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Critical Review Form – Quantitative Studies 1) Complete a critical review of a minimum of 2-3 articles (depending on the number members in your group) that were found during your literature search. Article #1 CITATION: Backus, PT, PhD, D., Manella, PT, MT, C., Bender, MPT, A., & Sweatman, PhD, M. (2016). Impact of Massage Therapy on Fatigue, Pain, and Spasticity in People with Multiple Sclerosis: a Pilot Study. International Journal of Therapeutic Massage & Bodywork: Research, Education, & Practice, 9(4), 4. https://doi.org/10.3822/ijtmb.v9i4.327 Comments STUDY PURPOSE: Was the purpose and/or research question stated clearly? FORMCHECKBOX yes FORMCHECKBOX no Outline the purpose of the study and/or research question. “The purpose of this study was to measure the effects of six weeks of a standardized massage routine on fatigue, pain, spasticity, perception of health, and QOL in people with MS” (Backus, et al.,2016). It was hypothesized that MT would decrease complaints of fatigue, pain, and spasticity. In reducing these impairments, it would lead to an improved perception of health and quality of life. Yes. The purpose of the study was clearly defined as whether MT is a productive, useful addition to MS therapy. LITERATURE: Was relevant background literature reviewed? FORMCHECKBOX yes FORMCHECKBOX no Describe the justification of the need for this study. Was it clear and compelling? Multiple Sclerosis (MS), "a chronic, immunemediated, inflammatory disease of the central nervous system affecting over two million people world-wide. The resulting loss of independence and restrictions on recreational, vocational, and social activities, leads to a progressive decline in quality of life. While disease-modifying therapies may prevent or slow the progression of the disease, many symptoms remain, even with the use of these medications “(Backus, et al., 2016). The three most common symptomatic complaints are pain fatigue, and spasticity. The study clearly states that the conventional treatments are not enough to manage the MS symptoms. This study was designed to discuss MT as an added element to medical treatment as ‘traditional’ medical approaches are ineffective in helping these symptoms. Yes, relevant literature was reviewed that reinforces the common complaints/ailments of patients afflicted with MS. How does the study apply to your practice and/or to your research question? Is it worth continuing this review? Yes, this is continuing to review, it applies to the research questions because it is investigating if massage therapy is a good therapy treatment for patients with MS and relieving fatigue problems. It will give a better understanding of the physiological changed that are produced with massage and how it can help with fatigue, a predominant symptom of MS. A great education tool to better understand how massage therapy impacts such conditions. STUDY DESIGN: What was the design? FORMCHECKBOX phenomenology FORMCHECKBOX ethnography FORMCHECKBOX grounded theory FORMCHECKBOX participatory action research FORMCHECKBOX other _ _____________ Was the design appropriate for the study question? (i.e., rationale) Explain. The study design is phenomenology because it focuses on the meaning of a particular aspect of experience, and this enables researchers to get a better understanding of the human experience. In a smaller group you can tell common themes in their descriptions of their experiences. Given that Fatigue is subjective to the patient, this is an appropriate method for the study question. Was a theoretical perspective identified? FORMCHECKBOX yes FORMCHECKBOX no Describe the theoretical or philosophical perspective for this study e.g., researcher’s perspective. Researcher’s perspective is clear in their hypotheses they made, assuming massages will decrease complaints of fatigue, pain, and spasticity. It is also stated, “Approximately a third of surveyed individuals with MS report they use massage therapy (MT) as an adjunct to their medical treatment, often because conventional treatments are not effective in managing their symptoms “(Backus, et al., 2016). Method(s) used: FORMCHECKBOX participant observation FORMCHECKBOX interviews FORMCHECKBOX document review FORMCHECKBOX focus groups FORMCHECKBOX other _ _____________ Describe the method(s) used to answer the research question. Are the methods congruent with the philosophical underpinnings and purpose? To gather information of the patients, they are asked to complete a Modified Fatigue Index Scale (MFIS), the Modified Ashworth Scale (MAS; spasticity), and the MOS Pain Effects Scale Secondary outcome measures included assessment of perception of health and quality of life using subscales of the MS QLI” (Backus, et al., 2016). Given that this a pre-post pilot study, the outcome measurements are taken before and after 6 week intervention stage. There is also document review for the therapists to complete after each session to ensure they are all following the same protocols and treatment plan, called the massage weekly process evaluation form. SAMPLING: Was the process of purposeful selection described? FORMCHECKBOX yes FORMCHECKBOX no Describe sampling methods used. Was the sampling method appropriate to the study purpose or research question? The study involved 24 patients