Chamberlain College of Nursing NR439: Evidence-Based Practice

Reading Research Literature Week 5

Type your answers to the following questions using complete sentences and correct
grammar, spelling, and syntax. Click Save as and save the file with your last name and
assignment, e.g.,NR439_Reading_Research_Literature_Smith. Submit by 11:59 pm MT
Sunday at the end of Week 5. The guidelines and grading rubric for this assignment may be
found on the assignment page.
Title: RRL
Name: Hannah Dorvil
The following questions pertain to:

Velayutham, S. G., Chandra, S. R., Bharath, S., & Shankar, R. G. (2017). Quantitative

balance and gait measurement in patients with frontotemporal dementia and

Alzheimer diseases: A pilot study. Indian Journal of Psychological Medicine, 39(2),

176-182. doi:10.4103/0253-7176.203132

http://proxy.chamberlain.edu:8080/login?url=http://search.ebscohost.com/login.aspx?direct=
true&db=a9h&AN=122248443&site=eds-live&scope=site

1) What is the purpose of this research?

The purpose of this research study is to determine whether or not subcortical signs
such as abnormal adverse effects to gait and balance, which tend to be easier to
measure, can act as good biomarkers in early specific diagnosis of Alzheimers
Disease or Frontotemperal Demensia

2) What is the research question (or questions)? This may be implicit or explicit.

Can abnormal adverse effects to gait and balance, which tend to be easier to measure,
act as good biomarkers in early specific diagnosis of Alzheimers Disease or
Frontotemperal Demensia?

3) Give a complete description of the research design of this study.

This research study was a quantative study.

The study wanted to answer the following: Can abnormal adverse effects to gait and
balance, which tend to be easier to measure, act as good biomarkers in early specific

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diagnosis of Alzheimers Disease or Frontotemperal Demensia?

The hypothesis was that abnormal adverse effects to gait and balance, which tend to
be easier to measure, act as good biomarkers in early specific diagnosis of
Alzheimers Disease or Frontotemperal Demensia.
The sample for this study was 24 men ages 50 70, split into three groups. One group
with possible FTD diagnosis, one with possible AD diagnosis, and one with clean bill
of health to act as the control group. The patients with possible FTD and AD were
selected from Outpatient Department of Neurology and Geriatric Clinic. The Control
group was selected from the community. All the participants were informed of their
participation within the study. As such consent was obtained and ethical clearance
was achieved from the Institute Ethical Committee. Subjects with orthopedic, visual
deficit, other neurological conditions, and cardiovascular ailments were excluded as to
avoid potential biases. Also demographics factors (height, weight, age, gender) were
also recorded. These were important to see if any of those factors had bearing on the
result.
The balance was measured by Biodex Balance Master Incorp., using dynamic
posturography, in single and dual tasks. Gait was measured with Biodex Gait Trainer.
The Balance assessment was split into two parts, (1) dynamic balancing and (2) limits
of stability, and were performed as a single task and also as a dual task (included a
cognative test along with dynamic balancing and LOS). The Gait assessment also was
performed as a single task and dual task.
The results were acquired from the assessments using the recorded data from the
equipment, the Biodex Gait Trainer and Balance Master, where the assessments
where held on.

4) What is the population (sample) for this study.

There were 24 Men from ages 50 70, split into 3 groups. The first group was a
group of 8 men potentially having FTD. The second group of 8 men potentially had
AD. The third group of 8 men had a clean bill of health, and acted as the control
group within the study.

5) Was the sample approach adequate for the research design that was selected and explain
why.

The sample approach wasnt adequate since in order the gain small margins of error
more participants are required. Additionally the study only included men. AD and
FTD arent only restrictive to men, so it is important to include women as well in
order to get results that are representative of the entire population of people with or
suseptable to AD and FTD. Also it seems as though they used convenience sampling
in order to obtain their sample size. They picked people from the Outpatient
Department of Neurology and Geriatric Clinic. This can be considered adequate but it
still excluded women. And since women are still affected by FTD and AD for this

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Chamberlain College of Nursing NR439: Evidence-Based Practice

sample to encompass the demographic of those affected by AD and FTD then women
should be included.

6) Describe the data collection procedure.

