Criteria For Exclusion In A Study On Impact Of Music Therapy On Hospitalized Patients Post-Elective Orthopaedic Surgery

Exclusion Criteria

9. 

a. Random sampling method was used in the study by Gallagher et al. (2018) as patients were randomly assigned to experimental or control group through the use of a computerized block randomization table.

b. Some potential biases in the use of random sampling method is that the sample is not representative of population of interest if the population group is heterogeneous. It allows inclusion of irrelevant items into the sample by chance contributing to errors (Gray, Grove and Sutherland 2017).

c. The final sample size was 200. 200 were enrolled in the study and out of this, 91 did not consent to participate and one was not eligible for the study. Out of 200 participated, 109 accepted to take part in the study (Gallagher et al. 2018).

d. Yes, a G*power analysis was conducted that helped to estimate medium effect size. 79 patients were needed in each arm to achieve the needed power.

e. The inclusion criteria for the study included the following:

• All participants had to be at least 18 years
• They must be cognitively able to provide consent for participation
• They must speak, write and read in English.

The exclusion criteria for the study were as follows:

• Patients on isolation were excluded
• Patients on contact precautions were excluded
• Non-elective orthopaedic surgical patients were who had not completed testing at Euclid hospital were excluded (Gallagher et al. 2018).

f. Refusal rate is the proportion of all eligible samples who declined to be interviewed. The refusal rate for the study was:

Refusal rate= Number of refusals/ Number of samples originally desired to be achieved

                   = 91/200

                   =0.45%

g. Attrition rate is the number of participants who move out from the group.

Attrition rate= Number of participants lost/ number of participants at the beginning

                     =37/200  =0.18%

h. The random sampling method taken in the study can produce a sample representative of the study population. This is because it eliminates chances of sampling bias and ensure that appropriate sample group is selected (Gray, Grove and Sutherland 2017).

i. The researcher fulfilled ethical consideration by taking approval for research from the institutional review board at The Cleveland Clinic.

j. The setting for the study was orthopaedic unit of Euclid hospital (Gallagher et al. 2018). The setting chosen is appropriate as the aim of the study was to evaluate effect of music therapy on surgical patients. Choosing orthopaedic ward favoured getting surgical patients.

10. 

1. The instruments that were used in the study included iPad, a REDCAP database, point numeric rating scale and the Rogers Happy/Sad Faces Assessment Tool. The iPad was used to provide the music therapy. The point numeric rating scale was used to score pain, anxiety and nausea and the Rogers tools was to assess mood of patient (Gallagher et al. 2018).
2. Music therapist administered the iPad and REDCap database and the research assistant administered other tools  used in the study
3. Patients had to give a rating of 0-10 point on the numeric rating scale to assess pain, anxiety and nausea. In addition, they had to give a rating of 0-4 for mood assessment.
4. The Rogers tool and the point numeric rating scale were scored by means of numerical ratings.
5. The limitation in reporting about the tool is that no discussion has been given regarding the validity or efficacy of the tool and its use in future research. Brief description was provided only for REDCap database
6. Nothing has been mentioned regarding the reliability of the tools used in the research
7. The past validity of each tool is missing
8. The description regarding the validity of the tool for research is not present
9. There were no tools that were developed for the purpose of the study. The music therapy session was only individualized by collaborating with patients regarding individualized goal for the session.
10. Physiological measurements were taken for the analysis of  pain, anxiety and mood of the participants

11.

1. Data related to patient demographics were collected. Secondly, the Happy/Sad Face Assessment tool was used to measure mood and the point numeric rating scale was used to manage pain, anxiety and nausea.
2. Yes, there are more than one data collectors in the study. The first is the music therapist and the second is the research assistant. However, the study lack inter-rater reliability as thedata collectors were not trained.

12.

1. For description of patient characteristics, statistical test like two-sample t tests, Fisher’s exact test and the Pearson’s chi square test were used. Linear effect mixed model was used to detect change in scores and the results from the logistic regression model were characterised using the SAS software.
2. The two-sample t tests, Fisher’s exact test and the Pearson’s chi square test were some inferential statistics used to examine the data obtained from the subjects.
3. The level of significance set for the study is greater than 0.001.
4. Gallagher et al. (2018)provided 5-6 tables in the research. The contents of each table are as follows:

• Table 1: Details for patient demographics
• Table 2: Details for follow-up summary statistics
• Table 3: Summary of statistics on admission outcomes
• Table 4A: Day 1 outcome summary for control group and experimental group
• Table 4B: Day 2 outcome summary for control group and experimental group
• Table 4C: Day 3 outcome summary for control group and experimental group
• Table 5: Comparison of survey scores and patient level outcomes (Gallagher et al. 2018).

13.

1. The key findings from the study are as follows:

• Significantly better outcomes were found for pain anxiety and mood among the experimental group and the control group compared for Day 1, Day 2 and Day 3. The score for nausea only varied on Day 3 (Significant)
• Music therapy produced immediate improvement in pain and anxiety scores and in nausea occasionally (significant)

1. The first finding is not consistent with author’s hypothesis because it was hypothesized that music therapy would have positive effect on patient’s score of pain, anxiety, mood and nausea. However, the same outcome were not achieved for nausea.
2. The findings related to positive impact of music therapy on decrease in anxiety and pain was regarded as clinically significant outcome by the author.
3. The author has mentioned that not blinding the patients to the intervention was one limitation of the study. Another limitation identified was conducting the research only in one tertiary care center. Other limitation found in the work is that the author has not justified the rational for using the tools and not provided any details on reliability of the tool (Campbell and Stanley 2015). 
4. The findings has not been generalized to other setting because the research was done only in single health care center
5. The finding presented in the study can provide nurses the strategy to address pain and anxiety of patients. As the study has used wide variety of intervention, the nurse can use it to provide individualized session as per individual patient’s preference.
6. A future research implication given by Gallagher et al. (2018) was to research regarding the impact, value and efficacy of music therapy in health care institutions.

14. 

1. The strength of the study is the data analysis method as it helped to get analyse and compare outcomes by inferential statistics and several statistical test. Two sample t test, chi square test and Fisher’s exact test helped to compare patient characteristics as well as outcomes on several days.
2. One weakness of the study is the poor reporting of reliability and validity of the tools used in the research. As the results obtained from the tools determines the outcome of research, it was necessary to provide proper justification and evidence regarding the efficacy and reliability of the tools used in research (Noble and Smith 2015).

15. Overall, the findings of the study by (Gallagher et al. 2018) can be considered significant as it provides a solution to address discomfort of people with total knee replacement. Although the study lacked generalization because of conducting research in single center, it provided direction to improve the efficacy of the intervention. By conducting future research on efficacy of music therapy in other setting, it may help to decrease patient’s hospital stay as well as recovery time.

References:

Campbell, D.T. and Stanley, J.C., 2015. Experimental and quasi-experimental designs for research. Ravenio Books.

Gallagher, L.M., Gardner, V., Bates, D., Mason, S., Nemecek, J., DiFiore, J.B., Bena, J., Li, M. and Bethoux, F., 2018. Impact of Music Therapy on Hospitalized Patients Post-Elective Orthopaedic Surgery. Orthopaedic Nursing, 37(2), pp.124-133.

Gray, J., Grove, S. and Sutherland, S. 2017. Burn’s and Grove’s The practice of nursing research: Appraisal, synthesis, and generation of evidence (8th ed.). St. Louis, MO: Elsevier. ISBN978- 0-323-37758-4

Noble, H. and Smith, J., 2015. Issues of validity and reliability in qualitative research. Evidence-Based Nursing, pp.ebnurs-2015.