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Discuss about the Complementary Applications of Social Research Methods.

Methodology

It is considered vital to specify the research question, with regards to the methodological point of withdrawal of scholarly exploration in both the basic and social sciences. Most often a research attempts to present conclusive answers to all the questions that are posed. Stipulating a well formulated research question is one of the chief procedural stages a researcher has to take when conducting a particular investigation (Wildemuth, 2016). It is considered imperative for the research question to be precisely and clearly defined, with the aim of addressing the facets that the researchers want to explore.

Selection of an accurate research question is the vital element of both qualitative and quantitative research, and in most cases, the step often precedes the building of the theoretical framework of the research being conducted. The PICOT framework was used for the formulation of a searchable research question that took into account the population, intervention, comparison intervention, outcomes, and time (Echevarria & Walker, 2014). Owing to the extreme impacts that sleep deprivation creates on patients diagnosed with depression, such as, restlessness, anxiety, and negative thoughts, the PICOT framework took into account an intervention that addressed this irregular sleep pattern. The research question was as follows:

The MEDLINE electronic database was the primary search engine that was used for extraction of articles, along with Cochrane Library, PubMed and Google Scholar. The articles were retrieved following the input of several key phrases that were combined with boolean operators. Some search terms were depression’, ‘insomnia’, ‘sleeping patterns’, ‘music therapy’, ‘intervention’, ‘standard treatment’, and ‘sleep cycle’. The extracted hits were limited to peer reviewed articles that were published in English language, on or after 2014. The first article selected for the assignment is given below:

This article will be analysed with the use of the Joanna Briggs Institute Critical Appraisal tool for Randomized Controlled Trials. This tool will be selected since it will facilitate the evaluation of methodological quality of the study (Joanna Briggs Institute, 2017).

This article will be appraised using the Joanna Briggs Institute Critical Appraisal tool for Systematic Reviews and Research Syntheses. The tool will help to evaluate whether the article has addressed the likelihood of bias in its strategy, ways and analysis (Joanna Briggs Institute, 2017).

The researchers addressed a well-focused question where they tried to evaluate the impacts of sedative music on the sleep quality of older adults who resided in the community in Singapore. This research question was accurate since there is mounting evidence that have elaborated on the fact that with an increase in age, the likelihood of suffering from restless leg syndrome and sleep apnoea increases manifold. According to Jaussent  et al. (2013) insomnia has been found to be common among the elderly, which can be accredited to a range of health issues that are related to concerns of gaining and impacts of medications. The research was conducted among community-dwelling older adults from Singapore, in the form of an RCT. This means that the researchers recruited study participants from older people who independently lived in the community, in contrast to those admitted to nursing homes. Conduction of a randomised controlled trial was another good approach owing to the fact that it eliminated all forms of bias, with regards to the assigned treatment (sedative music), specifically confounding and selection bias (Neuman, 2013).

Critical evaluation of results

The researchers adopted a correct approach in designing the inclusion criteria that helped them recruit the prospective candidates for the trial. They included non-institutionalised individuals aged more than 55 years, psychologically sound, with good comprehension capabilities of English or Mandarin, and poor sleep quality. Furthermore, their act of eliminating participants who had been diagnosed with any cognitive or hearing difficulties was also correct since such people might find it difficult to provide appropriate responses to the questions asked by the researches. However, recruitment of patients from a single community centre was a wrong approach since it resulted in lack of representativeness of the findings and did not allow generalisation. Another correct methodology was the fact that the researchers used effect size to determine the sample for the study.

This can be accredited to the fact that effect size is a qualitative measure of a certain phenomenon that draws a correlation between two or more variables. However, the sample size might also create a negative impact on data generalizability. Blinding in research is vital since it helps in minimising bias and maximising the result validity. Blinding the participants, data collectors, analysts and/or any other individual, helps in eliminating potential bias in the results (Hróbjartsson et al. 2013). However, the researchers did not blind or conceal allocation of the participants or the interviewer. This was a weakness of the methodology adopted.

Data collection refers to the procedure that encompasses the collection of information from relevant sources, in order to draw definite conclusions to the research question. In the words of Brink, Yesavage and Lum (2013) the Geriatric Depression Scale was the primary data collection instrument and can be cited as relevant and valid. While there are a range of instruments and tools are available that assess depression, this GDS has been extensively tested amid older adults. The data collection process was rigorous since the PQSI was a self-administered questionnaire that helped in the assessment of sleep disturbances and quality over a period of time. Methodological congruence most often refers to the fact that research that has been conducted entails consistent ways of thinking. Thus, this research was congruent in its methodology. The researchers also eliminated probable ethical dilemmas by obtaining approval from the Institutional Review Board and informed consent from the participants.