The sample for this study was 24 men ages 50 70, split into three groups. One group
with possible FTD diagnosis, one with possible AD diagnosis, and one with clean bill
of health to act as the control group. The patients with possible FTD and AD were
selected from Outpatient Department of Neurology and Geriatric Clinic. The Control
group was selected from the community.
The balance was measured by Biodex Balance Master Incorp., using dynamic
posturography, in single and dual tasks. Gait was measured with Biodex Gait Trainer.
The Balance assessment was split into two parts, (1) dynamic balancing and (2) limits
of stability, and were performed as a single task and also as a dual task (included a
cognative test along with dynamic balancing and LOS). The Gait assessment also was
performed as a single task and dual task.
To test Dynamic Balancing, three trials were done with each of them being 20
seconds in duration. The amount of deviation from original BOS and direction of
deviation were recorded without using handrail support. The test results contain
overall balance index, anteroposterior index (amount of front to back sway),
mediolateral index (side to side sway). A higher score indicated poorer balance. This
was done as a single task and as a dual task which included balancing and a cognative
test.
To test the limits of stability, the subjects were required to perform a self-initiated
sway in eight different directions and then return to the original balanced position.
The maximum score to be achieved by an individual was 100 and they had 300
seconds to complete the test. The higher the score and the shorter the time taken is an
indicator better the balance. This was done as a single task and as a dual task which
included balancing and a cognative test.
The gait test was done by having the subject walk on a treadmill at a comfortable
speed. The gait speed, stride, step length, and the coefficient variation of the steps
were recorded. Then a congnitive test was added as well. The higher the score in gait
parameter indicates better gait stability, but an increased coefficient variation of steps
indicate poor gait stability.

7) How were the data analyzed after collection?

The Data was analyzed using the Shapiro-Wilkins test which tested the normality of
the parameters which included age, BMI, and education in years. The single and dual
tests in the groups tests were analyzed with paired t-test. One-way ANOVA was
conducted to reveal the difference between groups, followed by post hoc test with
Bonferroni correction.

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Chamberlain College of Nursing NR439: Evidence-Based Practice

8) Discuss the limitations found in the study.

As mentioned before the limitations for this study was the sampling, and as stated in
the end, the funding. There was no funding. It can be assumed that the funding had a
directing implication on the sample size of the study, since it was restricted to just one
Outpatient Department of Neurology and Geriatric Clinic. But also mentioned before,
the absence of women from the study could have also had an effect on the results.

9) Discuss the authors' conclusions. Do you feel these conclusions are based on the data that
they collected?
Yes I believe the conclusion is based on data that the authors collected. This was a
quantitative study. They saw that in older people balance and gait problems are
normal, as well as with people who have AD or FTD, during dual testing. It just goes
to show we cant do two things at once. But the study also shows that it was more
prevalent in people who did have AD or FTD. Also based on the study it was
discovered that in terms of balance those with FTD tend to tilt forward more while
those with AD tend to lean backwards. They conclude that this difference can help as
biomarkers for diagnosis for AD and FTD. The also mention that the study needs to
be conducted with a larger population.

10) How does this advance knowledge in the field?

It allows for earlier diagnosis and also preventative care for those who may develop
AD or FTD later in life. Those with AD or FTD tend to have a higher morbidity rate
with falls due to a lack of balance.

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Chamberlain College of Nursing NR439: Evidence-Based Practice

The following questions pertain to:

Pals, R. S., Hansen, U. M., Johansen, C. B., Hansen, C. S., Jrgensen, M. E., Fleischer, J., &

Willaing, I. (2015). Making sense of a new technology in clinical practice: a

qualitative study of patient and physician perspectives. BMC Health Services

Research, 15(1), 1-10. doi:10.1186/s12913-015-1071-1

http://proxy.chamberlain.edu:8080/login?url=http://search.ebscohost.com/login.aspx?direct=
true&db=her&AN=109884152&site=eds-live

11) What is the purpose of this research?

The purpose of this study was to find out the perspectives of patients and physicians
on whether or not they believed the new technologies for detecting Cardiovascular
Autonomic Neuropathy was useful. This occurred in specialist diabetes clinics. The
technology is a handheld device that measures resting heart rate and conducts three
cardiac autonomic reflex tests to evaluate heart rate variability.

