Advanced Levels of Clinical Inquiry and Systematic Reviews.

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Advanced Levels of Clinical Inquiry and Systematic Reviews.

´Introduction

´Assess topic: The effectiveness of the Prolonged Use of the Continuous Passive Motion (CPM), as an Adjunct to Physiotherapy after Total Knee Arthroplasty (TKA).Advanced Levels of Clinical Inquiry and Systematic Reviews.

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´Explore development of PICOT question.

´Evaluate the various research levels and the articles selected.

´General results from the research process.

´Clinical Issue of Interest

´The effectiveness of the Prolonged Use of the Continuous Passive Motion (CPM), as an Adjunct to Physiotherapy after Total Knee Arthroplasty (TKA).

´TKA is knee replacement surgery for those with knee damage.

´CPM is therapy using machine for joint motion.

´Developing PICOT Question

´PICOT Question: – What is the effectiveness of the Prolonged Use of the Continuous Passive Motion (CPM), as an Adjunct to Physiotherapy after Total Knee Arthroplasty (TKA)?Advanced Levels of Clinical Inquiry and Systematic Reviews.

´CPM is an alternative to physiotherapy in helping the patients move the joints.

´CPM mostly used on knee joints.

´Goal is to assess whether they are an effective supplementary for patients with TKA to enhance patient outcomes.

´Level I Research Database

´Cochrane Database of Systematic Reviews database.

´Used CPM as search term.

´Yielded 5 relevant sources.

´Harvey et al. (2014) article selected.

´Contends that effectiveness of CPM as treatment is unclear.

´Level II Research Database

´Used critically appraised topics.

´Used the National Guideline Clearinghouse database

´Used total knee replacement as key term.

´Yielded 27 relevant results.

´Evidence supports that CPM after TKA does not improve patient outcomes.

´Initializing rehabilitation measures early helps improve patient outcomes.

´Level III and IV Research Databases

´Level III Critically- Appraised Individual Articles

´Used evidence-based nursing database and total knee replacement as search term.Advanced Levels of Clinical Inquiry and Systematic Reviews.

´Erduran et al. (2017) contend that AROM is better than CPM for TKA in reducing pain severity.

´Level IV- Randomized Controlled Trial

´Used search term CPM or early mobilization and total knee replacement.

´Boese et al. (2014) contend that CPM is not beneficial especially in early mobility after TKA.

´Conclusion

´Topic: The effectiveness of the Prolonged Use of the Continuous Passive Motion (CPM), as an Adjunct to Physiotherapy after Total Knee Arthroplasty (TKA).

´Level I research contends that effectiveness of CPM as treatment is unclear.

´Level II research from National Guideline Clearinghouse database has evidence that CPM after TKA does not improve patient outcomes.

´Level III research contend that AROM is better than CPM for TKA in reducing pain severity.

´Level IV research shows that CPM is not beneficial especially in early mobility after TKA.Advanced Levels of Clinical Inquiry and Systematic Reviews.

´References

´Boese, C. K., Weis, M., Phillips, T., Lawton-Peters, S., Gallo, T., & Centeno, L. (2014). The Efficacy of Continuous Passive Motion After Total Knee Arthroplasty: A Comparison of Three Protocols. The Journal of Arthroplasty, 29(6), 1158–1162.

´Erduran, M., Eymir, M., & Ünver, B. (2017). AB0806 The effect of repetitive active range of motion versus continuous passive motion on early functional outcomes after primary total knee replacement. Abstracts Accepted for Publication. Advanced Levels of Clinical Inquiry and Systematic Reviews.

´Harvey, L. A., Brosseau, L., & Herbert, R. D. (2014). Continuous passive motion following total knee arthroplasty in people with arthritis. Cochrane Database of Systematic Reviews.

´National Guideline Clearinghouse (NGC). Guideline summary: American Academy of Orthopedic Surgeons clinical practice guideline on surgical management of osteoarthritis of the knee. In: National Guideline Clearinghouse (NGC). Rockville (MD): Agency for Healthcare Research and Quality (AHRQ); 2015 Dec 04.Advanced Levels of Clinical Inquiry and Systematic Reviews.

Searching Databases

In acquiring a background on a topic to develop evidence-based practice, a researcher must identify resources that are both accurate and scientific (Laureate Education, 2018). Using evidence-based research techniques and databases helps the nurse researcher find reliable information on topics for the implementation of new practices. Sifting through all the information available on a topic can be daunting at first. With the help of technology, researchers can wade through massive amounts of research by simply clicking a button or changing keywords in the search. Advanced Levels of Clinical Inquiry and Systematic Reviews.

