Critical Appraisal of Research Literature

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MARCH 2011-03-16


Effect of Accelerated Rehabilitation on Function after Ankle Sprain: Randomised Controlled trial.

The above study is to compare an intervention group utilising an accelerated exercise programme post injury against the standard protocol of rest, ice, compression and elevation (RICE). The following is to critically appraise the above quantitative piece of research with some guidance from the Critically Appraisal Skills Programme tool. The abstract gives clear objectives to the aims of the researchers and the chosen setting to allocate participants is pertinent to the research question. The samples for the trial are chosen at random a method considered as gold standard due to their design in attempt to remove bias, a technique considered to provide internal validity (Sibbald and Roland, 1998). The primary and secondary outcomes to be measured in the abstract are clearly focused, but to a non-statistician, the results section appear to be a barrage of figures and do not initially provoke further reading.

The introduction informs the reader of the estimated cases of ankle injury in the U.K. and its implications but gives no indication to the costs incurred to the NHS. Unfortunately it reports the estimated costs in the Netherlands and fails to explain the costs to the Royal Victoria Hospital in Belfast, or the sports injury clinic at the University of Ulster, where the research had been carried out. The authors made it clear of the prevalence of the injury that occurs in the UK but a more profound impact to engage the reader could be achieved if the costs to the UK rather than the Netherlands had been discussed. As the article was printed in the British Medical Journal in 2010, utilising a electronic data base search to ascertain these costs, the reader could have further insight to the impact of ankle trauma and its relevant literature regarding resources spent on this outpatient injury (Burns and Grove, 2001). Having said that, to understand the above article it is imperative to read the authors former article preceding this study that informs the reader that in the UK’s accident and emergency departments, 302,000 admissions are due to ankle injuries alone (Bleakley et al, 2007). From this preceding article the researchers continued to follow their developed protocol.

Sample size was determined with parameters of statistical significance set at 0.05 and a power calculation of 80% in addition to standard deviations for the continuous primary outcome. Confidence intervals to estimate the mean differences between the samples was more than adequate set at 98.75%. The methodology to recruit the samples utilised a computer generated randomisation sequence to obtain the participants with a stratified method to balance the randomisation. Stratification is utilised to ensure that equal numbers of participants share characteristics that may otherwise influence results in each comparison group (Salmond, 2008). Of the inclusion criteria the sample sizes were almost identical with 51 participants allocated to the control group and 50 in the standard group. One of the participants did not receive intervention in the control group contributing to a total balance of the samples. The authors do not say why one of the participants allocated to this control group did not receive treatment. Although it could appear to be selective rather than truly randomised, stratification strives to provide unbiased samples in order to produce valid results (Schulz and Grimes, 2002).

Within this piece of research, randomisation without the stratification of athletes and non athletes could have a high impact on the findings as it is likely that the athletic participants would be more compliant in the exercise group and possibly skew...
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