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Appraisal Paper 1

Discuss about the  Evaluating Usefulness of Evidence.

Article by Von Haaren, Haertel, Stumpp and Ebner-Priemer, (2015).

The article was prepared by 5 authors; Ebner-Priemer, Hey, S., Haertel, Stumpp and Von Haaren from different departments in Karlsruhe Instutute of Technology. The authors sought to find ways of reducing perceived stressors of life through physical exercise. Ethical considerations were observed in the journal in that there were no special characters that were chosen in carrying out the experiment. Instead the article explains that students were randomly picked and assigned to the AET and waiting control groups.

The title, “the reduction of reactivity to emotional stress…” describes the article. It is informative but not concise. The title indicates the research approach, that is, Ambulatory Assessment include in the randomised controlled trial.

In the introduction, the authors made the purpose clear. The introduction also states the actual problem being examined, that is, the daily life stressors such as when there is excessive demand to concentrate on a particular task and lead to effects on emotional and physical functioning of the person affected. The authors clearly explain the purpose of study as examination of whether the AET intervention can improve emotional stress when one is also faced with real-life stress. The purpose clearly states that it is to enhance reactivity of the emotions to the real life stress.

The section of methods details how research question were addressed or hypothesis were tested. There were randomly collected sample of about sixty-one students who were to act as a control group. In order for the experiment to be situation-specific, there was use of electronic diaries. Before and after the experiment, there was a cardiopulmonary exercise test was performed on both groups. In the discussion the authors provide an explanation of the results and how they are related to the research question, theoretical framework as well as the significance of carrying out exercises to reduce psychological and real life stress. Here, the research proved that the effects of improved reactivity to emotions raise the possibilities of having mental and physical disorders. Here the authors explain how assessment was done pre- and post- intervention. In order for the authors to make the most of subject differences in the reactivity of stress as well as show the treatment effect, there were two real- life periods of intervention.

The authors conclude by recommending performance of exercises as an effective way of dealing with health effects that are caused by stress. According to the purpose of the study, the conclusion showed the end results of performing the tests on the stressed individuals where the individuals started to experience little stress. In the conclusion, the author recommends that more studies to be performed on the evaluation and the impact of exercises on emotional and physiological stress reactivity.

Appraisal Paper 2

The study provides high quality information because its level and hierarchy of evidence is under unfiltered information of evidence hierarchy (Schneider et al., 2012). This is because the article is a randomized control trial. The article is applicable to Mariana’s scenario where, as a single mother she suffers from stress disorder because of her daughter being asthmatic and her lack of adequate support from her family. She also faces other daily life stressors. The journal is applicable to the scenario as it provides suggestions of carrying out exercises as a way of buffering psychological stress. The weakness of the article is that it fails to bring out an inexpensive strategy that are easier to use in the reduction of stress and that would take shorter time. 

Article by Kim, Yang and Schroeppel (2012).

The first paper is a peer-reviewed journal with the title, A Study to Examine Effects of Kouk Sun Do (KSD) on University Students who have Symptoms of Anxiety. It was prepared by three authors: Jong-Ho Kim and Heewon Yang from the department of Recreation and Health Education and Stephen Schroeppel from Education Psychology department, all from Southern Illinois University, Carbondale.

The title clearly describes the article. It is informative and concise at the same time. Before the reader gets the details of the article, they already understand that it is a report on a study that was conducted to examine the effects of ‘Kouk Sun Do’ (KSD) on students who had anxiety problems. The reader can also tell that the authors took a case study research approach from the title.

In the abstract, the authors provide an executive summary of the whole report. They point out that the objective of the article was to examine effects of KSD, the exercise involving mind and body, on mental health students. The population of participants included 30 students, 18 completed the pre-test as well as the post-test while 12 left during the intervention. A qualitative research method was used in data collection. In the abstract, the authors included a conclusion of the study, that is, self-induced relaxation KSD effects may reduce anxiety.


The introduction makes the purpose of the study clear. The authors explain the actual problem under investigation and how it can be solved. Anxiety, a prevalent class of mental disorders is highly associated with psychiatric conditions, uneasiness, physical symptoms like shortness of breath, muscle stiffness and tension, chest pains and palpitations. Mindfulness exercises have been a growing regimen for this problem’s psychological treatment. Here the authors give a rationale of the observations by other researchers. For instance, different authors previously reported that mindfulness stress reduction programs that are mindful and meditation stretchers significantly treat individuals by reducing stress. KSD has been practiced for years but was never scientifically evaluated on its efficacy. The introduction sets the scope of the problem and the limits of the study. A good example is the unresearched anecdotal reports on the KSD‘s psychotherapeutic effects.

Summary and Justification of Strongest Evidence

The authors mention the purpose of the study at the end of the introduction, that is, examination of KSD’s effects on the mental health of students in the university with symptoms of anxiety. However, the authors fail to offer a detailed explanation of the purpose. The methods section was broken down into participants, setting, instruments, procedures and data analysis subsections. Total participants were 30 university students. The procedure began by students completing the consent forms.

The authors used level IV evidence in their hierarchy of evidence. Level IV is where evidence is obtained from a cohort study or a case-study that is well designed (Schneider et al., 2012). The authors engaged 30 participants, university students, who had certain anxiety levels. As a level IV evidence study, 18 participants acted as the treatment group because they attended the five to eight KSD sessions, while 12 participants who failed to complete acted as the control group. Concerning the evidence hierarchy, this study is located at the first part, from the bottom, of the unfiltered information since it is a case-control study. The authors did not include the strengths and weaknesses of the study that could be maintained or included in future research. This study is relevant to Mariana’s scenario.

