Critical Appraisal of a Research Study

Introduction

The critical appraisal of the article is important as it helps in enhancing the focus on the relevant sources to be used in gathering evidence for the research topic or care delivery process. It helps in refuting the claims made in the article and identifying if the research is reliable to support high-level quality practice (Bhat, Chail and Srivastava, 2021). In this study, the critical appraisal skill programme (CASP) framework is to be used. This is because the CASP tool provide systematic and separate questions to be used for specific methodological research in specifically appraise the quality of the study and determine its efficiency of use in executing relevant care practice (Varai et al., 2020). The study by Lederer et al. (2020) named “Vegan diet reduces neutrophils, monocytes and platelets related to branched-chain amino acids e A randomized, controlled trial” is to be critically appraised which focus on identifying the impact of vegan diet compared to meat-diet on managing inflammation in rheumatoid arthritis. This is important topic to be discussed and appraised because vegan diet has been mentioned in many cases to be effective in managing inflammation in rheumatoid arthritis. However, there are least sources available that explains the biomechanism through which it acts to lower the inflammation (Alwarith et al., 2019). Thus, the current study is important to be appraised to understand its validity of use in understanding the mechanism of vegan diet in controlling lower inflammation in rheumatoid arthritis patients.

Critical Appraisal

Study Design

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The CASP tool informs to determine if the research addresses a focused research question (CASP, 2019). The presence of focussed research question is important because it helps in building effective plan to be followed in the study which would assist in foreseeing the challenges and problems to be resolved through the study leading to save wastage of energy, time and unnecessary effort out of confusion (Lawrie et al., 2020). In the study by Lederer et al. (2020), a clearly research question is focussed which is evident as the outcome of vegan diet on influencing blood cell types and amino acid chains to lower inflammation in rheumatoid arthritis is mentioned to be assessed. The research question also mentioned the population to be studied (healthy omnivore subjects), intervention given (vegan-diet), comparator chosen (meat-diet) and outcome measures (level of monocytes, neutrophils, platelets and amino acid chain) indicating it effectively addressed the focus of the study.

The CASP tool mentioned to confirm if the participants in the intervention was randomised and the use of the method was appropriate or not (CASP, 2019). This is because inappropriate use of method for randomisation of subjects leads to error in gathering participants that manipulate the results and avoid effectively resolving the raised questions (Viele et al., 2020). The study by Lederer et al. (2020) performed the randomisation of the participants electronically by using third dependent person that is python software. The use of the software for randomisation is appropriate because it uses simple syntax in providing highly general data analytics (Krebs et al., 2017). The randomisation helped in eliminating systematic bias because it assists in randomly allocating patients to the intervention and comparison groups where each individual having equal chance to get selected in either of the group. In the study, the participants were not analysed after getting randomised. In the study, no losses for follow-up was identified and the study was done in full course ensuring a complete action was taken to perform the research.

Study Methodology

The CASP tool ask to identify if the participants or the investigators are blinded during the intervention and randomisation event (CASP, 2019). This is because failure to blind the participants or researchers in the study raised the risk of the results to be manipulated by them (Traboulsee et al., 2018). In the study of Lederer et al. (2020), the allocation sequence could not be blinded from the investigator and participants due to the nature of the observational intervention. The CASP Tool mentioned to determine if the study groups were similar at the initiation of the randomisation trail (CASP, 2019). In the study by Lederer et al. (2020), the study groups were similar at the initiation of the study. The criteria for their selection are mentioned in detail which is evident as participants of 18-60 years of age and having BMI 21-30 kg/m2 were selected. The individuals who were under any medication except iodine, have eating disorder, donated blood within 4 weeks, have allergies, a pre-existing vegan, drink alcohol more than 20 g/day and involve in daily nicotine abuse are excluded. Moreover, eligible subjects are ensured they speak German and willing to complete standard nutrition protocol for the study. There were no identified differences in groups expect the diet nature for which the study is performed that could influence the outcomes of the study.

The CASP tool mentions to identify if all the participants were treated equally in the study (CASP, 2019). This is because unequal treatment of participants intends to create bias in the results (Ray et al., 2017). In the study by Lederer et al. (2020), well-defined study protocol was available and the participants in the study are equally treated to avoid any nature of bias. This is evident as each of the subjects were provided training regarding the way they are to maintain their assigned diet that is either meat rich or strict vegan food. The participants were equally provided opportunity to avail discounts that are offered by few of the restaurants in the area. Moreover, the follow-up interval was same for each of the study group that is their baseline and blood parameters were taken after same interval that is 4 weeks.

Results and Discussion

The CASP tool asks to inform whether the intervention in the study are reported comprehensively in appraising them (CASP, 2019). The study by Lederer et al. (2020) mentions that power calculation was executed to comprehensively report the results. The outcomes were also measured and clearly identified in the study which is evident as total platelets, neutrophil, monocyte and leukocyte counts have decreased in the vegan diet group compared to the meat diet group (ANCOVA: leukocytes p=0.003, neutrophils p=0.001, monocytes p=0.032, platelets p=0.004). In addition, serum level of amino acids is lowered in vegan diet group compared to the meat diet group. In each of the groups, the level of change in the outcome are expressed in tables. No missing or incomplete data are found in the study, but the potential sources of bias were not reported due to which if error has occurred in result presentation could not be identified. The p values are appropriately reported but the confidence intervals are not reported. Thus, the range of scores to be developed on repetition of the study could not be identified (Lederer et al., 2020). There was no differential dropout in the groups ensuring uniformity is maintained and a total of 53 participants are selected for the study.