PICOT Question

The PICOT question I developed is: What is the effectiveness of the Prolonged Use of the Continuous Passive Motion (CPM), as an Adjunct to Physiotherapy after Total Knee Arthroplasty (TKA)?

Search Terms

This week I used similar keyword searches to locate articles. My key search terms were: Continous Passive Motion (CPM), total knee replacement, and early mobilization.

Filtered Databases

Level I Systemic Review: I used the Cochrane Database of Systematic Reviews database, search term CPM, five hits yielded two relevant sources. I chose one article from those results. According to (Harvey et al. (2014), “The effects of continuous passive motion (CPM) on range of motion (ROM), pain, function and quality of life are too small to justify its use and costs but the effects of CPM on participants’ global assessment of treatment effectiveness are unclear” (p.20). Advanced Levels of Clinical Inquiry and Systematic Reviews.

Level II Critically- Appraised Topics: I used the National Guideline Clearinghouse database, searched the term total knee replacement, 27 hits yielded, and three relevant sources. I chose one source to gather the information I needed. According to the National Guideline Clearinghouse (2015), strong evidence supports that CPM after Total Knee Arthroplasty (TKA) does not improve outcomes. Evidence supports that postoperative mobilization in conjunction with early initiation of rehabilitation measures (started on the day of the TKA) reduces the duration of hospital stay. Advanced Levels of Clinical Inquiry and Systematic Reviews.

Level III Critically- Appraised Individual Articles: I used the Evidence-Based Nursing database, searched the term total knee replacement, 6,680 hits yielded, and four relevant sources. According to Erduranet. al. (2017), for patients with TKR, the application of repetitive AROM has better results than CPM to decrease pain severity.

Unfiltered Database

Level IV- Randomized Controlled Trial: I used CINAHL Plus with Full-Text database, search term CPM or early mobilization and total knee replacement, 51 hits yielded ten relevant sources. I chose one article from this search. According to Boese et al. (2014), results provide evidence that CPM is not beneficial, at least in a facility that is focused on early mobility and a short hospital length of stay following TKA surgery. Advanced Levels of Clinical Inquiry and Systematic Reviews.

Conclusion

There is strong evidence that the use of CPM machines for postoperative knee replacement patients is not beneficial. Currently, my facility has been without the use of CPM for three years, I have personally seen the decrease in post-op complications that can arise from being “anchored” to bed instead of early mobility that we currently practice. Advanced Levels of Clinical Inquiry and Systematic Reviews.

Evidence-Based Project Part 2: Advanced Levels of Clinical Inquiry and Systematic Reviews

Create a 7-slide PowerPoint presentation in which you do the following:

Identify and briefly describe your chosen clinical issue of interest. The clinical issue question is – What is the effectiveness of the Prolonged Use of the Continuous Passive Motion (CPM), as an Adjunct to Physiotherapy after Total Knee Arthroplasty (TKA)?
Describe how you developed a PICO(T) question focused on your chosen clinical issue of interest –Identify the four research databases that you used to conduct your search for the peer-reviewed articles you selected.

