Essay On Healthcare

 

The article selected for the purpose of this critical appraisal is the systematic review conducted and established in the paper Zhang, N., Houle, T., Hindiyeh, N., & Aurora, S. K. (2020). Systematic review: acupuncture vs standard pharmacological therapy for migraine prevention. Headache: The Journal of Head and Face Pain, 60(2), 309-317. The article has been selected for the purpose of this critical appraisal since it presents a distinct systematic review about therapies which address migraine prevention, and compare standard pharmacological therapy and acupuncture therapy based on their effectiveness. The paper will hence be critically appraised through the identified CASP (critical appraisal skills programme) tool.

The title of the article presents a concise idea about the purpose of the study and the design of study method utilised, which is comparing two therapies for migraine prevention, and systematic review, respectively. The abstract includes a background, methodology, results and conclusion section, each of which have explained in brief about the research conducted and the results obtained, and includes relevant keywords. Declaration about the conflict of interest of the authors have also been provided in the article, as the study was not funded by any agency or individual and there are no conflicts of interest for the author pertaining to this work (Munn et al., 2018, p.4).

 

The review has addressed a specific and clearly focused question which included a comparison of the effectiveness of the conventional pharmacological therapy and acupuncture for the migraine prevention. Hence the focus of the question is the interventions being considered and the comparison of the effectiveness of the above mentioned therapies in relation to migraine prevention. The outcomes have been considered effectively and the systematic review addresses a focused question accordingly (Li et al., 2020, p.14).

 

 

The researchers have included the right type of papers for the review as a systematic review is effective and rigour is high for those reviews which have included randomised controlled trails for the evaluation of interventions. The systematic review selected for the purpose of appraisal has included 7 such randomised trials and randomised controlled trials and a total of 1430 participants were included for review, as they met the inclusion criteria of the reviewers for the npurpose of their study. The custom designed strategy was utilised to identify the randomised trials and randomised controlled trials for the purpose of the review (Zhang et al., 2020, p. 312).

 

 

The bibliographic databases included for searching the right type of studies included SCOPUS (including EMBASE) and PubMed (including MEDLINE). It was not necessary to contact the original authors and the unpublished studies, as well as non-English published studies were not included in the review. The review also did not utilise date restriction and the follow up from the reference lists were also not performed. Personal contact with the experts were not necessary and hence were not included (Xu et al., 2018, p.315). The inclusion of 7 relevant randomised trials and randomised controlled trials hence presented the important and relevant studies for review in this study.

 

 

The eligibility of the studies was identified by the researchers as the full texts of the articles were reviewed. The data extraction process included the review of the specific headache classifications utilises, the number of randomised patients, duration of the treatment, the treatment characteristics and the reporting of the acupuncture protocol in accordance with the STRICTA (Standards for Reporting Interventions in Clinical Trials of Acupuncture) (Musil et al., 2018, p.1221). The assessment of the quality of the included studies hence included the study of rigour of the randomised trials and randomised controlled trials included basis certain inclusion and exclusion criteria.

 

 

The results obtained through the search strategy were not similar in every aspect from one study to another. The custom search strategy revealed initially 706 articles, from which 158 duplicates were removed, and them irrelevant articles basis the abstract or title, were removed (Zhang et al., 2019, p. 21). The full text screening process was conducted on 230 articles and finally 7 articles were included for the purpose of the systematic review. The methodological heterogeneity prevented the aggregation of the data as the comparison groups mostly differed among the selected studies. The primary outcomes also differed and hence a combined results review was not conducted by the researchers. The reasons for the variation in the results of the included studies were discussed in the article and the results of all included studies have been clearly displayed (Zhang et al., 2019, p. 24).

 

 

The overall results of the review have not been presented numerically but a narrative analysis of the results have been attempted by the researchers. The results have been expressed in a narrative manner and the variability of the study protocols have been identified to be a major issue in correctly analysing and interpreting the result of the included studies for review. The review results indicated that the acupuncture technique is effective in many subjects, especially in those patients who are unable to utilise the conventional pharmacologic methods for migraine prevention. However, very few acupuncture clinics properly practice the technique in accordance with the STRICTA protocol and thus there exists a lack of authentic acupuncture technique (Ou et al., 2020, p. 596). 

 

 

There does not exist any accuracy tests for the current systematic review since numerical analysis of the results obtained were not performed, and instead a narrative analysis has been conducted (Zhang et al., 2019, p.28).

 

 

The generalisability of the review results is not quite high considering the participants included in the review article were different basis their classification of headache, the type of acupuncture technique available and availed, the difference in comparison groups were drastic, prevalence of acupuncture sham, and active comparator used in various studies. The results hence can be applied to the local population to some extent and not fully considering there exists certain differences regarding the population characteristic, the characteristics of migraine headaches varies from one individual to another and the availability of the acupuncture techniques is also restricted (Lu et al., 2020, p. 52).

 

The outcomes of the applied search strategy were effective and all the important research outcomes were considered. However, a detailed analysis of the various acupuncture techniques, in different areas of a specific location, or comparison between different location, and their effectiveness in contrast to various conventional pharmacological interventions against migraine headache would have increased the rigour the study (Natbony et al., 2020, p.3). 

 

 

The benefits of the acupuncture technique in migraine prevention are quite high, however, it can be customised to specific kinds of migraines, and the applicability is to be analysed on a small scale, with a pilot study perhaps, before introducing it into the market on a larger scale. The systematic review revealed that there exists a lack of proper adherence to the STRICTA protocols, which could cause significant harm to individuals opting for such alternative therapies for their migraine headaches (Gao et al., 2018, p. 9). 

