Quantitative Research Methodologies

This paper critically evaluates three quantitative research methodologies to address the PICOT question. The main goal is to assess study quality regarding validity, reliability, and relevancy applied to shaping clinical practice. The studies under consideration are: “Effects of non-pharmacological interventions on sleep in chronic low back pain: A systematic review and meta-analysis of randomized controlled trials” (Craige et al., 2023), “Palliative care interventions for people with multiple sclerosis” (Latorraca et al., 2019), and ” Virtual reality assisted non-pharmacological treatments in chronic pain management”(Grassini, 2022).

Study 1: Effects of non-pharmacological interventions on sleep in chronic low back pain: A systematic review and meta-analysis of randomized controlled trials (Craige et al., 2023)

Validity of the Study

The systematic review and meta-analysis of non-pharmacological interventions for adults with chronic low back pain has been authored by Craige et al. in 2023. The strengths of the search strategy in this analysis were also that the literature search spanned across six extensive databases such as PubMed, CINAHL, SPORTDiscus, PsycINFO, EMBASE, as well as CENTRAL; the search was conducted from the inception to June 2, 2021. We had inclusion indications for RCTs to help evaluate non-pharmacological interventions for chronic low back pain.

In order to evaluate the presence of bias among the abovementioned studies, the Cochrane Risk of Bias method was applied to determine the weaknesses of the trials. Regardless of the scope of the search, the study revealed the paucity of data and actual high risk of bias, as illustrated in the case of specifically eligible trials (Craige et al., 2023). Sources of bias under bias assessment were random sequence generation, allocation concealment, blinding, incomplete outcome data, selective reporting, and other domains.

Despite the identified limitations, the study reported a moderate improvement in sleep quality (Hedges’ g: -0.33, 95% CI [-0.56, -0.11], p = 0.004 associated with an average decrement in pain intensity (Hedges’ g: -0.69, 95% CI [-1.00, -0.38], p < 0.001). This also highlights the alternative efficacy of non-pharmacological interventions in enhancing the effects of sleep disturbances observed among individuals with chronic low back pain.

Reliability of the Study

The systematic review and meta-analysis approach increases the precision of the study by explaining the evidence from different RCTs. A total of 13 studies involving 1348 participants were included in the review. Both estimated standardized mean differences (Hedges’ g) are based on the pairwise random-effect meta-analysis taken at the end-of-intervention follow-up. Nevertheless, the noted moderate heterogeneity (I2 = 59.3%) also poses contentions regarding the ideological validity of the results, along with distinct experiences among studies.

The study revealed a tiny effect size for pain relief effect; for reduction in pain intensity, they reported a moderate effect size and no significant changes in back-related disability. The homogeneity of these results in pain interventions varies, and this study. At the same time, its criteria considered this; it did not stipulate these search criteria to focus on pain interventions alone (Craige et al., 2023).

Applicability of the Study

The results reveal that non-pharmacological interventions mainly addressing the reduction of pain may better sleep disturbance in adults with chronic low back pain. Such interventions may include assessment to provide insight into the nature of pain, as Aiken’s study can be translated to clinical practice, mainly using pain management strategies for this population. Based on clinicians’ perspectives to find an answer to not only pain treatment but also rest disruption due to pain, Non-pharmacological interventions may be helpful (Craige et al., 2023). It can be included in the working repertoire. Nevertheless, it is essential to mention the limitations, including the high risks of bias prevalent in single studies and possible heterogeneity in interventions.

The recommendation for future research to explore sleep-focused interventions specifically developed to improve sleep further reflects the call for targeted treatments to address the intricate relationship between chronic low back pain and sleep disturbances. Due to the less GRADEy rating, future research should take subjective and objective assessments across diverse sleep areas.

Study 2: Palliative care interventions for people with multiple sclerosis (Latorraca et al., 2019)

Validity of the Study

Latorraca et al. (2019) reviewed the effects of palliative care interventions in the case of patients living with MS. It attempted to assess the efficacies and safety of palliative care interventions relative to standard care while diverse MS forms, such as relapsing‐remitting, secondary‐progressive, primary‐progressive, and progressive‐relapsing, were being considered.

The validity of the study is based on a broad literature search done on October 31, 2018, from an extensive range of databases, namely CENTRAL, MEDLINE, Embase, CINAHL, LILACS, ClinicalTrials.gov, and the WHO ICTRP. To be included, studies had to be RCTs, cluster‐RCTs, or the first stage of cross‐over trials that compared palliative care interventions with usual or other palliative care interventions (Latorraca et al., 2019). The evidence quality was evaluated using the Cochrane ‘Risk of Bias’ tool for risk of bias assessment.

However, the fact that only three studies (146 participants) were included in the systematic approach distinguished this method as insufficient evidence. The studies from the included studies evaluated palliative care and its home‐based intervention, one of the studies having participants with ‘neurodegenerative diseases and MS individuals being a subset of the randomized population.

Reliability of the Study

The validity of Latorraca et al.’s (2019) multiple sclerosis study concerning palliative care interventions is undermined by several factors. The study included only three studies with a total sample size of 146 participants; this is a narrow number of participants and raises concerns about the representativeness and generalizability of the findings. Heterogeneity is attributed to the changes in the design of studies employed in two studies, where parallel design is utilized, and a cross‐over design is used in one; this reduced the reliability and comparability of results.