	Excellent	Good	Fair	Poor
Part 2: Advanced Levels of Clinical Inquiry and Systematic Reviews Create a 7-slide PowerPoint presentation in which you do the following: · Identify and briefly describe your chosen clinical issue of interest. · Describe how you developed a PICO(T) question focused on your chosen clinical issue of interest. · Identify the four research databases that you used to conduct your search for the peer-reviewed articles you selected. · Provide APA citations of the four peer-reviewed articles you selected. · Describe the levels of evidence in each of the four peer-reviewed articles you selected, including an explanation of the strengths of using systematic reviews for clinical research. Be specific and provide examples.	81 (81%) – 90 (90%) The presentation clearly and accurately identifies and describes in detail the chosen clinical issue of interest. The presentation clearly and accurately describes in detail the developed PICO(T) question. The presentation clearly and accurately identifies four or more research databases used to conduct a search for the peer-reviewed articles selected. The presentation clearly and accurately provides full APA citations for at least four peer-reviewed articles selected, including a thorough and detailed explanation of the strengths of using systematic reviews for clinical research. The presentation includes specific and relevant examples that fully support the research. The presentation provides a complete, detailed, and accurate synthesis of two outside resources related to the peer-reviewed articles selected, and fully integrates at least two outside resources and two or three course-specific resources that fully support the presentation.	72 (72%) – 80 (80%) The presentation accurately identifies and describes the chosen clinical issue of interest. The presentation accurately describes the developed PICO(T) question focused on the chosen clinical issue of interest. The presentation accurately identifies at least four research databases used to conduct a search for the peer-reviewed articles selected. The presentation accurately provides APA citations for at least four peer-reviewed articles selected, including an adequate explanation of the strengths of using systematic reviews for clinical research. The presentation includes relevant examples that support the research presented. The presentation provides an accurate synthesis of at least one outside resource related to the peer-reviewed articles selected. The response integrates at least one outside resource and two or three course-specific resources that may support the presentation.	63 (63%) – 71 (71%) The presentation inaccurately or vaguely identifies and describes the chosen clinical issue of interest. The presentation inaccurately or vaguely describes the developed PICO(T) question focused on the chosen clinical issue of interest. The presentation inaccurately or vaguely identifies at least four research databases used to conduct a search for the peer-reviewed articles selected. The presentation inaccurately or vaguely provides APA citations for at least four peer-reviewed articles selected, including an inaccurate or vague explanation of the strengths of using systematic reviews for clinical research. The presentation includes inaccurate or vague examples to support the research presented. The presentation provides a vague or inaccurate synthesis or outside resources related to the peer-reviewed articles selected. The response minimally integrates resources that may support the presentation.	0 (0%) – 62 (62%) The presentation inaccurately and vaguely identifies and describes the chosen clinical issue of interest or is missing. The presentation inaccurately and vaguely describes the developed PICO(T) question, or is missing. The presentation inaccurately and vaguely identifies less than four research databases used to conduct a search for the peer-reviewed articles selected or is missing. The presentation inaccurately and vaguely provides APA citations for at least four peer-reviewed articles selected, including an inaccurate and vague explanation of the strengths of using systematic reviews for clinical research, or is missing. The presentation includes inaccurate and vague examples to support the research presented or is missing. The presentation provides a vague and inaccurate synthesis of no outside resources related to the articles selected and fails to integrate any resources to support the presentation or is missing.
Written Expression and Formatting—Paragraph Development and Organization: Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused—neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction is provided, which delineates all required criteria.	5 (5%) – 5 (5%) Paragraphs and sentences follow writing standards for flow, continuity, and clarity. A clear and comprehensive purpose statement, introduction, and conclusion are provided, which delineates all required criteria.	4 (4%) – 4 (4%) Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time. Purpose, introduction, and conclusion of the assignment is stated yet is brief and not descriptive.	3.5 (3.5%) – 3.5 (3.5%) Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60–79% of the time. Purpose, introduction, and conclusion of the assignment is vague or off topic.	0 (0%) – 3 (3%) Paragraphs and sentences follow writing standards for flow, continuity, and clarity < 60% of the time. No purpose statement, introduction, or conclusion are provided.
Written Expression and Formatting—English Writing Standards: Correct grammar, mechanics, and proper punctuation.	5 (5%) – 5 (5%) Uses correct grammar, spelling, and punctuation with no errors.	4 (4%) – 4 (4%) Contains a few (one or two) grammar, spelling, and punctuation errors.	3.5 (3.5%) – 3.5 (3.5%) Contains several (three or four) grammar, spelling, and punctuation errors.	0 (0%) – 3 (3%) Contains many (five or more) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.

Excellent

Good

Fair

Poor

Part 2: Advanced Levels of Clinical Inquiry and Systematic Reviews Create a 7-slide PowerPoint presentation in which you do the following: · Identify and briefly describe your chosen clinical issue of interest. · Describe how you developed a PICO(T) question focused on your chosen clinical issue of interest. · Identify the four research databases that you used to conduct your search for the peer-reviewed articles you selected. · Provide APA citations of the four peer-reviewed articles you selected. · Describe the levels of evidence in each of the four peer-reviewed articles you selected, including an explanation of the strengths of using systematic reviews for clinical research. Be specific and provide examples.

81 (81%) – 90 (90%)

The presentation clearly and accurately identifies and describes in detail the chosen clinical issue of interest.

The presentation clearly and accurately describes in detail the developed PICO(T) question.