The researchers presented the findings of the RCT in details and provided exhaustive information on the scores obtained in relation to PSQI, from the case group and the control group. They reported significant decreases in PSQI scores in the intervention cluster (n = 28) that comprised of listening to instrumental, soft and sedative music, which differed from the baseline measures (mean ± SD, 10.2 ± 2.5) to the 6th week (5.9 ± 2.4, p < 0.001). Nonetheless, those participants who were present in the control group (n = 32) and not subjected to sedative music therapy, demonstrated no difference in the scores from baseline measures (9.0 ± 2.4) to the 6th week (9.5 ± 2.6). At the end of 6th week, the intervention group presented an improved sleep quality, in comparison to the control (2 = 61.84, p < 0.001).

Hence, it can be suggested that the results were grounded in data. The researchers were also accurate in representing diversity of the participants who were recruited for the study. They demonstrated the variations in the case and the control group, in relation to different characteristics such as, marital status, gender, religious beliefs, and habit of listening music, chronic disease, GDS-15, age, and educational level. The researchers were able to demonstrate results of the trial that were consistent with other findings. They stated that listening soft and sedative music had the capability of improving the sleep quality among older adults. Noteworthy improvements have been cited by other researchers in relation to the impacts of music therapy on the quality of sleep (Loewy, Stewart, Dassler, Telsey & Homel, 2013).

Furthermore, accuracy of the findings can also be elaborated by the fact that the old age of the participants, and concomitant depression were positively correlated with the quality of sleep that they reported. Validity in a research helps in the determination of how sound the conducted research is. This research can be cited as valid owing to the fact that the findings were truly representative of the phenomenon (impact of music therapy) being investigated. Hence, the researchers made valid claims to support their outcomes. Usually, plausibility refers to the inference of a logical association between specific characteristics of the sample population that is being investigated. This research result can be cited as plausible owing to the fact with the implementation of music therapy, the community-dwelling older adults were able to demonstrate an enhancement in their quality of sleep and lowered depression associated signs and symptoms.

The article is of utmost importance since it found the confirmation that slow and sedative music listening acts as an effective intervention in improving the quality of sleep amongst older adults, in comparison to those who are not subjected to music therapy. Thus, it can be stated that the findings of the study supported the hypothesis. It has been found that the elderly often suffer from lack of sleep, and subsequent frequent walking and daytime fatigue (Yaffe, Falvey & Hoang, 2014). Inouye, Westendorp and Saczynski (2014) opined that along with the physical changes that are found to commonly affect a person, with an increase in age, alterations in sleep patterns are quite common in old age.

In addition to vicissitudes in sleep manner that occur with an increase in age, an additional factor disturbing sleep patterns in the aged population is the circadian rhythms that organises the scheduling of all bodily functions, counting sleep. For example, elder people incline to become drowsier in the first half of the evening and wake up early in morning, when equated to younger adults. This configuration is referred to as advanced sleep phase syndrome. Depression can also occur in the old people, nonetheless it is not considered as a usual part of aging. Although most individuals experience stages of grief at times, depression is a remediable medicinal condition. Elder adults are at an increased risk of false diagnosis of depression like conditions and absence of treatment amenities, owing to the fact that most of their signs mimic age-related normal health issues (Conradsson et al. 2013). The symptoms are also often mistakenly accredited to other diseases, medicines, or life variations.

Therefore, the findings that music therapy has the potential of improving sleep patterns among the elderly is quite significant. The intervention being discussed (music therapy) is least time consuming and can be efficiently implemented across all households, aged care facilities, nursing homes, and/or hospitals. Hence, efforts must be taken to make the elder listen to soft and sedative music for at least 30-40 minutes regularly, in order to enhance their sleep pattern and reduce the onset or progressive of depressive disorder. The article findings were also helpful in answering the original research question that was asked in the first section, with the aim of determining the impacts that music therapy exerts on the depression and sleep quality of older adults, when compared to standard care.

The research question was aimed at determining the effectiveness of music in improving the quality of sleep amid adults who suffered from primary insomnia. The researchers clearly focused their study on insomnia that is a sleep disorder, primarily characterised by problems in staying or falling asleep (Drummond et al., 2013). Furthermore, owing to the fact that in primary insomnia a person suffers from sleep problems that are not directly correlated with any other major health concern helps in establishing the appropriateness of the research question (Qaseem, Kansagara, Forciea, Cooke & Denberg, 2016). In addition, insomnia has also been identified as a major characteristic of depression and other comorbid mental illnesses. The search process was adequate since the researchers conducted their study based on a priori established protocol (PROSPERO CRD42017064750), followed a meta-analysis. The scholarly scientific articles were extracted from electronic databases and search engines such as, PubMed, the Cochrane Library, EMbase, and China National Knowledge Infrastructure Library.

