EBP project proposal

EBP project proposal

EBP project proposal Name: Course: Instructors Name: Date: Introduction The identified practical issue the paper will address is the osteoarthritis (OA) in women above the age of 55 years The Evidence-based practice (EBP) project will be present acupuncture as a pain management method on a patient whom has problems with osteoarthritic pain. The major factor causing OA consist of excess weight, injury or overuse and genes, and other developmental issues. At least 80 percent of the people over 55 will show x-ray symptoms of Osteoarthritis in at least one joint (Cherniack & Cherniack, 2013). Pain management is the challenge to these patients. Introduction Cont.

Treatment options include medication, surgery, and therapy. According to Bahrami-Taghamaki et al (2014), acupuncture for thousands of years have been practiced and plays a significant role in pain relief. Using this treatment method, acupuncturists relieve pain by inserting slender metallic needles at specific points on the body. A well inserted needle produce a signal that travels to the brain along the spinal cord. This triggers a release of enkephalins and endorphins which are transmitters that reduce pain sensation. Similarly, other studies suggest that inserting the acupuncture needle triggers cortisol production. Cortisol is a hormone that assists in controlling inflammation (Manyanga et al, 2014). Introduction Cont. Aim of project 1) Suggestion for acupuncture therapy for Osteoarthritis patients. 2)

Symptom management of OA 3) Pain alleviation for the OA patients 4) Improving functional status especially on the joint performance as well as enabling easy and painless movement by the patient 5) Controlling disease progress Introduction Cont. PICOT Question In women above 55 year old suffering from osteoarthritis of the lower back (P), how does acupuncture (I) compared to the adjunct standard medication therapy (C) decrease pain (O) within 6 months? (T). (P)- Population: the population will comprise of women aged 55 years and above who are ailing from OA of lower back. (I)-intervention: acupuncture treatment method that will be given to the subjects.

(C)- Comparison: adjunct standard medication therapy that will be used. (O)- Outcome: Pain alleviation and increased joint functionality from the subjects under acupuncture treatment (T)-Time: the outcome will be measured after 6 months. Introduction Cont. Significance Adoption of acupuncture treatment method is of importance to manage the effects and suffering of OA patients There have been several identified harmful effects of Non-steroidal Antiinflammatory Drugs (NSAIDs). There are over 12,000 hospitalizations and 2,000 deaths related to NSAIDs complications in the country annually (Pelletier, 2010). Acupuncture is therefore the best alternative to adjunct standard medication therapy. In females above the age of 55 years and above, the body is on a declining scale for most of its biological functions. With respect to the toxicity and unsafe side effects of adjunct standard medication therapy, it is recommendable that this age group of women turns to proven alternative methods such as acupuncture

Evidence Review and Synthesis The project got most relevant literature for Evidence Based Practiced from some of the most reputable search sites such as ProQuest (Souths Online Library), PubMed, Medline, among others. I filtered my search to ensure that I only accessed peer-reviewed academic journal articles. I filtered the sources by title of the books and articles that I was looking for. Specifically, I typed the words Evidence Based Practice in the search box and selected articles and books that could be read in their pdf forms or website hotmail versions. Evidence Review and Synthesis Summary of Keeper studies There is a wealth of clinical literature supporting the usefulness of the acupuncture in the treatment of elderly patients suffering from osteoarthritis Some of the studies used in the project include:

A study by Bahrami-Taghamaki et al. (2014) that argued that with the recent increased awareness of the acupunctures benefits for the management of chronic back pain by both the patients and professionals, the technique can be adjusted to become more beneficial than before. A study by Iloth et al (2014) where the authors argue that although there is evidence showing that acupuncture is an effective method in the management of chronic pain, it is not clear which method is the most effective. Evidence Review and Synthesis Summary of Keeper studies Cont. Manheimer et al (2015) also conducted a systematic review to show the efficacy of acupuncture in the treatment of low back pain. Furthermore, a study by Manyanga et al (2014) evaluated the utility of acupuncture in the management of osteoarthritis. Finally, the study by White et al (2012) provides a trial showing the effectiveness of acupuncture using patients with knee osteoarthritis which would otherwise be referred to an orthopedic surgeon.

Purpose of the project Clinical questions In women above 55 suffering from osteoarthritis, can acupuncture compared to the adjunct standard medication therapy decrease pain over a 6 month period? After the implementation of the intervention will there be any improvement in the outcomes among the patients, and what some of the outcomes expected are and how will they be determined or measured? The purpose of this project The purpose of this project is to bring forward an efficient, affordable and sustainable pain management solution for osteoarthritis in women over 55. Purpose of the project The detailed purposes for the study in summary include: 1) Suggest acupuncture therapy as a pain management method for Osteoarthritis patients. 2)

Management of symptom of osteoarthritis 3) Alleviation of Pain for the osteoarthritis patients 4) Improving functional status especially on the joint performance as well as enabling easy and painless movement by the patient 5) Controlling the progress of the disease Methods Study Design The project will use quasi-experimental study design by use of a randomized controlled trial of the acupuncture therapies on the sample population of women beyond 55 years with osteoarthritis. Procedure/intervention For patients with knee osteoarthritis, they will lay first supine with a pillow under their knees for the treatment of the posterior aspect. The needles for treatment will be 3cm, 30 gauge strong dispensable filiform stainless steel needles.

The deepness of the needle insertion will depend on the thickness of the skin and subcutaneous fatty tissues at the acupuncture points. Methods Cont. One group of participants will get administered with acupuncture intervention by qualified acupuncturists, while the other group will be administered using for the standard adjuvant treatment by qualified health professionals. Then, a comparison of the result from each of the two groups of providers will enable the researcher assess the accuracy and practicality of the evidence gathered from the literature review that acupuncture offers a better solution to pain problem in women over 55 years with osteoarthritis. Setting The study will be set at the health facilities serving the patients who meet the topic criteria according to verified medical records by the sample population, the health providers Instruments/scales A chart audit to track changes from the onset of the study to the end.

