Evidence-Based Project Part 3A: Critical Appraisal of Research

Use this document to complete the evaluation table requirement of the Module 4 Assessment, Evidence-Based Project, Part 3A: Critical Appraisal of Research

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Critical Appraisal Tool Worksheet Template  Filled (Evidence-Based Project Part 3A: Critical Appraisal of Research)

 Evaluation Table

Use this document to complete the evaluation table requirement of the Module 4 Assessment, Evidence-Based Project, Part 3A: Critical Appraisal of Research

Full APA formatted citation of selected article.	Article #1	Article #2	Article #3	Article #4
Stewart, S., Wiley, J. F., Ball, J., Chan, Y. K., Ahamed, Y., Thompson, D. R., & Carrington, M. J. (2016). Impact of nurse-led, multidisciplinary home-based intervention on event-free survival across the spectrum of chronic heart disease: composite analysis of health outcomes in 1226 patients from 3 randomized trials. Circulation, 133(19), 1867-1877. https://doi.org/10.1161/circulationaha.116.020730	Scuffham, P. A., Ball, J., Horowitz, J. D., Wong, C., Newton, P. J., Macdonald, P., … & WHICH? II Trial Investigators. (2017). Standard vs. intensified management of heart failure to reduce healthcare costs: results of a multicenter, randomized controlled trial. European heart journal, 38(30), 2340-2348. https://dx.doi.org/10.1093%2Feurheartj%2Fehx259	Gary, R., Dunbar, S. B., Higgins, M., Butts, B., Corwin, E., Hepburn, K., … & Miller, A. H. (2020). An intervention to improve physical function and caregiver perceptions in family caregivers of persons with heart failure. Journal of Applied Gerontology, 39(2), 181-191. https://doi.org/10.1177%2F0733464817746757	Wingham, J., Frost, J., Britten, N., Greaves, C., Abraham, C., Warren, F. C., … & Taylor, R. S. (2019). Caregiver outcomes of the REACH-HF multicenter randomized controlled trial of home-based rehabilitation for heart failure with reduced ejection fraction. European Journal of Cardiovascular Nursing, 18(7), 611-620. https://doi.org/10.1177/1474515119850011
Evidence Level * (I, II, or III)	Level I	Level I	Level I	Level I
Conceptual Framework   Describe the theoretical basis for the study (If there is not one mentioned in the article, say that here).**	Not Mentioned	Not Mentioned	Not Mentioned	Not Mentioned
Design/Method   Describe the design and how the study was carried out (In detail, including inclusion/exclusion criteria).	The researchers used a quantitative meta-analysis approach and conducted a secondary analysis of three randomized controlled trials involving 1266 patients. They compared home-based intervention was compared with standard management, combined, and analyzed baseline and outcome data.  Pro-essays.com has the top and most qualified writers to help with any of your assignments. All you need to do is place an order with us	The researchers used a quantitative multicenter, blinded/RCT and authors blinded the study using computer-generated randomization, a pre-determined technique, with block groups for every study site and stratum depending on the individual’s HF status. They carried the study during 12 months following discharge to determine and compare cost-effectiveness. The study included patients at mean age was 74 ± 12 years.	Researchers used a quantitative RCT having repeated measures. The selected family caregivers (FCGs) of individuals with heart failure were randomized into groups: usual attention control (UCAC); psychoeducation only (PE); psychoeducation plus exercise (PE + EX). The researchers obtained physical function measures and caregiving perceptions at the baseline and after 6 months.	The researchers used a mixed-method approach based on random allocation of participants. Caregiver interviews results and physical and psychological outcomes were obtained and analyzed. The authors randomly allocated the participants to two different groups depending on health status and outcomes measures after 4, 6, and 12 weeks of study. Twenty caregivers in the treatment groups were randomly selected for an interview during weeks 4 and 12.
Sample/Setting   The number and characteristics of patients, attrition rate, etc.	1226 patients were selected for the research. Selection included patients presenting with heart disease but not heart failure, atrial fibrillation but not heart failure, and heart failure.	The researchers selected 787 patients with chronic HF discharged from four tertiary hospitals. Patient characteristics: Mean age 74 ± 12 years, 65% with HF and a reduced ejection fraction (31.4 ± 8.9%) and 14% were remote-dwelling	The researchers selected 127 FCGs of individuals with heart failure.	The researchers selected 44 caregivers as controls and 53 caregivers receiving REACH-HF.
Major Variables Studied   List and define dependent and independent variables	Independent variable: Nurse-Led, Multidisciplinary Home-Based Intervention Dependent variable: vent-Free Survival Across the Spectrum of Chronic Heart Disease	Independent variables: Standard vs. intensified management of heart failure. Dependent variables: healthcare costs	Independent variables: 12-week home-based aerobic and resistance exercise program. Dependent variables: Physical Function and Caregiver Perceptions	Independent variables: REACH-HF intervention provision for caregivers of HF patients. Dependent variables: caregiver confidence of self-management
Measurement   Identify primary statistics used to answer clinical questions (You need to list the actual tests done).	Composite Analysis of Health Outcomes in 1226 Patients From 3 Randomized Trials	Multicenter randomized trial Median Cost Calculated probability	RCT Calculated probability	Confidence score Adjusted mean difference Calculated probability
