Qualitative Article Critique

Citation

Emmerson, K.B., Harding, K.E., Lockwood, K.J. and Taylor, N.F. (2018., Home exercise programs supported by video and automated reminders for patients with stroke: A qualitative analysis. Australian Occupational Therapy Journal, 65: 187-197. doi:10.1111/1440-1630.12461

Article Summary

In the article, the researchers examined the role of technology in prescribed home exercise programs for those who have experienced a stroke within the past year. Researchers approached this study in a qualitative fashion. They did this by conducting in-depth interviews. Once the information was gathered, the researchers looked at the commonalities between the results. The framework in this study was phenomenology. The researchers used this in order to get an idea of what the participants were thinking and experiencing during the study. The methods that the researchers used to collect data from the participants were through in depth, semi-structured interviews. These interviews were conducted to look into the patient’s perspective of incorporating technology into their home exercise programs and see the results of doing so. The participants in this study were ten males with a history of stroke and were experiencing upper limb impairment. Participants were chosen if “they had been admitted to a community rehabilitation program in a large metropolitan health service, and had participated in the intervention group of a randomized controlled trial comparing the impact of touch screen tablets to support upper limb home exercise programs with usual care post stroke” (Emmerson, 2018). The duration of the study was over a four week period. During this time, participants were given an iPad that had their home exercise program filmed on it. This was done so that participants could refer back to the videos if needed. Participants were instructed to observe themselves in the video and mimic the exercises while watching.

After the four week research period, interviews were conducted by the principal researcher in a private room at the health facility. These interviews were recorded on a cell phone and were later written out verbatim. Each interview took less than 15 minutes to complete. Four themes were covered during the interview process: “previous use of technology, experiences of using technology for home exercises, the impact of this technology on the patient’s rehabilitation, and their intentions for future use” (Emmerson, 2018). The responses from the interviews were reviewed by two researchers who examined the data closely and assigned codes to sections of the text separately. These codes were given to analyze and interpret data in a meaningful way. After creating common themes from these codes, the researchers met to establish common themes between all of the data. A third researcher joined the analysis process after this, and all together they refined the coding list while discussing their disagreements. Researchers determined that eight participants believed that technology was useful in their rehabilitation plan. Participants reported that using technology for their home exercise programs helped to improve their overall recovery, and it also helped them to recognize that they were making gains. The eight participants added that using technology made the exercise programs more enjoyable because they could monitor their improvement. They also reported that this program helped them to feel stronger and helped increase their upper extremity range of motion. The use of the tablet in their home exercise program also helped with motivation, ease of following instructions, improved organization, and an easier way to review their progress. Caregivers also reported that they enjoyed the use of the tablet because it gave them a way to see what was happening during therapy sessions and help hold the participants accountable. Not all of the participants believed that using the tablets was beneficial. Two of the participants reported that they “felt too old for technology” and that they had difficulty navigating functions (Emmerson, 2018).

Overall, the response to using technology with home exercise programs was positive. All of the participants in this study had the capability of using the technology for the purpose of the study. The majority of the participants believed that using technology in their home exercise program was beneficial to their stroke recovery. This study suggests that touch screen tablets are more beneficial for the delivery of information versus the previous paper-based approach to home exercise programs. The researchers believe this to be true because tablets offer multimodal learning opportunities through vision, hearing, and touch.

Level of Evidence

The level of evidence for this qualitative analysis article is a level 5 because it is a descriptive review of a qualitative study. The researchers looked at the information gathered from the participants on the specified topic. They used an in-depth process to assure that there was minimal bias. They answered a specific question, which looked at the effect of technology on home exercise programs, and drew conclusions about the data gathered. Add the source.

Critique

There were strengths and weaknesses of this article. One of the strengths of this study was that it addressed everything that is important to qualitative analysis: credibility, transferability, dependability, and confirmability. Credibility was addressed because the study used established qualitative research methods. Familiarity was addressed because the organization used to gather participants was well established. The principal researcher worked on the site that was used to gather participants. Transferability was shown through the contextual information gathered about the sites and the participants. All of this information had been provided to the research team. This trial was referenced and could easily be further examined. This research was dependable because there was in depth information provided about the research design and analysis process. Confirmability was addressed because an audit trail was provided. There was an in depth and clear description of the steps taken to complete and review the data collected from the research.

Limitations in the study were shown in the sample size that was used and in the participants used. The sample size that was used was small, it only had ten participants. Having a larger sample size to pull information from would give more information to the researchers. Also, the study only focused on the male reaction to home exercise programs and technology. If this study was to be done again, the researchers should include women. This could determine whether similar results would occur, and what differences could be found. Another limitation that could come from this study is the fact that interviews were conducted only by the principal researcher. This principal researcher also supervised many of the interventions. This could have caused respondent bias where participants may hold certain information from the researcher or alter their answers to make the researcher happy. Because of this possibility, the researchers used multiple strategies to prevent this. There was a strict schedule for interviews, member checking, and coding was done by multiple researchers. Also, the researchers involved in this study believed that prolonged engagement with participants built up credibility and also increased rapport between the participant and the researcher. The researchers believed this decreased respondent bias.

Application

1. Practitioners could apply this study to their own practice if they are working with a client who is experiencing memory loss. Practitioners could record their clients doing their exercises and instruct them to set an alarm for each day to complete the exercises. Setting an alarm can encourage participants to complete their home exercises daily and give them a schedule to follow. By combining this with a visual aid, there is a better chance of the client completing the exercise program given to them.

2. Families could use this information to help understand what is going on during therapy sessions. Family members can ask the participant’s occupational therapists or physical therapists to record things that are covered during therapy sessions. Family members and participants can then watch the videos back and repeat them at home together.

3. Caregivers can get involved in this by having practitioners record themselves doing specific care modalities. For example, if the client has lymphedema and needs someone at home to change their compression garments for them, then the therapist can record themselves changing them. During this recording, the therapist can provide verbal instructions and demonstrate the correct technique for compression wrapping. I experienced this during my level 1A fieldwork and the family member reported that this was helpful for their learning and comprehension of the task.

4. This study shows an alternative approach to the standard paper-based home exercise protocol. If someone is forgetful of the instructions on completing exercises, then this is a great method to use that is multimodal.

5. This research study shows that using multimodal approaches to learning new skills can be applied to different types of clients. Creating a video for a client to watch can be used to help someone remember how to complete transfers safely or remember how to dress themselves with assistive devices.

References

1. Burns, P. B., Rohrich, R. J., & Chung, K. C. (2011, July). The levels of evidence and their role in evidence-based medicine. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3124652/
2. Evidence Pyramid - Levels of Evidence (n.d.). Retrieved from http://www.unm.edu/~unmvclib/cascade/handouts/PICOTpyramidofevidence.pdf
3. Hierarchy of evidence. (2019, December 11). Retrieved from https://en.wikipedia.org/wiki/Hierarchy_of_evidence
4. Research Hub: Evidence Based Practice Toolkit: Levels of Evidence. (n.d.). Retrieved from https://libguides.winona.edu/c.php?g=11614&p=61584