12) What is the research question (or questions)? This may be implicit or explicit.

Do patients and physicians believe that the new technologies for detecting
Cardiovascular Autonomic Neuropathy are useful? Specifically the a handheld device
that measures resting heart rate and conducts three cardiac autonomic reflex tests to
evaluate heart rate variability

13) Give a complete description of the research design of this study.

This was a qualitative study, taking the perspectives of patients and physicians on a
new technology for determining CAN.
The study relied on three sources of data:
o The observations of medical consultations where results of the CAN test
were reported. The sample size was 8.
o Interviews with patients who had received the CAN test. The sample size
was 19.
o Interviews with physicians who reported results of the CAN test. The
sample size was 9.
The data was collected for a period of 3 months at a specialist diabetics clinic.
The data analysed using the concept of tech frames which is used to assess how
physicians and patients understand and think of new technology.

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Chamberlain College of Nursing NR439: Evidence-Based Practice

It was determined that physicians found in difficult to explain and justify the use of
new technologies in a patients routine Specifically, in a way the could understand.
Patients most of the time couldnt even recall using the new technology to test CAN
and they couldnt even recall whether or not they received results and explanations
from their physicians.
It was suggested that more information about the CAN test be provided to the patient
and that the physicians explain the results of a CAN test to the patient in ways they
could understance.

14) What is the population (sample) for this study?

The sample size for this study was 28 people. 19 patients, 9 physicians.

15) Was the sample approach adequate for the research design that was selected and explain
why.

Since this was a qualitative study the sample approach was adequate for the research
design. The intention of a qualitative study is to provide insight into a topic that needs
further study and examination. Also since it wasnt measuring something with the
intention of producing concrete data in the form of numbers, and rather, was trying
gain insight into patient and physician technological frames, the sample was adequate.

16) Describe the data collection procedure.

The data was collected alongside a quantitive study covering the implementation of
the device in question, the vagus. This was a convenience sampling since the facility
presented the study with the appropriate population to sample from. Physicians were
asked to participate in seminars and if the chose to do so the were taught about CAN
and CAN Diagnosis, as well as the vagus. The Laboratory Technicians were the ones
to actually conduct the testing with the Vagus. The results were available to the
physicians, and the researchers conducting the study asked those physicians if they
could act as observer when the results were presented to the patient.

17) How were the data analyzed?

The data (interviews and field observations) were analysed using content analysis to
make inferences about the intentions and interpretations of physicians and patients.
The researchers first tried to identify the technological frames of the physicians and
the patients. Then the data was examined using the following criteria:
o First the separated the data into statements and actions of the physicians and
patients

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Chamberlain College of Nursing NR439: Evidence-Based Practice

o Then they sorted the data into categories suggested by the data
o Then they compared categories generated by the data of physicians and
patients to identify common themes
o Finally they recoded the data using the proposed themes.

The researchers also had to reflect on their own preassumptions and had to figure if their
presence also had an influence on the clinical performance.

18) Discuss the limitations found in the study?

First limitation was that some of patients could not recall whether or not the received
their CAN test results and/or could not elaborate on their feelings for the way the
CAN test was operated
Second limitation was that the Vagus was not test against other similar technologies
that attempted the same thing, CAN Testing.
Third limitation was that there could have been more people included within the
sample, thus making a better study.
The three central concepts used for analysis were intertwined so they couldnt really
be used to determine the technological frames of the patients and physicians involved
within the study.

19) Discuss the authors' conclusions. Do you feel these conclusions are based on the data
that they collected?

The authors concluded that because physicians could not explain the test results well
and use those results to show the implications of the technolology used in the testing
and treatments. Thus it was unlikely for the patients to understand their results and did
not motivate them to change their habits. The authors determined that in order for the
use of technology to stick, more information about the CAN testing and the device
used, the vagus, should be presented to the patients. Additionally a dialogue based
approach was recommended in communicating with the patients, in order to gauge
theyre understanding of the CAN testing method and technology.

20) How does this advance knowledge in the field.

It implies that integrating new technology into clinical practices is extremely difficult
and that providing more information to the physician and the patient will allow for the
patient to be more willing and accepting of new technology whle providing physicians
with more efficient ways of testing, specifically in regards to CAN testing.

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