According to the scenario, Mariana, a single mother suffers from a stress disorder due to different issues. She suffers from a rare blood disorder and diabetes while her 18 month daughter suffers from severe asthma. This first year student also has limited support from her family and lives in a small unit away from the university. While she attends her classes, she leaves her daughter in a child care center near the university. All these conditions are day-to-day circumstances that she has to live with and face. Among the two articles appraised, Von Haaren et al.’s of 2015 provides the most relevant information that can be used for Mariana’s case. The discussion clearly reaffirms the reader that the information can be used without any doubts in Mariana’s case. Von Haaren et al. (2015) explains that they were able to prove that the aerobic intervention has the ability to reduce emotional stress when an individual is faced with real-life stress like Mariana is going through. 

Von Haaren et al.’s article examined whether a 20-week aerobic exercise intervention (AET) has the potential of improving emotional stress while still undergoing real-life stress. In contrast to Kim, Yang and Schroeppel’s study, Von Haaren et al.’s examined emotional stress such as the one Mariana is going through amidst real-life stress. The 61 students that were used in the study used to go through daily stress that was as a result of what life struggles. Kim, Yang and Schroeppel’s study did not provide the source of depression that the students were going through. In addition, the study used a very small number of participants (18 students) which might not be a good representation of a whole population of individuals suffering from stress. A sample of sixty one students provides more accurate results.

The accuracy of this study and its relevance to Mariana’s case is further driven by the method and procedure used. The authors clearly explain the procedures used in the study. In the first two weeks of study, a pretest on cardiopulmonary exercise was done while the post test was done 3.5 months later. In addition, emotional stress was assessed before and after the intervention. The first, pre-test assessment was done when the semester begun because it was assumed that most had low stress at that period. This acted as the baseline assessment. To maximize the difference, the post-test assessment was done after the exam to act as a real-life stressful period. This difference increased the accuracy and relevance of the study. Kim, Yang and Schroeppel’s study did not have a baseline disqualifying it from being relevant to Mariana’s case.

The study is well detailed using supporting materials from past researchers. According to Friesen-Storms et al. (2015), an evidence based article that uses more recently published articles is the best for provision of information. Von Haaren et al. (2015) used 71 references to support their arguments. Most of the references used were peer reviewed journals published between 2008 and 2014. The references used before this period mainly provide facts. Kim, Yang and Schroeppel’s study used only 58 reference materials, most of which were used before 2007, making the evidence less up-to-date.

Apart from a strong evidence as a result of the materials used, Von Haaren et al.’s study was strengthened by a confirmation of results from the two assessments that were carried at the same time. Kim, Yang and Schroeppel’s study did not have a second assessment like in the first paper, making its information to be weaker. The evidence in this article is stronger because of the fact that the study took a longer duration than the other one. Unlike in the first study that took five to eight weeks out of the 10 that were planned for, this study took a 20-week aerobic exercise intervention.

Kim, Yang and Schroeppel’s study falls under the case-controlled studies while Von Haaren et al.’s fall in the randomized Controlled trials. Although the quality of evidence with this research is a step below that of Kim, Yang and Schroeppel’s study in the hierarchy of evidence, the information is still unfiltered and hence of high quality (Ingham-Broomfield, 2016). According to Von Haaren et al. (2015), the previous researches that had been conducted were randomized controlled trials that had a lot of short comings. However, this research considered all the shortcomings and ended up using Ambulatory Assessment to avoid them. An Ambulatory Assessment is one which involves a wide range of methods to study people within their environments (Carpenter, Wycoff and Trull, 2016). This study used momentary self-reports, physiological and observational methods and ecological momentary assessments. The reduction of shortcomings increased the accuracy of the study.

References

Carpenter, R. W., Wycoff, A. M., & Trull, T. J. (2016). Ambulatory Assessment. Assessment, 23(4), 414-424. doi: 10.1177/1073191116632341

Friesen-Storms, J. H., Moser, A., Loo, S., Beurskens, A. J., & Bours, G. J. (2015). Systematic Implementation of Evidence-Based Practice in a Clinical Nursing Setting: A Participatory Action Research Project. Journal of Clinical Nursing, 24(1/2), 57-68. doi:10.1111/jocn.12697

Ingham-Broomfield, R. (. (2016). A Nurses' Guide to the Hierarchy of Research Designs and Evidence. Australian Journal of Advanced Nursing, 33(3), 38-43

Kim, J., Yang, H., & Schroeppel, S. (2012). A Pilot Study Examining the Effects of Kouk Sun Do on University Students with Anxiety Symptoms. Stress and Health, 29(2), 99-107. https://dx.doi.org/10.1002/smi.2431

Von Haaren, B., Haertel, S., Stumpp, J., Hey, S., & Ebner-Priemer, U. (2015). Reduced emotional stress reactivity to a real-life academic examination stressor in students participating in a 20-week aerobic exercise training: A randomised controlled trial using Ambulatory Assessment. Psychology of Sport and Exercise, 20, 67-75. https://dx.doi.org/10.1016/j.psychsport.2015.04.004

Schneider, Z., Whitehead, D., Elliott, D., LoBiondo-Wood, G., & Haber, J. (2012). Nursing and Midwifery Research: Methods and Critical Appraisal for Evidence-Based Practice (3rd ed.).

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