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Critical appraisal is useful in knowing the scientific literature's validity and generalizability. With that, it can also be known whether the study is authenticated or not (Umesh, Karippacheril & Magazine, 2016). For this critical appraisal, each section of the paper is carefully analyzed and also appropriate Critical Appraisal Skills Programme (CASP) is used.
The abstract of the paper talks about the background and objectives of the paper and the topics that have been discussed in it. It mentioned about obesity and chronic obstructive pulmonary disease (COPD). The researchers have also talked about the aim of the paper which is to identify low-energy diet coupled with resistance exercise training in COPD patients who are obese. They have also highlighted the methods which are used in the research which was conducting a clinical trial on the patients and reviewing the progress of the participants every two weeks in the program. After this, they have written about the results and explained that intervention has worked in participants and that there was decrement seen in body mass index, dyspnea, exercise score and obstruction in COPD patients. Researchers then concluded the findings that their intervention was significant in improving the health status of COPD obese patients. They also said that their study could be used to change the guidelines for COPD management in obese patients (McDonald et al., 2016). Abstract of the article is very important and it is a synopsis of the full text that is presented in the paper. It needs to be clear, concise, self-sufficient, balanced and complete. They should highlight all the main parts of the article (Tullu et al., 2019). In this paper, the researchers have not shown which type of study they have done. In addition to that, they have also not mentioned the number of participants they have chosen for their study. Therefore, it can be said that the abstract of the article is incomplete.
In the introduction part, the researchers have explained about COPD and obesity. They have stated that how obesity causes major problems in the population such as cardiovascular disease and other syndromes related to metabolism. After this, researchers have combined these two topics and gave an explanation about how these two factors lead to higher rates of mortality in people. Then, they outlined the COPD patients who are obese and how their condition is poorly understood and managed. Then they stated the goal of the research that is aimed to test the hypothesis in patients of the COPD who are obese. The hypothesis involved a reduction in weight via low-energy diet which is combined with resistance training so as to improve the clinical outcomes in COPD patients and to decrease the inflammation while maintaining the mass of the skeletal muscles (McDonald et al., 2016). The introduction part of the paper tells about the topic by stating the facts from current literature. It also enlightens the problem clearly which is related to the topic of the paper. This section also involves statements which generate curiosity in the readers (Armağan et al., 2013). Therefore, in the paper, it can be seen that the researchers did not briefly describe the COPD disease. They have not mentioned about how this condition occurs and what are the problems faced by the patients of this disease. They also have not provided the data of COPD prevalence and also about the incidence of COPD patient with obesity. However, they have clearly explained their paper’s aim in a systematic manner.
The method of the research involves the sample size, intervention, diet intervention, exercise, measurement and statistical analysis (McDonald et al., 2016). Researchers stated that they have taken 33 participants for the study as they want to see weight loss and decrement of high-sensitivity C-reactive protein in the COPD patients who are obese. They also told about the intervention that it goes on for three months and after that follow-up studies were also performed on the participants. For the diet intervention, subjects have prescribed a diet between 3850-5000 kJ/day or up to 5900 kJ/day and also some exceptions were made for the people who have body mass index (BMI) greater than 40kg/m2, that they will be given 3 meals. In the duration of the programs, participants also were counselled continuously by the dieticians so as to improve the quality of food that has been selected by them (McDonald et al., 2016). Intake of protein was also described to the participants. For the exercises, the subjects were told to perform a strength-based training program in their homes so that they can work on the lower and upper limbs. A physiotherapist was also made available to the participants so that the progress made by COPD obese patients could be analyzed. Face-to-face counselling sessions were also performed between the physiotherapist and the participants. Measurement was done by doing various evaluations like chronic obstructive pulmonary disease clinical assessment, evaluating body composition and lung function. Dietary analysis was also performed in addition to the assessment of inflammatory markers (McDonald et al., 2016). The nature of the study was a quantitative study. However, the study that should be performed for this experiment should be a randomized controlled trial. The strength of this kind of study is that it consists of the development of the experiment's protocol with firm exclusion and inclusion criteria. It is a very well explained intervention and has endpoints which are predefined. (Faraoni & Schaefer, 2016). Hence, it can be said that the chosen study should also be a randomized controlled trial.