Evidence Based Practice (EBP) is 'the integration of best research evidence with clinical expertise and patient values which when applied by practitioners will ultimately lead to improved patient outcome’ (Shelton et al., 2018, p. 32). There exist three essential components of evidence based practice which includes patient expectations and values, best external evidence and individual clinical practice. The evidence based practice in any healthcare sector requires that the explicit, judicious and conscientious usage of the current best evidence is utilised to make decisions about the care of patients. The decisions in healthcare are required to be based in available relevant, valid and current evidence. The clinical expertise of healthcare professionals is paired with the patient preferences and values and the best research evidence thus presenting evidence based practice for patients. In this systematic review, the results or findings can be presented with relevance to the alternative therapies for the management of migraine. The current conventional pharmacologic treatment for migraine does not yield expected results for all patients and hence acupuncture therapy is being introduced for such a purpose. The review revealed that there exist some benefits of the acupuncture therapy for migraine prevention, however it is necessary for this therapy to adhere to the STRICTA protocol so that sham methods utilised in certain clinics can be avoided to prevent harm (Grove & Gray, 2018, p.31). The study of acupuncture hence needs to be standardised for its increased efficacy and acceptability among migraine patients.

 

Thus, the systematic review critically analysed above presents a convincing review of the efficacy of the acupuncture therapy compared with the conventional pharmacologic therapies for migraine prevention. The review revealed some level of efficacy of the acupuncture therapy and an extensive search strategy to increase the rigour of the study. The limitations of the study included the difference in outcome measures and heterogenous study protocols, somewhat complicated the study analysis process. Nonetheless, the study presented a proper narrative analysis of the selected articles and hence presented details about the compared efficacy of the acupuncture techniques and pharmacologic interventions for the management of migraine.

 

Gao, Z., Giovanardi, C. M., Li, H., Hao, C., Li, Q., Zhang, X., & Mansmann, U. (2018). Acupuncture for migraine: a protocol for a meta-analysis and meta-regression of randomised controlled trials. BMJ open, 8(11), e022998. http://dx.doi.org/10.1136/bmjopen-2018-022998

 

 

Grove, S. K., & Gray, J. R. (2018). Understanding nursing research e-book: Building an evidence-based practice. Elsevier Health Sciences.

 

 

Li, Y. X., Xiao, X. L., Zhong, D. L., Luo, L. J., Yang, H., Zhou, J., ... & Jin, R. J. (2020). Effectiveness and safety of acupuncture for migraine: an overview of systematic reviews. Pain Research and Management, 2020. https://doi.org/10.1155/2020/3825617

 

 

Lu, T., Lu, C., Li, H., Xing, X., Deng, X., Li, X., ... & Yang, K. (2020). The reporting quality and risk of bias of randomized controlled trials of acupuncture for migraine: methodological study based on STRICTA and RoB 2.0. Complementary therapies in medicine, 52, 102433. https://doi.org/10.1016/j.ctim.2020.102433

 

 

Munn, Z., Peters, M. D., Stern, C., Tufanaru, C., McArthur, A., & Aromataris, E. (2018). Systematic review or scoping review? Guidance for authors when choosing between a systematic or scoping review approach. BMC medical research methodology, 18(1), 1-7. https://doi.org/10.1186/s12874-018-0611-x

 

 

Musil, F., Pokladnikova, J., Pavelek, Z., Wang, B., Guan, X., & Valis, M. (2018). Acupuncture in migraine prophylaxis in Czech patients: an open-label randomized controlled trial. Neuropsychiatric disease and treatment, 14, 1221. https://doi.org/10.2147%2FNDT.S155119

 

 

Natbony, L. R., & Zhang, N. (2020). Acupuncture for migraine: a review of the data and clinical insights. Current Pain and Headache Reports, 24(7), 1-6. https://doi.org/10.1007/s11916-020-00864-w

 

 

Ou, M. Q., Fan, W. H., Sun, F. R., Jie, W. X., Lin, M. J., Cai, Y. J., ... & Zhou, H. H. (2020). A systematic review and meta-analysis of the therapeutic effect of acupuncture on migraine. Frontiers in neurology, 11, 596. https://doi.org/10.3389/fneur.2020.00596

 

 

Shelton, R. C., Cooper, B. R., & Stirman, S. W. (2018). The sustainability of evidence-based interventions and practices in public health and health care. Annual review of public health. https://psycnet.apa.org/doi/10.1146/annurev-publhealth-040617-014731

 

 

Xu, J., Zhang, F. Q., Pei, J., & Ji, J. (2018). Acupuncture for migraine without aura: a systematic review and meta-analysis. Journal of Integrative Medicine, 16(5), 312-321. https://doi.org/10.1016/j.joim.2018.06.002

 

 

Zhang, N., Houle, T., Hindiyeh, N., & Aurora, S. K. (2020). Systematic review: acupuncture vs standard pharmacological therapy for migraine prevention. Headache: The Journal of Head and Face Pain, 60(2), 309-317. https://doi.org/10.1111/head.13723

 

 

Zhang, X. T., Li, X. Y., Zhao, C., Hu, Y. Y., Lin, Y. Y., Chen, H. Q., ... & Tian, G. H. (2019). An overview of systematic reviews of randomized controlled trials on acupuncture treating migraine. Pain Research and Management, 2019. https://doi.org/10.1155/2019/5930627