Not excluding articles that were published in language other than English helped in retrieving all relevant scientific exploration that have dealt with the phenomenon being investigated. However, search filters and limiters are usually considered powerful literature search strategies that help in aligning the search results properly, thus restricting the time that is spent in going through irrelevant information (Aromataris & Riitano, 2014). Extracting all articles that had been published from the inception of the databases and the search engine was a wrong step as it violated result currency. Research currency is all about setting, and helps in determining whether the publication dates are relevant to the argument (Pinar, 2013). Thus, including older articles might make the research less up-to-date. According to Franco, Malhotra and Simonovits (2014) publication bias usually occurs in academic research when the outcome of a certain research or experiment impacts the decision whether to print or disseminate the results. The researchers reported plotting a comparison-attuned funnel plot, in relation to the network meta-analysis.

Owing to the fact that funnel plot is primarily used in the form of a visual aid for ascertaining bias and/or systematic heterogeneity, this funnel plot assisted them to perceive the presence of any overriding publication bias (Chaimani, Higgins, Mavridis, Spyridonos & Salanti, 2013). The researchers clearly elaborated on their inclusion and exclusion criteria. They included certain articles that were clinical trials conducted upon patients aged more than 18 years, suffering from primary insomnia, residing in the community or hospital, and subjected to passive or interactive music based intervention. They also stated that articles that contained information on patients aged less than 18 years, reviews on music efficacy, and background records were not eligible to be included in the study. In the words of LoBiondo-Wood, Haber, Berry and Yost (2013) critical appraisal is important in systematic reviews since it encompasses the procedure of systematically and carefully evaluating the consequences of scientific evidences, with the aim of assessing the value, trustworthiness and relevance of the research context.


The researchers used the Critical Appraisal Skills Program (CASP) program for evaluating the articles that were included in the review. Owing to the fact that CASP helps in making a sense of the evidences, the appraisal was correct. Two investigators were involved in abstraction of data and the further assessment of all kinds of risk bias in the research. The term reproducible research refers to the concept that the final outcomes of a certain academic research is the article, concomitant with computational environment and statistical data (Stodden, Leisch & Peng, 2014). The findings of the research were reproducible in this case. Risk of bias refers to the risk of systematic deviation or error from truth, in the research outcomes or inferences, and the term is interchangeably used with internal validity. The authors stated that they assessed the risk of bias with the use of Physiotherapy Evidence Database (PEDro) scale scores and the CASP.

Hence, this step of the methodology was also accurate. However, they could have used the Grading of Recommendations Assessment, Development and Evaluation Working Group (GRADE) for measuring the quality of the evidences that were amalgamated in the review (Andrews et al., 2013). The researchers did not subject the systematic review to ethical approval. However, some of the common ethical issues that might have originated include goal related considerations such as, (i) financial support, (ii) justification, (iii) conflict of interest; duty related consideration; right related consideration namely, (i) safety, (ii) informed consent, (iii) confidentiality; and approval from the research ethics committee.

Systematic reviews are often conducted without meta-analysis under circumstances when the trials included in the review are quite heterogeneous and/or there are no reported data or effect estimates (Hutton et al., 2015). The researchers stated that they combined indirect and direct trials that comprised of 12 varied interventions and encompassed 1,339 patients. Owing to the fact that a single study most often does not suffice to underpin the concept of systematic reviews, the authors combined the results from multiple trials. This can also be accredited to the fact that all articles were clinically similar since all the interventions that focused on music were able to significantly create an effective impact on the primary outcome of the patients (PSQI scores), in comparison  to usual care. Furthermore, with the aim of reducing inconsistency and heterogeneity among the included trials, those that contained descriptive information were excluded from the network meta-analysis (Kontopantelis, Springate & Reeves, 2013). The size of discrete clinical trials is most often small for detecting the treatment impacts dependably. Thus, a meta-analysis has the potential of increasing the power of statistical assessment by pooling the available results of all trials. However, the discrete estimations of treatment consequence will differ by chance; certain variations are expected. Upon instances when extreme variation occurs, statistical heterogeneity arises. Hence, the researchers were accurate in conducting an assessment of statistical heterogeneity with the use of P values and I2 statistics.

