Multidisciplinary Rehabilitation - Concepts Benefits, Setbacks, and Possible Future Improvement - Essay Example

? Critical Appraisal of Multidisciplinary Research Articles Introduction In multidisciplinary rehabilitation (MDR), a team of healthcare professionals, the patient and the latter’s primary caregivers work together to enable the affected maximize their psychosocial and functional potential. Professionals in such a team may include clinical physicians, rehabilitation nurses, occupational therapists and psychologists, among others. The approach is beneficial since it combines input and knowledge from diverse areas thus increasing chances of patient overall health improvement. This paper aims at critically analyzing and appraising research articles on multidisciplinary rehabilitation, thus giving deeper insight into the concept’s benefits, setbacks and possible future improvement. Summary and Critical Appraisal The first article under scrutiny details research by Mitchell et al. (2008) titled ‘Multidisciplinary care planning in the primary care management of completed stroke: A systematic review.’ The authors adopted a method combining literature review, analysis of randomized and non-randomized trials, qualitative studies and observation of stroke patients within the two aforementioned care settings. Results indicated that the mortality rate of stroke patients was not affected by multidisciplinary care, but it was uncertain if multidisciplinary setting contributed to the positive outcomes. The authors concluded that multidisciplinary care does not guarantee improvement of stroke patients, but provides process benefits like better task allocation among team members hence improved patient care. The article is significant because it provides proof that improvement of care approaches depends on collaborative functioning of professionals. However, the outcomes and interventions of the studies examined appear to be uniform, hence findings are presented mostly in a narrative manner and the comparison basis is not sufficiently diverse. Although the authors claim to have conducted a comprehensive information search, there is a possibility that some literature could have been left out. There is also no use of statistical analysis, making it difficult to determine significance of the results. The second article is ‘Multidisciplinary rehabilitation for adults with multiple sclerosis (Protocol)’ by Khan et al. (2007). The method followed by the authors involves analysis of participation strategies and activities defined by the world health organization (WHO). The authors intend to use an information search strategy made in collaboration with the Cochrane Multiple Sclerosis Group (CMSG) search coordinators, in order to avoid duplication. The article outlines considerations intended to enhance accuracy and credibility of outcomes. These include: adequate randomization, sufficient blinding of patients, care providers and outcome assessors to intervention, as well as, ensuring baseline similarity of partisan groups in terms of prognostic indicators. As a proposed protocol for multidisciplinary rehabilitation, this article is rather comprehensive. However, it does not mention specific prognostic indicators that could be used in selection of patients for the research and ways in which they would be measured. Further, there is no use of statistical analysis for eligible studies, making it difficult to determine significance of the results. Lang et al.’s (2003) article ‘Multidisciplinary rehabilitation versus usual care for chronic low back pain in the community: Effects on quality of life’ is the third in this analysis. The authors suggest that MDR may improve treatment capacity and availability of rehabilitation services for patients with back pain. The authors utilize a comparative study design, comparing outcomes of randomly chosen back pain patients, in an MDR group and a conventional intervention group, after 6 months treatment. The article also clearly describes the prognostic aspects used to select patients involved in the study. There is also a description of the outcome measures used to evaluate treatment effects, which include health-related life quality and average pain severity based on a numeric scale, among others. The article makes a significant contribution to MDR as it provides experiential proof of the approach’s potential to improve back pain patients’ quality of life. Statistical significance was established at a level of 0.05. Pain related outcome measures did not depict much statistical significance, unlike measures such as role limitations, social functioning, emotional well-being and reduction of sick days, which all had a P value lower than 0.05. However, the authors should not have relied on voluntary participation of patients and physicians during the study, since this possibly inhibited randomization of study samples. Further, only 56 patients were included in the MDR study group, this is a limited number and it is difficult to consider the outcome as being representative of MDR’s positive outcome, thus limiting the study’s validity. The fourth article in this analytical series is Stein and Miclescu’s (2013) ‘Effectiveness of multidisciplinary rehabilitation treatment for patients with chronic pain in a primary health care unit.’ The authors selected 51 patients suffering from chronic pain to engage in the study. Prognostic measures were clearly defined and included, age and pain persistence for 3 months or more. The article also indicates outcome measures like pain intensity and severity, depression and anxiety scores, among other secondary outcomes. Patients were initially treated in groups for 6-week duration and there were follow-up sessions for a year. Results indicated that patients with chronic pain can gain health quality from MDR within primary healthcare units. Statistical significance of the study’s results was set at a P value of 0.05. In regard to primary outcomes like social activity, sick leave and depression, statistically significant differences were observed because the P value was less than 0.05 but the same did not apply to physical activity whose P value was 0.08. However, the research involved a low number of patients, limiting its validity. Additionally, there was no control group, meaning that there is no basis for comparison and proving efficacy of MDR beyond doubt. The last article is ‘Effectiveness of multidisciplinary rehabilitation services in postacute care: State-of-the-Science: A Review’ by Bettger and Stineman (2007). The article sought to propose future strategies of increasing MDR effectiveness. The authors systematically reviewed research papers in English language that evaluated MDR services. MDR records dating back to 25 years were chosen through Medline, CINAHL and Cochrane databases. Information regarding populations, study designs, sample sizes and designs was extracted from the records and later synthesized. The conclusion drawn was that stronger evidence can be obtained to support MDR policies, services and availability for patients’ benefits. While the article gives significant information about MDR, it is not specific to certain ailments, making it a generalized approach. Additionally, there is no use of statistical analysis for eligible studies, making it difficult to determine significance of the results. Comparison and Contrast The first, second and fifth articles (by Mitchell et al., Khan et al., and Bettger and Stineman in that order) adopt a systematic literature review approach and all of them utilize Medline, CINAHL and Cochrane databases, as the source of their secondary information. However, the first is different from the second and fifth in the sense that it involves experiential studies in combination with the systematic literature review. In all the studies involving review of previous research, the results’ accuracy is not guaranteed, since there is a possibility that some records were left out. In contrast, articles three and four by Lang et al. (2003) and Stein and Miclescu (2013) respectively, comprised purely experimental methods. This means that researchers in both studies randomly chose patients to participate in MDR based treatments, and later draw conclusions on whether there was any positive change. In both studies, that is, three and four, the number of participants was limited thus limiting credibility of the outcomes. All articles tend to show the importance of quantitative research methods like numerical analysis, questionnaires or surveys and experimental, as well as, to secondary data analysis, even though every article does not incorporate all. Conclusion Irrespective of the disparities in the analyzed research articles, they all provide results indicating that the multidisciplinary rehabilitation approach is potentially beneficial to patients suffering from serious chronic illnesses. Further, the scholars in all articles recognize the need for additional research into multidisciplinary rehabilitation, in order to enhance its potential usage in future treatment of patients. References Bettger, J., & Stineman, M. (2007). Effectiveness of multidisciplinary rehabilitation services in postacute care: State-of-the-Science. A review. Arch Phys Med Rehabil, 88, 1526-1534. Khan, F., Turner-Stokes, L., Ng, L., Abrahamson, S., & Kilpatrick, T. (2007). Multidisciplinary rehabilitation for adults with multiple sclerosis (Protocol). The Cochrane Library, 1, 1-9. Lang, E., Liebig, K., Kastner, S., Neundorfer, B., & Heuschmann, P. (2003). Multidisciplinary rehabilitation versus usual care for chronic low back pain in the community: Effects on quality of life. The Spine Journal, 3, 270–276. Mitchell, G., Brown, R., Erikssen, L., & Tieman, J. (2008). Multidisciplinary care planning in the primary care management of completed stroke: A systematic review. BMC Family Practice, 9(44), 1-10. Stein, K. F., & Miclescu, A. (2013). Effectiveness of multidisciplinary rehabilitation treatment for patients with chronic pain in a primary health care unit. Scandinavian Journal of Pain, 197, 1-8. Read More