Data Analysis Statistical or Qualitative findings   (You need to enter the actual numbers determined by the statistical tests or qualitative data).	Prolonged event-free survival (90.1% [95% confidence interval, 88.2-92.0] versus 87.2% [95% confidence interval, 85.1-89.3] days-alive and out-of-hospital; P=0.020). All-cause mortality (adjusted hazard ratio, 0.67; 95% confidence interval, 0.50-0.88; P=0.005). Unplanned hospital stay (median, 0.22 [interquartile range, 0-1.3] versus 0.36 [0-2.1] days/100 days follow-up; P=0.011)   Pro-essays.com has the top and most qualified writers to help with any of your assignments. All you need to do is place an order with us	(A$1 equivalent to ∼EUR €0.7) of applying INT-HF-MP significantly greater than SM ($152 vs. $121 per patient per month; P < 0.001) No difference in total health care costs for the INT-HF-MP vs. SM group (median $1579, IQR $644 to $3717 vs. $1450, IQR $564 to $3615 per patient per month, respectively) Minimal differences in all-cause mortality (17.7% vs. 18.4%; P = 0.848) and recurrent hospital stay (18.6 ± 26.5 vs. 16.6 ± 24.8 days; P = 0.199) between the INT-HF-MP and SM groups, respectively.	Significant improvement in 6-min walk distance (p = .012). Greatest improvement in caregiver perceptions (p < .001)	(57.5 vs 62.8, adjusted mean difference: 9.3, 95% confidence interval: 1.8-16.8, p = 0.016)
Findings and Recommendations   General findings and recommendations of the research	The data offers increased support for post discharge HBI application across hospitalized patients for chronic diseases.	In the 12-month follow-up, the healthcare cost did not lower and health outcomes did not improve as a result of INT-HF-MP relative to SM.	The intervention improved caregivers’ confidence and supported the caregiving role.	REACH-HF intervention provision for caregivers of HF individuals improved their confidence of self-management. The intervention supported the caregiver role.
Appraisal and Study Quality     Describe the general worth of this research to practice.   What are the strengths and limitations of study?   What are the risks associated with implementation of the suggested practices or processes detailed in the research?   What is the feasibility of use in your practice?	The research enlists and supports a crucial intervention for the clinical issue of interest. The three groups analyzed adopted randomization of participants and characterization of the extent of patients’ conditions crucial for eliminating cofounding factors. The results were consistent with previous research outcomes. To implement the intervention, it is critical to consider informed consent and compliance with ethical standards.	The researchers compare standard and intensified management of heart failure patients regarding medical costs. The two interventions studied are crucial for chronic heart disease. The randomized controlled trial provides the highest level of evidence. RCTs offer reliable evidence on the effectiveness of research interventions since the processes involve minimizing risks of confounding factors that influence result outcomes. The risks associated with the interventions involved informed consent, compliance, and need for ethical practice. The intervention was effective in managing heart failure.  Pro-essays.com has the top and most qualified writers to help with any of your assignments. All you need to do is place an order with us	The established intervention physical function of caregivers and their perceptions on persons diagnosed with heart failure. The intervention helps with family caregivers’ physical and psychological health, vital for positive patient outcomes. The randomized controlled trial provides the highest level of evidence since factors that limit the quality of outcomes are minimized. Informed consent is required from caregivers and patients.	The intervention studied supports family caregivers for persons with chronic heart failure. The intervention also enhances caregivers’ confidence and supported the caregiving role. The randomized controlled trial offers the highest level of evidence since it minimizes factors that limit the quality of outcomes. Issues regarding caregivers’ and patients’ informed consent constitute the risk when implementing the intervention. The intervention is feasible because the effect on caregiver confidence is significant.
Key findings	Patients under HBI achieved significantly prolonged event-free survival, days-alive and out-of-hospital. HBI contributes to less all-cause mortality and unplanned hospital stay.	The median cost of adopting INT-HF-MP was significantly higher than SM. No significant difference in total health care costs for the INT-HF-MP vs. SM group in the 12 months.	PE + EX improved walk distance, handgrip, and lower extremity strength than PE and UCAC groups. PE + EX indicated the greatest improvement in caregiver perceptions	Caregivers receiving REACH-HF reported higher confidence than the controls. The researchers did not find significant differences in other caregiver outcomes for both groups.
Outcomes	HBI proves better for older patients from 60 to 82 years. HBI has a significant reaction with all-cause mortality and comorbidity.	There was minimal differences in all-cause mortality for the INT-HF-MP vs. SM group.	FCGs randomized in the mixed group (PE + EX) improved the most regarding physical function and caregiver perception outcomes.	REACH-HF improved caregiver confidence and supported their role.
General Notes/Comments	Nurse-led, multidisciplinary home-based intervention used for hospitalized patients improves event-free survival.	Standard and intensified management of heart failure reduce healthcare costs.	Physical activity and exercise prove vital in improving family caregivers’ physical function and perception when working with heart failure individuals.	Rehabilitation EnAblement in Chronic Heart Failure is an effective home-based program for heart failure patients, and it also strengthens caregiver confidence.

