics and frail score which shows its applicability and can be given score 1. 

3. Are the benefits worth the harms and costs?

Yes, the intervention used in this research is cost-effective and showed efficacy in terms of decrease in frail score. Also, the intervention clearly shows that there are no adverse side effects. Moreover, the study evaluates that participants admitted an improvement in the quality of life and satisfaction. Thus it is worth harms and cost-effective and can be given score 1(Buti & Zaheer, 2019). 

Summary score- 9 that is high quality 

Conclusion 

The above assessment shows that article by Yu et al. (2020) has attained a high-quality score. Hence this is an applicable, valid and reliable source.  The strengths of the paper include its participant's randomization, equality towards the control and treatment group which does not hinder the outcomes. Also, the outcomes are clearly defined and meet the identified issue and the results show efficacy in primary and secondary outcomes.  Although, the research needs further work as there are many weaknesses. First, the population size should be maximized to now the effect of the intervention on different local and urban populations and to know its impact on different ethnicities. Secondly, to avoid the regression to pre-intervention settings, methods to reduce detraining consequences should be established because some older adults, through targeted therapies, will continue to undergo functional deterioration.