The CASP tool mentions to determine if the size of the experimental intervention has over weighted the harms and cost of the study (CASP, 2019). In the study by Lederer et al. (2020), the size of the intervention effect was 53 subjects. No harm were intended towards them and all the participants are mentioned to willingly participate in the study. In the study, written consent from the participants are taken and their confidentiality are strictly maintained. it ensures that ethical considerations are effectively followed in executing the study. The results in the study are going to help locally by acting as evidence regarding the better health to be expected with taking vegan diet compared to meat rich diet for patients with rheumatoid arthritis.

Evidence Based Study

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Evidence based study indicates that information from existing studies are taken in making decision regarding patients care so that quality support could be provided. The evidence-based research is important because it helps in limiting error in care and ensure better explanation of the way care is to be delivered to the patients. It helps in imparting greater knowledge to the patients and nurses regarding the importance of inclusion certain care (Melnyk et al., 2018). The findings from the study is to be used as evidence to inform rheumatoid arthritis patients regarding the need of them to adopt vegan diet and explain the parameters to be reduced with the adoption of the diet that would offer them relief from the inflammation.

Conclusion

The above discussion informs that the study by Lederer et al. (2020) is effective in informing the way blood cells are impacted to reduce inflammation in rheumatoid arthritis patients who are vegan diet compared to meat rich diet. In the study, the methodology for randomised control trail is effectively followed and no dropout from the group are identified during the course of the study. The study explained that the white blood cells which are responsible for causing destruction and inflammation of joints in rheumatoid arthritis are lowered in people who follow vegan diet compared to meat rich diet indicating the later diet is avoided to be followed by the participants.

References

  • Alwarith, J., Kahleova, H., Rembert, E., Yonas, W., Dort, S., Calcagno, M., ... & Barnard, N. D. (2019). Nutrition interventions in rheumatoid arthritis: the potential use of plant-based diets. A review. Frontiers in nutrition, 6, 141. https://www.frontiersin.org/articles/10.3389/fnut.2019.00141/full?fbclid=IwAR07QwRV1CBXJMjVGtu96lu35zDyH6TG3z0NK8LFOBhrJ6GdePdGwHHX2kA
  • Bhat, P. S., Chail, A., & Srivastava, K. (2021). Critical appraisal of journal article by psychiatry PG residents using a new module: Impact analysis. Industrial Psychiatry Journal, 30(1), 153. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8395553/
  • CASP 2019, CASP Randomised Controlled Trial Standard Checklist, Retrieved on 20 November 2021 from: https://casp-uk.b-cdn.net/wp-content/uploads/2020/10/CASP_RCT_Checklist_PDF_Fillable_Form.pdf
  • Krebs, N. M., Allen, S. I., Veldheer, S., Martinez, D. J., Horn, K., Livelsberger, C., ... & Muscat, J. E. (2017). Reduced nicotine content cigarettes in smokers of low socioeconomic status: study protocol for a randomized control trial. Trials, 18(1), 1-13. https://link.springer.com/article/10.1186/s13063-017-2038-9;
  • Lawrie, G. A., Graulich, N., Kahveci, A., & Lewis, S. E. (2020). Steps towards publishing your thesis or dissertation research: avoiding the pitfalls in turning a treasured tome into a highly-focussed article for CERP. Chemistry Education Research and Practice, 21(3), 694-697. https://pubs.rsc.org/en/content/articlehtml/2020/rp/d0rp90007a
  • Lederer, A. K., Maul-Pavicic, A., Hannibal, L., Hettich, M., Steinborn, C., Gründemann, C., ... & Huber, R. (2020). Vegan diet reduces neutrophils, monocytes and platelets related to branched-chain amino acids–A randomized, controlled trial. Clinical Nutrition, 39(11), 3241-3250. https://www.sciencedirect.com/science/article/abs/pii/S0261561420300595
  • Melnyk, B. M., Gallagher‐Ford, L., Zellefrow, C., Tucker, S., Thomas, B., Sinnott, L. T., & Tan, A. (2018). The first US study on nurses’ evidence‐based practice competencies indicates major deficits that threaten healthcare quality, safety, and patient outcomes. Worldviews on Evidence‐Based Nursing, 15(1), 16-25. https://sigmapubs.onlinelibrary.wiley.com/doi/abs/10.1111/wvn.12269
  • Ray, L. A., Bujarski, S., Yardley, M. M., Roche, D. J., & Hartwell, E. E. (2017). Differences between treatment-seeking and non-treatment-seeking participants in medication studies for alcoholism: do they matter?. The American journal of drug and alcohol abuse, 43(6), 703-710. https://www.tandfonline.com/doi/abs/10.1080/00952990.2017.1312423
  • Traboulsee, A. L., Machan, L., Girard, J. M., Raymond, J., Vosoughi, R., Hardy, B. W., ... & Li, D. K. (2018). Safety and efficacy of venoplasty in MS: A randomized, double-blind, sham-controlled phase II trial. Neurology, 91(18), e1660-e1668. https://n.neurology.org/content/91/18/e1660.abstract
  • Varai, S., Dehghan Nayeri, N., Hosseiny, S. F., & Ahmadi Chenari, H. (2020). Critique and evaluation of published articles quality of Health Sciences qualitative Researches Journal based on CASP scale. Journal of Qualitative Research in Health Sciences, 8(4), 9-15. http://jqr1.kmu.ac.ir/article_90986_12194.html
  • Viele, K., Broglio, K., McGlothlin, A., & Saville, B. R. (2020). Comparison of methods for control allocation in multiple arm studies using response adaptive randomization. Clinical Trials, 17(1), 52-60. https://journals.sagepub.com/doi/pdf/10.1177/1740774519877836
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