*These levels are from the Johns Hopkins Nursing Evidence-Based Practice: Evidence Level and Quality Guide

• Level I

Experimental, randomized controlled trial (RCT), systematic review RTCs with or without meta-analysis

• Level II

Quasi-experimental studies, a systematic review of a combination of RCTs and quasi-experimental studies, or quasi-experimental studies only, with or without meta-analysis.  Pro-essays.com has the top and most qualified writers to help with any of your assignments. All you need to do is place an order with us

• Level III

Nonexperimental, a systematic review of RCTs, quasi-experimental with/without meta-analysis, qualitative, qualitative systematic review with/without meta-synthesis

• Level IV

Respected authorities’ opinions, nationally recognized expert committee/consensus panel reports based on scientific evidence

• Level V

Literature reviews, quality improvement, program evaluation, financial evaluation, case reports, nationally recognized expert(s) opinion based on experiential evidence

**Note on Conceptual Framework

• The following information is from Walden academic guides which helps explain conceptual frameworks and the reasons they are used in research. Here is the link https://academicguides.waldenu.edu/library/conceptualframework

• Researchers create theoretical and conceptual frameworks that include a philosophical and methodological model to help design their work. A formal theory provides context for the outcome of the events conducted in the research. The data collection and analysis are also based on the theoretical and conceptual framework.