afflicted with MS but aimed for 25 patients. “Individuals were excluded if they had uncontrolled hypertension, unstable fractures, neurological injury, or disease, pregnant or trying to get pregnant, received MT within the last 6 months, weight exceeding 350lbs, unable to get out of a wheelchair to transfer to a massage table or unable to comfortably be positioned on a massage table. Subjects were recruited by word of mouth, RRC–approved fliers, and through the patient database at the Shepherd Center in Atlanta, Georgia “(Backus, et al., 2016). This sampling number is appropriate for a phenomenology study, which does better with fewer numbers. Was sampling done until redundancy in data was reached? FORMCHECKBOX yes FORMCHECKBOX no FORMCHECKBOX not addressed Are the participants described in adequate detail? How is the sample applicable to your practice or research question? Is it worth continuing? The participants are described in adequate detail and the sample is applicable to the research questions and practice because they all have been diagnosed with MS and fit the criteria to be in the study. It is worth continuing. Was informed consent obtained? FORMCHECKBOX yes FORMCHECKBOX no FORMCHECKBOX not addressed It is not specifically mentioned that consent was attained but states that all participants received the intervention for massage. DATA COLLECTION: Descriptive Clarity Clear & complete description of site: FORMCHECKBOX yes FORMCHECKBOX no participants: FORMCHECKBOX yes FORMCHECKBOX no Role of researcher & relationship with participants: FORMCHECKBOX yes FORMCHECKBOX no Identification of assumptions and biases of researcher: FORMCHECKBOX yes FORMCHECKBOX no Describe the context of the study. Was it sufficient for understanding of the “whole” picture? Participants received a specific routine of MT for approximately 1 hour each week, for six weeks, in a quiet room, on a massage table, by a licensed massage therapist at Not-for-profit long-term care facility (Backus, et al., 2016). Therapist would complete an evaluation on their treatment ensuring that all therapists are committing to the same treatment plan designed for this study. The treatment consisted of, “A specific routine of MT was designed by two study investigators who are licensed physical therapists and licensed massage therapists. In general, the MT routine consisted of a combination of effleurage, petrissage, friction, and static compression strokes” (Backus, et al., 2016). What was missing and how does that influence your understanding of the research? What Is missing is a clear control group that does not get any massage interventions, that way it can be compared between the two groups. This can impact the understanding and how to participants gave them the forms, was it over email or in person. Procedural Rigour Procedural rigor was used in data collection strategies? FORMCHECKBOX yes FORMCHECKBOX no FORMCHECKBOX not addressed Do the researchers provide adequate information about data collection procedures e.g., gaining access to the site, field notes, training data gatherers? Describe any flexibility in the design & data collection methods. Data collection was taken pre and post to the study, at the beginning and after 6 weeks. The procedure was vigorous and detailed. Two primary LMTs and one investigator were trained in the MT routine. Two of the study investigators, also LMTs, filmed a video of delivery of the specified routine for training, they had to watch a video on how to do the massage and once they understood, practiced on volunteers to ensure correctness. “Specific instructions were not given regarding speed of strokes; the speed of each stroke was implied in the overall time period associated with the body area addressed. Level of pressure was determined relative to participant tolerance, particularly with the techniques of petrissage, linear friction, and static compression. All attempts were made to assure that the same primary LMT administered all six massages on a given participant. However, if a primary LMT was not available for some reason, the other primary LMT or the trained investigator administered the MT for that session” (Backus, et al., 2016). The forms completed each session by the LMT is reviewed by a coinvestigator weekly, to ensure that the routine is being followed correctly. The patients were to record and note their findings on their own time. DATA ANALYSES: Analytical Rigour Data analyses were inductive? FORMCHECKBOX yes FORMCHECKBOX no FORMCHECKBOX not addressed Findings were consistent with & reflective of data? FORMCHECKBOX yes FORMCHECKBOX no Describe method(s) of data analysis. Were the methods appropriate? What were the findings? The findings concluded that Auditability Decision trail developed? FORMCHECKBOX yes FORMCHECKBOX no FORMCHECKBOX not addressed Process of analyzing the data was described adequately? FORMCHECKBOX yes FORMCHECKBOX no FORMCHECKBOX not addressed Describe the decisions of the researcher re: transformation of data to codes/themes. Outline the rationale given for development of themes. “We employed descriptive statistics to evaluate means and standard deviations. Paired t tests were used to determine statistically significant differences pre- and postintervention in fatigue (MFIS), pain (MOS Pain) and spasticity (MAS), perception of health (MHI),