The article “ Drug-free interventions to reduce pain or opioid consumption after total knee arthroplasty: A systematic review and meta-analysis” by Tedesco et al. focus on the non-pharmacological solutions on relieving pain. The purpose of the study is to analyze the primary sources and the randomized clinical tests on reducing pain after carrying the TKA. The authors provide background information to introduce the reader to the basics of the analysis (Tedesco et al., 2017).
Statement of Problem
The study aimed to analyze the effective non-pharmacological intervention in relieving pain in TKA. The statement of the problem identified the variable that was being examined. The primary variables of the study were investigated were non-pharmacological interventions as the independent variable. The dependent variables were pain relief on the VAS, pain relief on the WOMAC, opioid consumption, NSAID consumption, time to first PCA (Tedesco et al., 2017).
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Hypotheses or Research Questions
The research problem of the study was to systematically analyze and examine the sources on the non-pharmacological solutions in decreasing pain in TKA. This problem is essential to the nursing practice because some of the methods increase the patient’s pain. The patient is tolerant of the pain because it is subjective. The medical professionals attest that their responsibility is to make sure that the patients get comfort. The patients are relieved from suffering through the use of non-pharmacological along with pharmacological approaches. The healthcare provider should rate the pain of the patient after administering treatment. The clinicians should determine the appropriate method that is effective in pain reduction. The article presents the aim, hypotheses in a concise way (Tedesco et al., 2017).
Literature Review
The literature review of the research was short, but the authors gave a detailed description of the past studies. The researchers used articles that were related to the study. These were few publications that were used to analyze the evidence on non-pharmacological interventions. The authors used some articles that were old which weakened the reliability of the data. They could have used peer-reviewed articles for the research to be valid and reliable. The literature was clear and in line with the goal of the journal (Tedesco et al., 2017).
Conceptual/Theoretical Framework
The theoretical framework in the research provided a context for analyzing the challenge of managing pain using non-pharmacological as well as pharmacological approaches. The article did not have a section of theoretical framework. The evidence and the arguments on the past findings were based on the systematic views. The used concepts based on the previous studies to define the hypotheses of the research. The premise of the study was the administration of non-pharmacological approaches has an effect reduction and intake of opioid (Tedesco et al., 2017).
Methodology
The researchers defined all the variables and principle in the research methodology part. The authors carried out a standardized and meta-analytical process to obtain information about the research. The authors carried out a gray literature search to retrieve data from the documents which were appropriate for analyzing the data contained in the articles to provide a detailed description of the answer to the research question (Tedesco et al., 2017) .
Criteria
The researchers explained the methods that the used to collect the data suitable for non-pharmacological approaches that reduce pain after TKA surgery. The first potential threat to the validity is that only a few articles provided information on every solution and resulted in the research due to the increase in the changes in timing along with the mode of intervention. Secondly, the analysis indicated problems associated with biases which resulted in overestimating or underestimating of the consequential reports. Thirdly, some of the studies were not analyzed in a practical way which could have been the cause of the wrong presentation of data. Lastly, some of the articles did not have adequate information on measures of dispersion to determine the appropriate quantity of data. The study had a low inter-rater reliability agreement because the data analyzed from the sources are not reliable and there is a need for further analysis on the topic (Tedesco et al., 2017) .
Sample
The authors have explained on the interventions, comparisons, results and the variables of the study and they utilized random sampling methods to select the data. The sample of the research comprised of 5,509 studies which contained 39 randomized clinical tests and 2,391 patients which were adequate in research concerning the variable and research design that was employed. The snowball method was used to select articles that could be used in giving evidence for the research. The randomized clinical procedures and regular care were used to select the data (Tedesco et al., 2017).
Instruments
The instrument used to collect information for the research is the search method that facilitated the collection of the appropriate information from the books, journals, and articles. The search criteria facilitated the collection of data from complex sources. The tool was tested to make sure that reliable and credible information was gathered (Tedesco et al., 2017).
Data Analysis
The heterogeneity of the statistical data was examined using forest plots which were computed using the I 2 statistic that describes the variation of the estimation brought by the discrepancies. The random-effects approach was used in cases where the studies were below than five or were measured to be divergent. A software program was used to analyze the data of the research (Tedesco et al., 2017).
Results
The primary interventions addressed in the study include electrotherapy, consistent passive motion, exercises before the operations, acupuncture along with cryotherapy. The outcome of the survey indicated that electrotherapy decreased the utilization of opioids, but acupuncture slowed its consumption. The result of the study was represented in the tables and figures. The findings supported the evidence of the reviews on the effects of non-pharmacological methods on opioids (Tedesco et al., 2017).
Discussion
The authors concluded from the results of the analysis which were electrotherapy as well as acupuncture affects the quantity and intake of opioids. The authors also found that the study was the first one to carry out an analysis of the various prescriptions. The research did not include the application of their conclusion, but they had limitations to the validity of the study (Tedesco et al., 2017).
Research Utilization Implications
The research is adequate to meet scientific attention because the information has been analyzed using reliable tools and methods such as forests plots, software, and random-effects technique. The research has used a unique approach, and other scholars cannot carry out an analysis to produce similar outcomes. The study can be used by healthcare providers to determine the suitable method for administering treatment on patients to relieve then from pain (Tedesco et al., 2017).
Reference
Tedesco, D., Gori, D., Desai, K. R., Asch, S., Carroll, I. R., Curtin, C., ... & Hernandez-Boussard, T. (2017). Drug-free interventions to reduce pain or opioid consumption after total knee arthroplasty: A systematic review and meta-analysis. JAMA surgery , 152 (10), e172872-e172872.