• As stated by Grant and Osanloo (2014), “Without a theoretical framework, the structure and vision for a study is unclear, much like a house that cannot be constructed without a blueprint. By contrast, a research plan that contains a theoretical framework allows the dissertation study to be strong and structured with an organized flow from one chapter to the next.”

• Theoretical and conceptual frameworks provide evidence of academic standards and procedure. They also offer an explanation of why the study is pertinent and how the researcher expects to fill the gap in the literature.

• Literature does not always clearly delineate between a theoretical or conceptual framework. With that being said, there are slight differences between the two.
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References

The Johns Hopkins Hospital/Johns Hopkins University (n.d.). Johns Hopkins nursing evidence-based practice: appendix C: evidence level and quality guide. https://www.hopkinsmedicine.org/evidence-based-practice/_docs/appendix_c_evidence_level_quality_guide.pdf

Grant, C., & Osanloo, A. (2014). Understanding, selecting, and integrating a theoretical framework in dissertation research: Creating the blueprint for your house. Administrative Issues Journal: Education, Practice, and Research, 4(2), 12-26.

Walden University Academic Guides (n.d.). Conceptual & theoretical frameworks overview. https://academicguides.waldenu.edu/library/conceptualframework

Evidence-Based Project

Part 1: Identifying Research Methodologies

The chosen clinical issue of interest is determining the efficacy of home-based care intervention for patients diagnosed with chronic heart conditions. Heart disease is the leading cause of death across most ethnic and racial groups in the USA. About 659,000 people die in the USA from heart disease, i.e., one in every four deaths (CDC, 2020). In theory, home-based nursing and therapy are cost-effective, promote recovery for individuals with chronic heart conditions, and potentially reduce readmissions. This paper identifies evidence-based peer-reviewed articles on the most effective interventions crucial for home-based care for patients with chronic heart conditions.

Article 1: Stewart, S., Wiley, J. F., Ball, J., Chan, Y. K., Ahamed, Y., Thompson, D. R., & Carrington, M. J. (2016). Impact of nurse-led, multidisciplinary home-based intervention on event-free survival across the spectrum of chronic heart disease: composite analysis of health outcomes in 1226 patients from 3 randomized trials. Circulation, 133(19), 1867-1877. https://doi.org/10.1161/circulationaha.116.020730

Reasons for Choosing the Article

The article was chosen because it enlists and supports a crucial intervention for the clinical issue of interest. The article presents an evidence-based nurse-led and multidisciplinary approach as a significant intervention for home-based patients diagnosed with chronic heart diseases. The ethical concerns for this study are informed consent and proof of compliance with ethical standards.

Research Aims

This article aimed to determine the impact of a home-based, multidisciplinary and nurse-led intervention for hospitalized patients with various types of chronic heart disease. The aim was founded due to the need to establish cost-effective strategies for nursing patients diagnosed with chronic heart disease. Consequently, the authors conducted three trials to determine the impact of a home-based intervention, multidisciplinary, and nurse-led care model in preventing re-hospitalization and premature mortality.

Research Methodology

A quantitative meta-analysis approach was adopted for this research. The authors conducted a secondary analysis of three randomized controlled trials involving 1266 patients in which home-based intervention was compared with standard management. Baseline and outcome data from the three articles were combined and analyzed using SPSS v22.0.

Research Methodology Strengths

Significantly, the three studies analyzed adopted randomization of participants and characterization of the extent of patients’ conditions crucial for eliminating cofounding factors (Melnyk & Fineout-Overholt, 2018). The secondary analysis was consistently applied to all results from the three RCTs, and the results were consistent with previous research outcomes. The authors adopted the best methodology, i.e., secondary analysis of available data, to establish the efficacy of nurse-led multidisciplinary interventions for individuals with chronic heart disease.

