Treatment of Neck Pain with Collateral Meridian Acupressure Therapy by the Australian Journal of Acupuncture - Article Example

Name Institution Course Tutor Date A Critical Review of Treatment of Neck Pain with Collateral Meridian Acupressure Therapy: A Randomized, Sham Intervention Controlled Trial The following is a critical review of the article “Treatment of neck pain with collateral meridian acupressure therapy: A randomized, sham intervention controlled trial” [1] which is published in the Australian Journal of Acupuncture and Chinese Medicine. The research question addressed is whether the Collateral Meridian Acupressure Therapy (CMAT) technique has a short term analgesic effect on neck pain. The research question is stated in such a way that it represents a research problem. It is concerned with the impact of an intervention. As much as a lot of studies have focused on the effectiveness of the new CMAT technique on pain reduction, none of the studies had looked at its effectiveness on neck pain. The use of a control design for such a research question will ensure that the validity of the study is enhanced as the outcome will be measured between the treatment and the control group. According to Roberts & Dicenco [2] a randomised controlled trial (RCT) is the most appropriate design for questions that answer whether healthcare interventions are beneficial. Thus, the research question in this study is well-stated as it seeks to find out whether the CMAT (health intervention) technique is beneficial for neck pain relief. Treatment of neck pain with CMAT is a randomized controlled trial (RCT) type of study. RCT is a study type in which the participants are allocated to a study group, which is usually the treatment condition [3]. The primary objective of using an RCT is to test whether an intervention is plausible by comparing it to a control circumstance, usually either a lack of intervention or other intervention [3]. In this study, CMAT is the treatment intervention being tested for efficacy in treatment of intractable neck pain while sham treatment is the control. The participants are assigned to the available treatment conditions in a random way such that they have an equal chance of being assigned to any group, and hence there was no distinction as to what type of candidates are selected for the CMAT versus the sham treatment groups. The procedures in this study type are controlled in a way to ensure that all the participants in either of the treatment conditions are treated the same way except just for the factors that is supposed to be unique to their group. This unique factor is the intervention being given to them (i.e. CMAT vs. Sham). Thus, from this description, the study type is appropriate to the research question, and the results will be useful as they will help to establish a more appropriate, or advanced intervention for relieving neck pain. The outcome factors for the study were short-term effect of CMAT and neck pain which were most relevant and were all assessed to reveal the relationship. The outcomes were measured in terms of ‘no pain’ and ‘severe pain’ after the interventions had been administered. To measure the outcomes, the study has involved people experiencing intractable neck pain from which the outcomes were measured as from the intervention and control groups. The measurement error is greatly minimized because random allocation minimizes the chance that either group is not replica of the population [4]. Measurement error can be an important source of bias but the random allocation in this study has greatly helped to reduce the bias. When part or all of an important link between two outcomes arises through being related with another variable, a confounding occurs [4]. The study has adequately considered important confounders that may have complicated the relationships between the variables. One of the most important considerations is ensuring that there is no group difference in the demographics of the participants and the pain data. The study has only considered pain originating from the neck despite the demographic characteristics that the participants may fall in. This ensures that the data collected is precise to address the research question as to whether CMAT is a better technique for relieving neck pain among the patients. The control of confounders such as age and gender enhances the validity of the study as it concentrates on the neck pain variable which is meant to be studied. It also reduces the chances of biasness that may arise from labelling a group within a group as being more likely to face pain than the other. Control of the confounding factors has enabled the restriction to study of the variables that were originally intended for the study. RCT is believed to provide the most valid evidence on the effectiveness of the studied interventions because the procedures used during the carrying out of an RCT reduces the risk of confounding factors affecting the results. Therefore, the results generated by RCTs are at a higher chance of being closer to the true effect as compared to findings generated by other research types. In this regard, it can be comfortably stated that the measurement error is greatly minimized in the procedure used, and hence the validity of the study has been enhanced. The sampling procedure is an important part of any study as it enables the researcher to decide on the respondents that will adequately provide answers to the research question or objective. Therefore, determining the sample size and the sampling method is a major issue in planning research. A sampling frame is a pre-defined list or traits that the researcher uses to determine the population of interest [6]. The sampling frame defines a set of characteristics from which a researcher can choose a sample of the target population. A sampling frame is necessary because the researcher lacks direct access to the entire population of interest in the research to come up with an intervention to benefit the entire population [6]. Thus, the researcher must rely on the sampling frame. The sampling frame in this study is ideal for getting answers to the research problem as it entailed 60 patients suffering from neck pain and restricted neck movement. Random sampling which is also referred to as probability sampling was used to allocate the patients either to the intervention group or the control group. The random sampling achieved an equal number of 30 participants in the intervention group and 30 participants in the control group. Random sampling is often used when the participant being selected is known and these participants are sampled independently from each