Botulinum Toxin Type A Use In Piriformis Muscle Syndrome: A Pilot Study

Critical Appraisal

Describe about the Botulinum Toxin Type for A Use in Piriformis Muscle Syndrome.

‘Botulinum Toxin Type A Use in Piriformis Muscle Syndrome: A Pilot Study’ is an article that presents the study conducted by  Childers MK, Wilson DJ, Gnatz SM, Conway RR, and Sherman AK. The article was published by Lippincott Williams & Wilkins in the 2012 edition of the American Journal of Physical Medicine & Rehabilitation. The main objective of the research was to test the extent to which intramuscular Botulinum Toxin type A (BTX-A) decreases the piriformis muscle syndrome chronic pains in comparison to a vehicle/saline injection. To effectively respond to the research question, the study adopted a double-blind single group strategy. In this design, a proportional sample was taken to represent the entire target population. A sample of nine women with lower limb pain and chronic hip and buttock was taken to participate in the research. After examining the participants by submitting an injection of units of botulinum toxin type A, they had to get another vehicle injection to help in comparing the results. From the study, it was established that the 100 units of botulinum toxin type A injection has higher chances of reducing pain as compared to an injection with a vehicle alone. This paper conducts a critical appraisal of the article by adopting the RAMMbo mnemonic. After critically analyzing the Recruitment, Allocation, Maintenance and Measurement, Blind and Objectives, the paper will go ahead to interpret the research findings and evaluate its relevance to nursing practice.

R = Recruitment: The recruitment for the participants of the research was properly done. After identifying the target population, a sample was selected to represent it. The sample chosen was quite proportional to the entire population. The consideration of demographic factors in the sample made it to be representative. Apart from selecting a representative sample, the researchers did a great job by ensuring that everything was done as per the expected standards. Since participation in the study was voluntary, all the participants were given an opportunity to sign an informed consent before being subjected to the studies. The other strength of the research is that the researcher strictly followed a proper inclusion and exclusion criteria (DiCenso; Cullum & Ciliska 2011). To be included in the study, all participants had to be thoroughly screened to determine if they possess the required traits. Those who had experiences like pregnancy during the studies were deemed excluded because they became unfit for the research. This shows that the recruitment of the participants had no limitations at all.

Interpretation of the Results

A = Allocation: In this research, the sample population used as participants was mainly divided into two categories-intervention and control groups. When these samples were subjected into the research, the results were compared to help in providing answers to the research question. The randomization method used in the samples was not biased at all (Lamb 2015). The researchers took all measures to ensure that the groups were matched as closely as possible right from the very begging of the trials. This qualifies the allocation process of the research to be above board because of the careful manner in which it was applied in the studies.  

M = Maintenance: In terms of maintenance, it is obvious that the researchers took the initiative to ensure that all the study groups were accorded equal treatment throughout the study period. All the study groups were keenly followed up by the researchers without any discrimination categories (Natsis, Totlis, Konstantinidis, Paraskevas, Piagkou & Koebke 2014). From the information provided by the researcher, it is evident that all the groups were treated as equal apart from the fact that they were subjected to different interventions. Indeed, the equal treatment of all the study groups was a noble initiative that made the research to be reliably unbiased. 
M = Measurement (blinding, objective measures): After the trial, the outcomes were measured to determine the results. Given that the research was double-blind in nature, the researchers had to measure the results using blinded subjects. This was a good decision because it played a significant role in eliminating any bias that might occur (Lamb 2015). Furthermore, to obtain a bias-free result, the measurement had to be objectively done. The production of unbiased results is one of the strengths of the research that was obtained by making a proper choice of the measurements.   

The major finding of the research is that there were differences in the VAS scores for the BTX-A and vehicle injections. For BTX-A, there was a decrease in the VAS score. The outcome revealed that there was a decline in the VAS score because the post injection scores were significantly lower than the baseline scores. In fact, there was a decrease in the VAS scores in all categories (Natsis, Totlis, Konstantinidis, Paraskevas, Piagkou & Koebke 2014). This differed from the vehicle injected scores that did not show any change even after the injection. Unlike in BTX-A injection, vehicle injection only resulted into a VAS score decrease in the distress category.

Applying the Evidence

The results indicate that BTX-A can reduce pain. This is why an injection of 100 units of BTX-A led to a great change in the VAS scores. The injection brought clinically desirable outcome that proves its effectiveness in pain reduction. If used appropriately, BXT-A injection can greatly contribute to the treatment of pains. It is much better than other alternatives (Parahoo 2014). The cases of lower limb pains recorded during the test did not result from the failure of the injection to serve its purpose. It was proven that the complaints were caused by the involuntary muscle contraction that occurred to the participants during the test period. Contrarily, a 0.680 deviation in the VAS score for the vehicle injection indicates that it is less effective in pain reduction as compared to BTX-A.  

The scores support the indisputable ability of the BTX-A to reduce muscle tension, muscle force and the tension of the nerve axons. The VA scores of P-0.05 in the distress category demonstrate that BTX-A is effective in distress reduction. This is why the participants recorded a reduction in the symptoms of distress-related pains during the entire period when the test was carried out. When it comes to headache reduction, the test results proved that an injection of BTX-A has a potential of greatly minimizing severe headache-related symptoms. It is for this reason that the participants who were injected with BTX-A reported a significant reduction in the severe headache (Melnyk, Gallagherâ€ÂFord, Long & Fineoutâ€ÂOverholt 2014). However, this did not happen to the participants who were injected with the vehicle because they kept on complaining about headache. So, in a nutshell, the outcome of the statistical analysis and primary results demonstrate that BTX-A is more effective than the vehicle injection.

The results from this research is deserves to be applied in everyday practice because it is relevant, valuable, reliable and trustworthy. The methodology and design used in the collection and analysis of data was appropriate in testing answering the research question (Fairman, Rowe, Hassmiller & Shalala 2011). For example, a proper choice of the proportional sample helped in eliminating any bias by accurately representing the target population. Furthermore, the statistical method used in the analysis of data was appropriate for the kind of data generated. The research generated valid results that conform to the standards of evidence practice.

The evidence that BTX-A is more effective than vehicle injections in the decrease of chronic pain attributed to piriformis muscle is valid. It should therefore be relied upon by a practitioner to make important decisions regarding the patient. The evidence should not be faulted because it was produced by a well-organized research that was done by involving different an intervention and control groups to test how effective the vehicle and BTX-A can be effective in pain reduction. So, when treating the patient, the result can be relied on (Alligood & Tomey 2012). It presents a feasible treatment option that can yield great results if used in the treatment of patients. It should be incumbent upon the practitioner rely on the findings to help in making informed judgments regarding the patient.

However, when applying the evidence, the practitioner should follow a well-outlined procedure. One of the major activities to undertake while applying the evidence is to conduct more research to acquire additional information on the condition and all available treatment options. This is not the only available option because there are other alternatives that can be applied in the treatment of chronic pain associated with piriformis muscle syndrome (Jankovic, Peng & van Zundert 2013). Once this is done, the practitioner should go ahead to analyze the situation before making informed decisions. By doing all these, the practitioner will stand a better chance of relying on evidence whose implications on the patient is ascertained.

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