Article 2: Scuffham, P. A., Ball, J., Horowitz, J. D., Wong, C., Newton, P. J., Macdonald, P., … & WHICH? II Trial Investigators. (2017). Standard vs. intensified management of heart failure to reduce healthcare costs: results of a multicenter, randomized controlled trial. European heart journal, 38(30), 2340-2348.https://dx.doi.org/10.1093%2Feurheartj%2Fehx259 

Reasons for Choosing the Article

The article compares standard and intensified management of heart failure patients regarding medical costs. The two are crucial home-based interventions for chronic heart disease. The essential ethical concerns identified in this study include informed consent, proof of compliance with the CONSORT guidelines, and Helsinki’s declaration for ethical practice.

Research Aims

This study aimed to assess whether an intensified management program for heart failure is effective compared to standard management. The intervention, i.e., intensive management program, is informed by individual characteristics or status.  The authors carried the study during 12 weeks following discharge to determine and compare cost-effectiveness.

Research Methodology

The authors adopted a quantitative multicenter, blinded/RCT. The authors blinded the study using computer-generated randomization, a pre-determined technique, with block groups for every study site and stratum depending on the individual’s HF status.  The study involved 787 patients from four tertiary hospitals and was randomized to standard and intensive management interventions.

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Research Methodology Strengths

The randomized controlled trial provides the highest level of evidence (Melnyk & Fineout-Overholt, 2018). In addition, RCTs provide reliable evidence on the effectiveness of research interventions since the processes involve minimizing risks of confounding factors that influence result outcomes (Melnyk & Fineout-Overholt, 2018). The intervention was effective in managing heart failure.

Article 3: Gary, R., Dunbar, S. B., Higgins, M., Butts, B., Corwin, E., Hepburn, K., … & Miller, A. H. (2020). An intervention to improve physical function and caregiver perceptions in family caregivers of persons with heart failure. Journal of Applied Gerontology, 39(2), 181-191. https://doi.org/10.1177%2F0733464817746757

Reasons for Choosing the Article

The article provides intervention for the physical function of caregivers and their perceptions on persons diagnosed with heart failure. Family caregivers are critical in nursing persons with HF, and their physical and psychological function is crucial in the effective delivery of nursing processes. The ethical considerations for this study include approval for human subjects’ participants and informed consent.

Research Aims

This study aimed to assess the outcome of a 12-week home-based aerobic and resistance physical exercise among caregivers attending to individuals diagnosed with heart failure. The authors determined improvement in caregivers’ physical function and perception regarding caregiving role. The study aims were informed by caregivers’ crucial role in supporting heart failure patients in home-based care.

Research Methodology

The authors adopted a quantitative RCT having repeated measures. The participants included 127 family caregivers. The caregivers were randomized into usual care (control), psychoeducation, exercise, and psychoeducation. The authors measured physical function and caregiving perceptions at baseline and after six months.

Research Methodology Strengths

The randomized controlled trial provides the highest level of evidence (Melnyk & Fineout-Overholt, 2018). The adopted intervention is flexible and convenient, enabling the authors to achieve reliable results. The intervention effectively improved the physical and psychological functions of family caregivers.

Article 4: Wingham, J., Frost, J., Britten, N., Greaves, C., Abraham, C., Warren, F. C., … & Taylor, R. S. (2019). Caregiver outcomes of the REACH-HF multicenter randomized controlled trial of home-based rehabilitation for heart failure with reduced ejection fraction. European Journal of Cardiovascular Nursing, 18(7), 611-620. https://doi.org/10.1177/1474515119850011

Reasons for Choosing the Article

The established intervention supports family caregivers for persons with chronic heart failure. Family caregivers play a crucial role in helping individuals with chronic heart failure, and their physical and psychological health is vital for positive patient outcomes. The ethical concerns for this study include informed consent from caregivers and patients and the declaration of Helsinki for ethical practice.