In addition, the lack of long-term follow-up results (> six months postintervention) in vital results such as health-related quality of life, serious adverse events, and hospital admission limits the possibility of coming to complete and durable conclusions. The absence of information dedicated to other outcomes, including fatigue, anxiety, depression, disability, cognitive function, relapse‐free survival, and sustained progression‐free survival, only adds to the unreliability of the evidence since all these variables are crucial to assessing the overall health of people affected by multiple sclerosis because of palliative care interventions (Latorraca et al., 2019). Considering such constraints to generalizing the outcomes reported in the study to justify clinical practice, future research with more significant sample sizes and long-term follow-up is necessary. It is best to create conclusions from studies on that critical aspect of multiple sclerosis management.

Applicability of the Study

The trial draws uncertainty about the effectiveness of palliative care interventions in patients with MS. With the low‐ or very low‐certainty evidence; the study advises a careful use of palliative care interventions under the given limitations. The available evidence should be considered despite the uncertainty by the clinician when opting for palliative practice in patients based on MS.

This limited evidence warrants more studies in the future to understand the effects of palliative care long-term interventions in terms of health-related quality of life, adverse events, and hospital admission. Clinicians should recognize the applicability of palliative care for the patient of MS as it still may vary in interventions and outcomes.

Study 3:Grassini, S. (2022). Virtual reality assisted non-pharmacological treatments in chronic pain management: a systematic review and quantitative meta-analysis.

Validity of the Study

In 2022, Grassini (Grassini, 2022) carried out a systematic review and meta-analysis to determine the efficacy of visual reality regarding chronic pain management, with particular emphasis on chronic neck or back pain. The research’s methodology reveals trustworthy validity in its robust literature review of databases such as PubMed, APA Psychoinfo, CINAHL, clinicaltrials.gov, Cochrane Library, and Embase. This exhaustive search strategy and the fulfillment of keywords and Medical Subject Headings (MeSH) terms guarantees the coverage of literature on VR-assisted chronic pain management (Grassini, 2022). In addition, the study’s inclusion criteria are clear and based only on RCTs emphasizing VR interventions for chronic pain, which adds more strength to the findings. In essence, the research design is reliable, allowing the audience to regard the findings as well-substantiated. It can be used to bolster the current evidence basis, which supports the application of VR for publishing in chronic pain management.

Reliability of the Study

Reliability is evidenced in Grassini’s (2022) study, in which data were extracted systematically with consideration to good quality assessment. Evaluating each identified article was scrupulously conducted to confirm compliance with the study criteria, such as removing duplicate pieces and materializing full-text reviews for in-depth assessment. The data extraction was done thoroughly from each article, and the recorded skills were collected in a standard data-collection form. Using the Newcastle–Ottawa Scale (NOS) to measure bias strengthens the quality of information-level evaluation, with studies scoring above five on the r NOS used for analysis (Grassini, 2022). The main goal of this approach is to give preference to the risk of biased studies. It also increases the validity of the study findings within this study. Moreover, the statistical analysis implemented in the survey, manifested by forest plots and heterogeneity estimation by the I2 test, provides evidence synthesis and improved quality of the results obtained. Grassini’s (2022) study demonstrates methodological and analytical reliability, increasing the evidence quality of VR-assisted chronic pain management.

Applicability of the Study

Grassini’s (2022) research is relevant in addressing a prevalent yet evolving field associated with pain management. Chronic pain is joint, particularly relating to low back and neck pain, and this poses a considerable health challenge worldwide upon the quality of life and resources applied to efficient health service provision. The impact of the study’s findings is significant, mainly for healthcare practitioners and researchers interested in studying the prevalent conditions and developing effective pain management strategies. On the contrary, the omission of non-English publications undermines the validity of universalizing the findings as the non-English speaking population will be left out of the picture, hence leading to the limits of the generalizability of these findings. In addition, though the study focuses on chronic neck and back pain, further study is necessary to understand the real-world VR interventions across other pain conditions, thereby increasing its relevance and use across various healthcare settings.

Conclusion

Overall, the crucial criticism of the three quantitative studies research has valuable information on the validity, reliability, and application of the same in clinical practice. The studies provide relevant conclusions in sleep management in chronic low back pain, palliative care interventions for multiple sclerosis, and non-pharmacological interventions in chronic pain. They also demonstrate their weak points and areas for further research. When considering patient care decisions, clinicians should pay particular attention to the strengths and weaknesses of the evidence that these studies present.

References

Craige, E. A., Memon, A. R., Belavy, D. L., Vincent, G. E., & Owen, P. J. (2023). Effects of non-pharmacological interventions on sleep in chronic low back pain: A systematic review and meta-analysis of randomized controlled trials. Sleep Medicine Reviews, 101761. https://doi.org/10.1016/j.smrv.2023.101761

Grassini, S. (2022). Virtual reality assisted non-pharmacological treatments in chronic pain management: a systematic review and quantitative meta-analysis. International journal of environmental research and public health, 19(7), 4071. https://doi.org/10.3390/ijerph19074071

Latorraca, C. O., Martimbianco, A. L. C., Pachito, D. V., Torloni, M. R., Pacheco, R. L., Pereira, J. G., & Riera, R. (2019). Palliative care interventions for people with multiple sclerosis. Cochrane Database of Systematic Reviews, (10). https://doi.org/10.1002/14651858.CD012936.pub2

Appendices

Legend: SR (systematic review), MS (multiple sclerosis), PC (palliative care)