other. For example, in the study, all the participants are known to have neck pain and restricted neck movement but no other factor is used to determine which person should be placed in the control or treatment group. Selection bias is reduced in this study because of selecting the participants on the basis of a random number. Thus the external validity of the study can be relied upon. The way in which subjects are assigned to study groups are crucial to the validity of studies. Ways of assigning subjects to groups may vary from one type of experiment to another. In RCT they are randomly assigned to treatment and control groups as already discussed. Experimental assigning of subjects involves having a group on which the experiment is administered, or varies from the control group while assessing the variable under study [6]. In a longitudinal study, subjects are assigned in cohorts that enable the researcher to do a follow up over a stretched period of time. Longitudinal studies are affected by many threats of internal validity, especially on the basis of time factor or validity. Thus, in a longitudinal study, usually not all participants reach the final follow up. In a case control, subjects with a specific condition-the case-and the persons without the condition-the controls-are assigned to the relevant groups [6]. In the article under review, all participants completed the study as the experiment offered faster and more valid results as compared to a longitudinal study in which time factor can be an issue. CMAT is a technological procedure that can be affected by the time factor or historical and social changes. Statistical tests have been considered in the study as it involved measurement of pain after treatment effects had been administered. Pain was recorded on a scale of 0 to 5 to show least severe pain to most severe pain after treatment. A confidence interval is calculated for a measure of treatment effect and shows the range within which the true measurement effect will occur [7]. In the study, it has been given as 0.7+/-0.6 with CMAT. Other important statistical measures included are Chi-square tests to analyse categorical data, and t-tests which were used to analyse continuous data. These tests were appropriate for the data as the data was presented in categories (CMAT vs. Sham) and in a continuous way (pains scale 0-5). The difference between effects in the two groups is usually the pure effect of the treatment in a well conducted RCT, and this further increases the validity of the results. The results are presented as relative risk reduction as the CMAT potential benefits are emphasized. CMAT has been stated as being able to induce a sudden analgesic impact on neck pain. This result is useful as can enable to provide an intervention in the area of neck pain treatment in the society. The results obtained from the study are clinically and socially significant. People develop neck pains and various ways to administer analgesics are being tried through studies. The discovery that CMAT can be effective to neck pain as it is to other forms of pains is important in helping health policy makers to arrive at beneficial health decisions. Acupuncture therapies are proving to be vital and can be of great assistance as analgesic therapies [1]. Acute and chronic pain is very common among the population and thus such an intervention is of great benefit. The findings of the study prove its worth that the health budget can be increased for the further study and utilization of the CMAT technique. Ethical procedures are very important especially for human subjects. One of the strong points of this study is that ethical procedures were followed in the recruitment and selection of participants [5]. Participants were involved in the treatments after informed consent was given. However, this was also with serious challenges that have been noted, but for most randomized trials. First, for valid results, it was required that the subjects be blinded, hence the entire contents of the research could not be revealed. Also, it is unethical to assign participants to the inferior treatment. Although the subjects were blinded, it does not seem right that some subjects received the sham treatment which is far less inferior to the CMAT. However, the ethical issue can be argued on the basis that the researchers were not aware of the CMAT technique being the one of superior treatment in regards to neck pain. The ethical issue has been resolved by subjecting the control participants at least to some form of treatment rather than if they were subjected to none. Completely resolving this ethical issue would require informing the subjects of all the procedures but this would have affected the validity of the study because of being aware of the ongoing experiment. Every good study must have concluding remarks from the author in order to show in summary the research problem that has been addressed and their thoughts about the entire research process. The authors concluded that CMAT technique has the ability to induce a short-term effect on neck pain, and further research is required to find out its long-term effect on the same. This conclusion well-answers the research question about finding the effect of CMAT technique on neck pain relief. The results are well suited to the intended population, and can be replicated for future studies. In conclusion, the research question presented in the article has been well addressed through the randomized control study design. All procedures have been followed in a way that validity of the results has been enhanced. The conclusion presented by the authors captures all the issues addressed in a precise manner. References: 1. Wong K, Yap B, Fung BK. Treatment of neck pain with collateral meridian acupressure therapy: A randomized, sham intervention controlled trial. Australian Journal of Acupuncture and Chinese Medicine, 2012; 7(1): 10-15 2. Roberts J, & Dicenso, A. Identifying the best research design to fit the question, part 1: Quantitative designs. Evidenced Based Nursing Journal, 1999; 2: 4-6. 3. West A, Spring B. Randomized controlled trials. EBBP, 2009; 1-62. 4. Hopkins W. Quantitative research design. SportScience, 2000; 4(1). 5. Kendall JM. Designing a research project: Randomized controlled trials and their principles. Emergency Medicine Journal, 2003; 20: 164-168. 6. Bowling A. Research methods in health: Investigating health and health services. 2nd ed. Philadelphia: Open University Press; 2002. 7. Balakrishnan N, Read C, Vidakovic B, Kotz S, Johnson N. Methods and applications of statistics in the life and health sciences. NY: John Wiley &Sons; 2009 Read More