The results of the experiment conducted stated that the body fat mass was significantly reduced in the participants and the muscle mass was still maintained. However, the COPD patient still remained obese after the intervention was completed and neither of the participants gained BMI which was lower than 25 kg/m2. The dietary analysis also revealed a reduction in energy. The health status of the participants also improved by taking the intervention but no change was seen in biomarkers of systemic inflammation. Improvement in forced vital capacity was also observed by the researchers (McDonald et al., 2016). The limitation of the study conducted was that it was an experimental design which was lacking a control arm. The study design was however appropriate but it should be a randomized control trial to get a better result. The participants that were chosen were also in less in numbers. There is also a need for the longer follow-up time period so that various other factors could be assessed in the participants such as hospitalization, mortality and decline in lung function. The researchers have also shown an improved trend in forced vital capacity and yet, they did not notice any change or alteration in static lung volumes. This result came due to the small sample size that was considered for the study (McDonald et al., 2016).
For the study’s critical appraisal, appropriate CASP tool is used. The trial which was conducted by the researchers clearly outlined the focused issue. They have mentioned the issue in the introduction section of the paper. The assignment of the diseased individuals of the treatment was not randomized but the patients in the study were properly accounted for. The COPD obese patients were blind to treatment in addition to the healthcare workers and study personnel. There were no groups involved in the study so for that there will not be any similarity between the group. Moreover, because of no groups, they also cannot be treated equally in the intervention. The treatment effect was large enough to notice that there is a reduction in BMI of the people by combining two activities which were low dietary diet and exercise. The estimate that was made for the treatment was not appropriate because researchers have hypothesized that the weight will decrease and inflammation will also be reduced in COPD obese patient but the systemic inflammation did not change in the participants after the intervention. The results that are gained after the experiment cannot be properly used for the local population because it was not a randomized controlled trial and also it has included an only small number of participants which cannot demonstrate the effect on the wider population. For the study, every clinical outcome was assessed and considered (McDonald et al., 2016; Critical Appraisal Skills Programme, 2020).
In conclusion, it can be said that the researchers have noticeably mentioned all the important sections in the paper. They have highlighted abstract, introduction, methods, results and conclusion. In abstract they have not mentioned the size of the sample and have not stated the study type which was a quantitative study. In the introduction section, they have not briefly described the COPD condition and the implication on obese patients. The method that was used was also not appropriate, the study design should be randomized control trial but the researchers have nicely explained about all the interventions and results. The other limitation was that the sample size was also very small. With the help of the CASP tool, it was also known that the paper did not provide much information so that the study could not be used for the wider population. Hence, it can be said that the research paper and the study was not much reliable.
Armağan A. (2013). How to write an introduction section of a scientific article?. Turkish Journal of Urology, 39(Suppl 1), 8–9. https://doi.org/10.5152/tud.2013.046
Critical Appraisal Skills Programme. (2020). CASP randomized controlled trial checklist. Available at https://casp-uk.net/wp-content/uploads/2018/03/CASP-Randomised-Controlled-Trial-Checklist-2018_fillable_form.pdf
Faraoni, D., & Schaefer, S. T. (2016). Randomized controlled trials vs. observational studies: Why not just live together?. BMC Anesthesiology, 16(1), 1-4. https://doi.org/10.1186/s12871-016-0265-3
McDonald, V. M., Gibson, P. G., Scott, H. A., Baines, P. J., Hensley, M. J., Pretto, J. J., & Wood, L. G. (2016). Should we treat obesity in COPD? The effects of diet and resistance exercise training. Respirology, 21(5), 875-882. https://doi.org/10.1111/resp.12746
Tullu M. S. (2019). Writing the title and abstract for a research paper: Being concise, precise, and meticulous is the key. Saudi Journal of Anaesthesia, 13(Suppl 1), S12–S17. https://doi.org/10.4103/sja.SJA_685_18
Umesh, G., Karippacheril, J. G., & Magazine, R. (2016). Critical appraisal of published literature. Indian Journal of Anaesthesia, 60(9), 670–673. https://doi.org/10.4103/0019-5049.190624
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