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Evidence Based on Practice Knowledge and Critical Appraisal Skills

The trial in “Non-surgical treatment choices by individuals with lumbar intervertebral disc herniation in the United States: Associations with long-term outcomes” by Thackeray et al. (2017), addressed the main issue to be analysed. The trial was able to focus on pain management well. Pain relief post-management was done through physical therapy and was significantly well-represented in the given study. The study, however, did not provide an insight based on the surgical interventions, although the results pointed out measures to improve the outcomes. This study failed to identify significant differences in pain and disability among those receiving physical therapy after enrollment compared with those who did not.

A total of 363 patients were selected on a randomised basis and were then divided into patients who took physical therapy treatment and those who did not. It was based on a secondary analysis formula to carry out an observational cohort study.

The study accounted for all the patients selected for the study evaluation. The study was based on a comparison between patients receiving treatment and the ones not receiving treatment. The study did not exclude any participant until the end, and the study results were used aptly to draw the conclusion. Eligible patients were invited to participate in the trial on a randomised basis and were compared in terms of having surgical and non-surgical interventions. The study will be worth continuing with the same patient crowd, as it will help evaluate the best possible healthcare outcomes in such patients, to manage them in the most efficient manner (Fineout, 2019).

The patient’s health report and the healthcare workers’ current status were not kept undercover throughout the study. They were not kept blind and the participants were well-informed regarding the procedure as well as the processes of the study to be conducted, along with its importance. As the study was based on defining a better treatment method, diagnosed patients with herniated disc problems were taken under consideration for the study purpose. The participants were aware of the study purpose, and they were duly informed about their importance and choice of being selected for the study purpose.

There were two different groups of patients, the first group comprised participants who received physical therapy management for pain. The other group, however, was kept neutral and did not get any physical therapy treatment. The study compared the results between the two groups. Although a total of 363 participants were selected, they were segregated into two groups from the beginning to be analysed separately.

The whole study was based on comparing the results between patients getting treatment and those not getting the same. As one of the groups did not receive any treatment, they were left behind in terms of any intervention management. The intervention program for the group getting treatment was set for a period of six weeks. The group that did not receive any physical therapy intervention, was kept off from any other kind of intervention as well. The control group received intervention while the other group was not provided with any measures. The baseline data of the group provided with the intervention was used for comparison with the group not getting any other treatment. The study reflected significant results, and the intervention of physical therapy in the affected individuals proved to be largely helpful in reducing the symptoms.

The patients who did not receive any treatment were then treated with further interventions. Post-intervention, the participants reported no adversity in their symptoms and were able to carry on with their daily routines, continuing along with the exercise regimen taught to them. These were individualized programs based on personal difficulties faced by the participants. The participants were asked to mark their disability using the SF-36—a generic health status measure scaled from 0 to 100 (Laddu, 2018). Primary outcomes of the study measured a disability score of 0 to 100 while indicating a prevalence of higher scores and, thus, higher rates of disability. Secondary outcomes were based on self-rated opioid use. It was shown to have a significantly positive result on the patients. Patients also reported self-improvement as well as symptoms related to improvements, post administration of the medication.

The study is not applicable to the local population. It was based on an intervention program for people suffering from herniated disc problems. However, the patients having symptoms like back pain and being prone to developing disc degeneration, are bound to be at risk of the same. These populations should be identified for timely management and intervention application for the same. The study can also be conducted by giving physical therapy interventions for the complete group and then detecting for the underlying positive outcomes in the patients.

All clinical outcomes were analysed in a schematic manner. The patient’s clinical outcomes were duly monitored, including assessing the pain range, muscle strength, improved quality of life and so on. The effect model was very accurately used to detect the comparison between the baseline participants and the control group (Karyotaki, 2018). The results of the study were significant, reflecting the co-efficient of significance with a value of more than 0.5% (Şen, 2017). The results were also in sync with the requirements set for the study. The study was also able to provide a comparison between various interventions and the positive and negative outcomes of the same in the patient population, upon implementation.

The benefits obtained from the study will be helpful for the patient population. This will help implement physical therapy intervention, right from when mild symptoms are observed in the patient. It can be implemented in the form of patient education or posture correction and so on. However,, the study failed to establish a direct or indirect relation between pain and disability experienced by the patient population. The interventions taken under consideration in the study can, however, help define specific and standardised measures for the purpose of treatment interventions. Although, more research is needed, especially in terms of further useful treatment interventions for this case study.

The treatment effect was quite precise. The participants receiving intervention benefited a lot from an adequate amount of the six-week protocol, yielding positive results. The management was effective, as it takes time to get positive outcomes in patients suffering from chronic pain.


Fineout-Overholt, E. (2019). A guide to critical appraisal of evidence. Nursing 2020 Critical Care, 14(3), 24–30.

Karyotaki, E., Ebert, D. D., Donkin, L., Riper, H., Twisk, J., Burger, S., ... & Geraedts, A. (2018). Do guided internet-based interventions result in clinically relevant changes for patients with depression? An individual participant data meta-analysis. Clinical Psychology Review, 63, 80–92.

Laddu, D. R., Wertheim, B. C., Garcia, D. O., Woods, N. F., LaMonte, M. J., Chen, B., ... & Manson, J. E. (2018). 36‐Item short form survey (SF‐36) versus gait speed as predictor of preclinical mobility disability in older women: The women’s health initiative. Journal of the American Geriatrics Society, 66(4), 706–713.

Şen, Z. (2017). Innovative trend significance test and applications. Theoretical and Applied Climatology, 127(3–4), 939–947.

Thackeray, A., Fritz, J. M., Lurie, J. D., Zhao, W., & Weinstein, J. N. (2017). Non-surgical treatment choices by individuals with lumbar intervertebral disc herniation in the United States: Associations with long-term outcomes. American Journal of Physical Medicine & Rehabilitation, 96(8). https://dx.doi.org/10.1097%2FPHM.0000000000000685

Remember, at the center of any academic work, lies clarity and evidence. Should you need further assistance, do look up to our Medical Science Assignment Help

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