The researchers identified more than 214 unique citations that comprised of 20 trials, 12 interventions. Almost all the trials comprised of music therapy, while the interventions focused on acupuncture, language induction, music listening (alone, with acupuncture, or induction), music with exercise, and music-assisted relaxation. Thus, the authors adopted a correct approach in defining the studies that reported a plethora of interventions and comparators, in the form of sub-studies, with the sole intent of averting data mistreating and double-counting. They performed direct meta-analyses with random-effects models, to determine the mutual truth behind all theoretically comparable scientific studies. This was followed by incorporation of heterogeneity by using STATA v14.0 (Grant, Furr, Carpenter & Gelman, 2016). Conduction of a random-effects meta-analysis, and ranking all probabilities for each intervention were also correct approaches.

The researchers presented their results in the form of tables, and figures. While table 1 and 2 contained a summary of the fundamental differences between intervention and control group, table 3 presented the assessment of research quality. This in turn was a correct approach in distinguishing between the potential dissimilarities that led to varied impacts of the intervention (music therapy). The fact that listening to music created most impact on sleep quality in PSQI scale, followed by music-assisted relaxation, music with acupuncture, music with exercise, acupuncture, and Western medicine was accurately represented in the network meta-analysis figure. They also presented the results in a well-defined format by formulating a figure that ranked the interventions, based on their impact on overall sleep quality (music-assisted relaxation was highest; Western medicine was lowest).

The pairwise meta-analysis for general sleep quality was also depicted in supplementary figure S2, thus making the results more valid and reliable. This was followed by representation of the assessment-adjusted funnel plot related to sleep quality. Nonetheless, this plot was not indicative of any publication prejudice, thus confirming the reliability of the results found by the researchers. Accuracy of the results can also be established by the fact that the researchers put an emphasis on diagrammatic representation of the secondary outcomes, thus reporting the effects of the intervention discussed in the trials on sleep onset latency and sleep efficiency. Precision of the results can also be established by the fact that the difference in baseline characteristics among the participants (case and control) had a 95% CI. Presence of 95% CI indicated that, upon taking repeated samples, there is a 0.95 probability of obtaining the same results. Furthermore, transparency of the systematic review can be established by the fact that the researchers followed the exact guidelines that encompass conduction of systematic reviews.


Formulation of a definite and precise literature search strategy and determining all possible publication bias by statistical assessment are indicators of research rigour and reliability. Coherence labels the fit between the objective, the logical perspective accepted, and the investigator role in the study. Furthermore, it also encompasses the different approaches of investigation, scrutiny and appraisal undertaken by the researcher. This systematic review can be cited as coherent since it followed the aforementioned approaches. However, there were certain major limitations in the review. Owing to the fact that the researchers considered adult patients suffering from primary insomnia as the target population, they had to eliminate prospective articles that talked about the intervention on people suffering from secondary insomnia. Secondary insomnia is a common disorder and encompasses a condition where an individual has sleep problems due to different factors such as, existing health abnormalities (arthritis, depression, cancer, asthma, and heartburn), medication or pain (Koffel, Koffel & Gehrman, 2015).

In addition, presence of a small sample size in most of the included trials was another potential limitation. Larger samples help in closely approximating the larger population. Likewise, small sample size of the included trials might have also created an impact on the reliability of the individual results that were further analysed in the network meta-analysis (Marshall, Cardon, Poddar & Fontenot, 2013). Lack of reliability can also be aligned with the fact that the researchers measured only four outcomes, due to small sampling size. Another potential source of bias can be accredited to the fact that the databases that were not used for extraction of articles such as, MEDLINE, SCOPUS or CINAHL are usually considered as strong repositories of information that pertains to medical and biological field.

The systematic review is extremely relevant to the research question since it was able to establish music intervention as an effective approach in treating primary insomnia among adults. There is mounting evidence for the fact that older adults are found to suffer from primary insomnia that is usually manifested by problems in falling asleep, feeling tired, or early awakening (Baron, Reid & Zee, 2013). Owing to the fact that the risks of acquiring primary insomnia increases with an increase in age, and is a relapsing and chronic condition, the findings of the review can prove beneficial in implementing music therapy as an intervention in evidence based practice (Winkler, Auer, Doering & Rief, 2014).

Furthermore, clinical depression among the elderly is one of the most common mental disorders and only a handful of those people have been found to access proper treatment for their depression. Depression and insomnia often go hand-in-hand and have made researchers conclude that management of the underlying sleep problem will prove beneficial in treating clinical depression among the older adults (Roberts & Duong, 2013). Hence, the results of the systematic review suggests that subjecting depression patients who report sleeping difficulties, to music therapies where they will be asked to listen soft and soothing music each day, for at least 30 minutes will prove effective in management of their condition.

References

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