The presentation clearly and accurately identifies four or more research databases used to conduct a search for the peer-reviewed articles selected.

The presentation clearly and accurately provides full APA citations for at least four peer-reviewed articles selected, including a thorough and detailed explanation of the strengths of using systematic reviews for clinical research.

The presentation includes specific and relevant examples that fully support the research.

The presentation provides a complete, detailed, and accurate synthesis of two outside resources related to the peer-reviewed articles selected, and fully integrates at least two outside resources and two or three course-specific resources that fully support the presentation.

72 (72%) – 80 (80%)

The presentation accurately identifies and describes the chosen clinical issue of interest.

The presentation accurately describes the developed PICO(T) question focused on the chosen clinical issue of interest.

The presentation accurately identifies at least four research databases used to conduct a search for the peer-reviewed articles selected.

The presentation accurately provides APA citations for at least four peer-reviewed articles selected, including an adequate explanation of the strengths of using systematic reviews for clinical research.

The presentation includes relevant examples that support the research presented.

The presentation provides an accurate synthesis of at least one outside resource related to the peer-reviewed articles selected. The response integrates at least one outside resource and two or three course-specific resources that may support the presentation.

63 (63%) – 71 (71%)

The presentation inaccurately or vaguely identifies and describes the chosen clinical issue of interest.

The presentation inaccurately or vaguely describes the developed PICO(T) question focused on the chosen clinical issue of interest.

The presentation inaccurately or vaguely identifies at least four research databases used to conduct a search for the peer-reviewed articles selected.

The presentation inaccurately or vaguely provides APA citations for at least four peer-reviewed articles selected, including an inaccurate or vague explanation of the strengths of using systematic reviews for clinical research.

The presentation includes inaccurate or vague examples to support the research presented.

The presentation provides a vague or inaccurate synthesis or outside resources related to the peer-reviewed articles selected. The response minimally integrates resources that may support the presentation.

0 (0%) – 62 (62%)

The presentation inaccurately and vaguely identifies and describes the chosen clinical issue of interest or is missing.

The presentation inaccurately and vaguely describes the developed PICO(T) question, or is missing.

The presentation inaccurately and vaguely identifies less than four research databases used to conduct a search for the peer-reviewed articles selected or is missing.

The presentation inaccurately and vaguely provides APA citations for at least four peer-reviewed articles selected, including an inaccurate and vague explanation of the strengths of using systematic reviews for clinical research, or is missing.

The presentation includes inaccurate and vague examples to support the research presented or is missing.

The presentation provides a vague and inaccurate synthesis of no outside resources related to the articles selected and fails to integrate any resources to support the presentation or is missing.

Written Expression and Formatting—Paragraph Development and Organization:
Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused—neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction is provided, which delineates all required criteria.

5 (5%) – 5 (5%)

Paragraphs and sentences follow writing standards for flow, continuity, and clarity.

A clear and comprehensive purpose statement, introduction, and conclusion are provided, which delineates all required criteria.

4 (4%) – 4 (4%)

Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time.

Purpose, introduction, and conclusion of the assignment is stated yet is brief and not descriptive.

3.5 (3.5%) – 3.5 (3.5%)

Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60–79% of the time.

Purpose, introduction, and conclusion of the assignment is vague or off topic.

0 (0%) – 3 (3%)

Paragraphs and sentences follow writing standards for flow, continuity, and clarity < 60% of the time.

No purpose statement, introduction, or conclusion are provided.

Written Expression and Formatting—English Writing Standards:
Correct grammar, mechanics, and proper punctuation.

5 (5%) – 5 (5%)

Uses correct grammar, spelling, and punctuation with no errors.

4 (4%) – 4 (4%)

Contains a few (one or two) grammar, spelling, and punctuation errors.

3.5 (3.5%) – 3.5 (3.5%)

Contains several (three or four) grammar, spelling, and punctuation errors.

0 (0%) – 3 (3%)

Contains many (five or more) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.

Provide APA citations of the four relevant peer-reviewed articles at the systematic-reviews level related to your research question. If there are no systematic review level articles or meta-analysis on your topic, then use the highest level of evidence peer reviewed article.
Describe the levels of evidence in each of the four peer-reviewed articles you selected, including an explanation of the strengths of using systematic reviews for clinical research. Be specific and provide examples.Advanced Levels of Clinical Inquiry and Systematic Reviews.

Advanced Levels of Clinical Inquiry and Systematic Reviews.

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