Research Aims

The study aimed to compare the outcomes of Rehabilitation Enablement in Chronic Heart Failure (REACH-HF) and control groups. The study also aimed to establish the caregiver’s experience using REACH-HF. The research aim was informed by the paucity of evidence supporting REACH-HF as a crucial home-based intervention supporting HF patients and their caregivers.

Research Methodology

The authors adopted a mixed-method approach based on random allocation of participants. Caregiver interviews results and physical and psychological outcomes were obtained and analyzed. The authors randomly allocated the participants to two different groups depending on health status and outcomes measures after 4, 6, and 12 weeks of study. Twenty caregivers in the treatment groups were randomly selected for an interview during weeks 4 and 12. (Use this document to complete the evaluation table requirement of the Module 4 Assessment, Evidence-Based Project, Part 3A: Critical Appraisal of Research)

Research Methodology Strengths

The randomized controlled trial provides the highest level of evidence since factors that limit the quality of outcomes are minimized (Melnyk & Fineout-Overholt, 2018). The number of participants was large, and the results can be generalized. The intervention improved caregivers’ confidence and supported the caregiving role. 

References

Centers for Disease Control and Prevention. (2020). The underlying cause of death 1999-2018. CDC WONDER online database. Atlanta, GA. Available at: http://wonder.cdc.gov/ucd-icd10.html (Accessed December 14, 2021)

Gary, R., Dunbar, S. B., Higgins, M., Butts, B., Corwin, E., Hepburn, K., … & Miller, A. H. (2020). An intervention to improve physical function and caregiver perceptions in family caregivers of persons with heart failure. Journal of Applied Gerontology, 39(2), 181-191. https://doi.org/10.1177%2F0733464817746757

 Pro-essays.com has the top and most qualified writers to help with any of your assignments. All you need to do is place an order with us

Grant, M. J., & Booth, A. (2009). A typology of reviews: An analysis of 14 review types and associated methodologies. Health Information and Libraries Journal, 26, 91–108. doi:10.1111/j.1471-1842.2009.00848.x 

Melnyk, B. M., & Fineout-Overholt, E. (2018). Evidence-based practice in nursing & healthcare: A guide to best practice (4th ed.). Philadelphia, PA: Wolters Kluwer.

Scuffham, P. A., Ball, J., Horowitz, J. D., Wong, C., Newton, P. J., Macdonald, P., … & WHICH? II Trial Investigators. (2017). Standard vs. intensified management of heart failure to reduce healthcare costs: results of a multicenter, randomized controlled trial. European heart journal, 38(30), 2340-2348. https://dx.doi.org/10.1093%2Feurheartj%2Fehx259

Stewart, S., Wiley, J. F., Ball, J., Chan, Y. K., Ahamed, Y., Thompson, D. R., & Carrington, M. J. (2016). Impact of nurse-led, multidisciplinary home-based intervention on event-free survival across the spectrum of chronic heart disease: composite analysis of health outcomes in 1226 patients from 3 randomized trials. Circulation, 133(19), 1867-1877. https://doi.org/10.1161/circulationaha.116.020730

Wingham, J., Frost, J., Britten, N., Greaves, C., Abraham, C., Warren, F. C., … & Taylor, R. S. (2019). Caregiver outcomes of the REACH-HF multicentre randomized controlled trial of home-based rehabilitation for heart failure with reduced ejection fraction. European Journal of Cardiovascular Nursing, 18(7), 611-620. https://doi.org/10.1177/1474515119850011

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Use this document to complete the evaluation table requirement of the Module 4 Assessment, Evidence-Based Project, Part 3A: Critical Appraisal of Research

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 Pro-essays.com has the top and most qualified writers to help with any of your assignments. All you need to do is place an order with us – Use this document to complete the evaluation table requirement of the Module 4 Assessment, Evidence-Based Project, Part 3A: Critical Appraisal of Research