The article uses a retrospective observational research method which positively influences the study by identifying the health risks associated with mobility while on CRRT, the occurrence intensity, and the prognosis of patient safety events. According to Euser et al. (2009, pg. 215), accuracy value and improved efficiency are the key benefits of retrospective cohort studies. Additionally, the backdated layout improves data accessibility, saving time and money (Song and Chung, 2010, pg. 2240). However, recall bias, where respondents fail to recall specifics of a former encounter or incident or omit information while responding about it, is a prevalent issue in retrospective research (Thiese, 2014, pg. 200). Nevertheless, the study reduced this bias: it exploited the hospital’s computerized database rather than personalized interviews.
Inclusion/ Exclusion Criteria
The study inclusion or exclusion standards for choosing individuals are vague. It is unclear whether patients were excluded or included in the trial based on different factors. This may have affected causal links between treatment and control groups and the validity findings (Patino and Ferreira, 2018, pg. 84)
Design and Methodology
The study relies on manual chart review and electronic health information, which may result in mistakes or inconsistencies. The retrospective nature may also restrict the quality and comprehensiveness of the data acquired (Norvell, 2010, pg 8). As an illustration, it’s possible that the researchers only documented risks pertinent to their study (Drolet et al., 2022, pg. 5), distorting the results on the safety and practicability of mobility in Renal Replacement Therapy patients. The researchers overlooked negligible safety incidents during physical therapy treatments, such as hypotension or oxygen desaturation, which could have contributed to understanding the safety of physical therapy interventions during CRRT. Negligible incidents can provide valuable information (Mayer et al., 2020, pg. 40). Therefore, overlooking these incidents might compromise the data of a particular patient and, eventually, the study’s validity. Nevertheless, the study reduces the bias by considering safety events such as catheter dislodgement, bleeding, and hemodynamic emergency (Bento et al., 2020, pg.3).
Additionally, a retrospective structure limits reliable comparability between the safety occurrences linked to the treatments and those that may have happened without them (Hansrivijit et al., 2020, pg. 1265). It is hard to determine whether physical therapy may or may not cause any safety issues in the absence of a placebo group.
Cohort studies require an accurate assessment of the risk and the result to produce reliable conclusions (Wang and Katan, 2020, pg. 75). Retrospective design limits this accuracy. The researchers rely on the controls set up by the preceding doctors who provided treatment because the incidents had already happened (Song and Chung, 2010, pg. 2234). The findings documented in the patient’s medical file by previous doctors had to satisfy the study’s researchers. The researchers would be unaware of any incidence that would have been of interest to them if it hadn’t been noted. These factors can negatively affect the quality of the results (Song and Chung, 2010, pg. 2234). Therefore, we cannot accurately quantify the outcome of this study.
A prospective study design would have solved the challenges of this study. This design allows for gathering more precise data regarding the patient’s hemodynamic response to the therapies (Biele et al., 2019, pg. 927). In a prospective cohort study, researchers may monitor patients and, more precisely, document the behaviors of persons of interest (Adams and McGuire, 2022, pg. 500). This may have given a fuller picture of the safety incidents connected to the measures.
Randomization
It is not mentioned whether the patients were assigned trials and treatments randomly. Since the subjects were not randomized, the study may have lacked comparable groups, resulting in treatment allocations and selection bias (Suresh, 201, pg. 8). Selection bias may have affected the validity of the outcome.
Year/ location of study/ Sample Size
The data was gathered between December 2016 and November 2018. This was an excellent period to obtain reliable results for Renal Replacement Therapy (Chen et al., 2021, pg. 2). If data collection were consistent during the time apart, the outcome would be reliable. Furthermore, if the data collection was consistent, the study was valid. The therapy is still done today in the United Kingdom. The sample of 206 patients who were 18 years of age and older was good (Chen et al., 2021, pg. 4). They underwent CRRT and were admitted to the ICU.
Sampling
There is no indication of the sampling method. However, we can deduce that the researchers used a non-probability purposive sampling based on the defined feature of the sample population in the ICU that needed CRRT and mobility evaluations (Bhardwaj, 2019, pg. 157). This sampling approach was appropriate since the study’s sample population was chosen with consideration to reflect the study’s primary aims (Vijayamohan, 2023, pg. 1). However, it was prone to bias due to researchers relying on the personal judgment in choosing participants (Norvell, 2010, pg. 9). This might have affected the data and eventually the outcome.
For data collection, the manual electronic record review seems to have collected data on physical therapy sessions, neglecting to consider other factors. The manual electronic record review cannot be replicated outside Utah due to controls. It is unclear if differences in sedation levels, kinds of breathing machines, devices that keep patients’ airways open, comorbidities, and variances in severity-of-disease ratings were considered. Without these details, it is challenging to determine whether the sample is representative of the population at large and whether the findings can be extrapolated to other populations, making it difficult to draw conclusions that are both valid and reliable (Meline, 2006, pg. 23). Therefore, the study’s safety and viability of physical therapy sessions for ICU patients receiving CRRT are questionable.
The participant dropout rate is not mentioned in the article. However, given that the study was retrospective and relied on a manual record review, there was no chance that the sample(s) would refuse to participate (Bankhead, Aronson, and Nunan, 2017, pg. 21). It may be assumed that there were no significant risks involved with the statistical analysis because there were no losses, and every subject was considered (Bankhead, Aronson, and Nunan, 2017, pg. 21).
Results
The progression of physical treatment sessions was decided based on the patient’s tolerance level. Their mobility was advanced depending on the participant’s tolerance level and whether or not they had medical instability. The ICU mobility scale (IMS), which ranges from 0 (no mobility) to 10 (walking freely with an assistive device), was employed by the authors to describe mobilization numerically. There were various levels of movement in around 83%. With the CRRT machine in tow, 39% could ambulate, and the average IMS was 5 (bed-to-chair transfers). Cardiac arrest was the only safety incident that occurred throughout the research. Bento et al. (2020, pg.4) assert that this had no impact on the safety and mobility of patients while receiving CRRT, but they did not elaborate on this conclusion. Failing to elaborate on why cardiac arrests had no impact on the safety of patients leaves the study with some gaps. The authors needed to be corrected on such gaps since it results in inconclusive results.
The study assumed that a sizable percentage of patients could move around while receiving CRRT and that doing so was safe, given that there was only one significant safety issue (cardiac arrest) throughout the trial that the authors did not attribute to the existence of the CRRT device. I cannot entirely agree with the conclusion since the study has many assumptions and gaps in findings.
References List
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