The management of chronic healthcare conditions is paramount in enhancing quality living. There are medical conditions that cannot be fully cured, but can be managed with ideal therapeutic procedures. For instance, health management practices can be used to handle Painful Diabetic Neuropathy (PDN) which results from diabetes. The article, ‘Treatment of painful diabetic neuropathy’ by Javed, Petropoulos, Alam and Malik in 2014 examines how the PDN condition can be managed. However, the article has some limitations as held by Vetter and Chou in 2014 through the indication that evidence-based medicine (EBM) recognizes that simple intuition, unsystematic clinical understanding, and a pathophysiologic rationale are insufficient bases for clinical decision making. Hence, EBM pushes for the critical inspection of evidence from clinical research. Detailed below is an extensive assessment of the limitations of the article, ‘Treatment of painful diabetic neuropathy,’ basing on its study methodology, selection of patients, and choice of pain measurement instruments.
Study Methodology
The study aims to establish how PDN can be effectively diagnosed and treated. The authors of this article incorporate ideas, concepts, general knowledge, and statistics from past researchers concerning the state of PDN in the world. In this case, they assert that care for the condition is not intensive the way it is supposed to be (Javed, Petropoulos, Alam & Malik, 2014). However, the authors fail to incorporate primary data in supporting this allegation. For instance, first-hand data from questionnaires and interviews have not been used to show the states of this issue currently in society. Therefore, this undermines the reliability and applicability of findings obtained from the study. Furthermore, the entire readership is unable to draw a connection between reality and what has been alleged in the studies being reviewed. Then also, the author fails to explain how findings from the review of secondary and past studies have been analyzed to arrive at a conclusion.
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Also, Javed, Petropoulos, Alam and Malik in 2014 indicate that previous studies show that PDN patients report intermittent or continuous indicators of pain designated as burning, tingling, stabbing, numb, hot, cold or irritating typically beginning in the feet. Usually, the pain is regular and aggravates at night. However, Vetter and Chou (2014) show that even though pain may mirror a patient’s subjective encounters, it is inadequate because self-reported pain does not relate well with the actual capability to function. As such, it is vital for studies of pain to go past self-reports of pain, and to also regularly study outcomes that measure patients’ behavior and function in their day-to-day lives (Vetter & Chou, 2014) .
Patient Selection
The authors have incorporated researches which have an ideal selection of patients. Notably, the researchers in those several studies aimed to examine how PDN had been handled in a specific group of patients and the effectiveness of the strategies used. In all of the studies used by the researchers, a considerable number of patients was used (Javed, Petropoulos, Alam & Malik, 2014). However, their number is considerably low keeping in mind the magnitude of PDN in the world today. This has an adverse impact on the applicability of the conclusion drawn from the studies on the treatment of PDN. A large number of respondents in this case significantly shows that an extensive section of the society was represented (Vetter & Chou, 2014). Nonetheless, the selection of patients should be at least above five thousand for more realistic feedback concerning the management of PDN. Then also, PDN patients in most of the documented studies have not been categorized into subgroups. For instance, they should offer detail regarding age groups, gender, and how long they have suffered from the condition. Failure to categorize the patients leads to selection bias due to the differences between groups apart from the intervention of interest ( Vetter & Chou, 2014). To evade this, there is the need to use sufficient randomization and allocation concealment to avert selection bias.
Choice of Measurement Instruments Selected
Generally, the authors have not incorporated any measurement instruments but rely on third-party instruments used by other studies that have been reviewed. Hence, the study should incorporate a way of analyzing and measuring feedback obtained from other sources to enhance the trust of people in the findings (Javed, Petropoulos, Alam & Malik, 2014). For instance, the researcher could apply Cronbach's alpha technical to determine internal consistency in the result obtained from various sources. In this case, outliers would be identified and a focus on more idea findings established. Lack of measurement instruments by the researcher undermines the credibility of the results since readers are not able to understand how the researcher came up with the conclusion. Therefore, the author failed in selecting the choice of instruments to be used in this particular study. T he Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT) recommends that trials regularly measure results in multiple basic domains comprising pain, physical functioning, emotional working, global development, gratification with treatment, and contrary events ( Vetter & Chou, 2014). To this effect, each of these domains has a list of recommended measurement tools. Hence, it was essential for Javed, Petropoulos, Alam and Malik (2014) to incorporate pain measurement instruments in their study.
Conclusion
The article ‘Treatment of painful diabetic neuropathy’ examines the issue of PDN in society. PDN can only be managed effectively through proper diagnosis and management. However, the authors fail to incorporated primary sources of collecting data, use studies with few numbers of participants, and fail to incorporate the ways of measuring final findings. Consequently, the conclusions of the researchers are not reliable and applicable.
References
Javed, S., Petropoulos, I., Alam, U., & Malik, R. (2014). Treatment of painful diabetic neuropathy. Therapeutic Advances In Chronic Disease , 6 (1), 15-28. doi: 10.1177/2040622314552071
Vetter, T., & Chou, R. (2014). Clinical Trial Design Methodology for Pain Outcome Studies. Practical Management Of Pain , 1057-1065.e3. doi: 10.1016/b978-0-323-08340-9.00080-3