VAS for determining pain level Methods Cont. Confidentiality The free will of patients will be sought by use of consent forms after thorough explanation of the study contents as required by the Institutional Research Board (IRB). Other ethical consideration like integrity and confidentiality of the patients will be observed by use of pseudonyms and coded data Data collection Johns Hopkins nursing evidence-based practice model (JHNEBP) will be used as the vehicle to guide the nursing change and process in the study in addition to current applications of Prochaskas transtheoretical model of behavior change as a means of effecting behavior change among the health provides to be used as the sample population. Methods Cont. Aligning stakeholders A stakeholder is a person who has interest in a particular project and benefits from it. The stakeholders whom will be involved in this project include

Clinician (will be providing the healthcare recommendations on osteoarthritis) Staff nurses (assist in the care of the women whom are suffering from osteoarthritis.) consultant Nurse coordinator (will collect, analyze, organize and distribute information about the EBP project). nurse director (chief decision maker) women above 55 suffering from osteoarthritis The Gathering Point Community Acupuncture (project owner) Data Analysis Expected Outcomes to be analyzed and how they will be analyzed The intervention seeks to improve the current conditions of the patients, and hence

the outcomes expected will assist in determining the effectiveness of the treatment There will be variations in the pain levels and therefore there will be data on the changes in pain levels after treatment from various patients Most of the changes after implementation of the intervention will be physical, thus, data may be collected through observation In addition, a t-test will be done to compare the effectiveness of the intervention among the patients affected in various parts of the body. The t-test will be used to measure dependent variables like natural therapies, physical activity, weight management or surgery. The analysis of variance, on the other hand, will be used to measure the independent variables which include level of pain and muscle strength. Data Analysis Cont. The types of demographic data to be reported on the participants The participants have different attributes or features which can be used to differentiate them.

Demographic data to be reported will be composed of age, income level, education level, geographical location, sex, race, gender, and religion. The demographic data regarding the participants will assist in knowing how they will affect or are affected by both the dependent and independent variables. Conclusion The practice of EBP is based on patients' preferences and knowledge, and physiotherapists' clinical skills. Regarding systematic reviews, it is evident that exercise tends to lower pain and enhance function in patients. Nonetheless, there is no enough proof that acupuncture ultimately diminishes pain and that psychoeducational interventions improve psychological results. Among physiotherapists, the most significant aim for the treatment of osteoarthritis is to lower pain and increase muscular strength. Physiotherapists are responsible for providing exercise, massage and stretching treatments for patients.

Characteristics of patients cannot define the differences in clinical practice and acupuncture was linked with having searched medical databases to assist in answering the clinical question. References Bahrami-Taghamaki, H., Liu, Y., Azizi, H., Khorsand, A., Esmaily, H., Bahrami, A., & Zhao, B.X. (2014). A Randomized, Controlled Trial of Acupuncture for Chronic Low-Back Pain. Alternative Therapies in Health and Medicine, 20(3). Cherniack, P., & Cherniack, N. S. (2013). Alternative medicine for the elderly. Berlin: Springer. Iloth, K., Saito, S., Sahara, S., Nartoh, Y., Imai, K., & Kitakoji, H. (2014). Randomized Trial of Trigger Point Acupuncture Treatment for Chronic Shoulder Pain: A Preliminary Study. Journal of Acupuncture and Meridian Studies, 7(2), 59-64. Manheimer, E., White, A., Berman, B., Forys, K., & Ernst, E. (2015). Meta-Analysis: Acupuncture for Low Back Pain. Annals of Internal Medicine, 142 (8). Manyanga, T., Froese, M., Zarychanski, R., Abou-Setta, A., Friesen, C., Tennenhouse, M., & Hay, B. (2014). Pain management with acupuncture in osteoarthritis: A systematic review and meta-analysis. BMC Complementary and Alternative Medicine, 14: 312. Retrieved from http://www.biomedcentralcom/1472-6882/14/1312

White, A., Richardson, M., Richmond, P., Freedman, J., & Bevis, M. (2012). Group acupuncture for knee pain: evaluation of a cost-saving initiative in the health service. Acupuncture Medicine, 30, 170-175. Doi: 10.1136/acupmed-2012-010151 Appendices Appendix 1: Search Tracker Search # Initial Search items Database And/Or Added Title (Ti) Anywhere, etc. Search terms # of articles found 1. Pain, acupuncture, alternative ProQuest Alternative therapies in Health & Medicine 1848

2. acupuncture; chronic shoulder pain; stiff PubMed NCBI 305 shoulder; trigger point 3. Acupuncture, low back pain ProQuest Health & Medical Complete 80 4. Pain Management, acupuncture, PubMed Medline 8 PubMed

NCBI 85 randomized trials 5. Acupuncture for knee pain Appendices Appendix 2: Evaluation Table First Author (Year) Conceptual Design/Method Framework Sample & Setting Major Variables Studied (and their Definitions) Measureme nt Data Analysis F

i n d i n g s Appraisal: Worth to Practice Appendix 2: Evaluation Table Bahrami- None RCT: examining Taghamak the efficacy of i, H. adding confluent (2014) acupoints to regular acupuncture and comparing with regular acupuncture N=60, who were randomly divided into two groups. IV: regular acupuncture with confluent

acupoints and regular acupuncture VAS, number Statistical Pain decreased from 69.6 therapies needed, analysis 7.9 to 11.8 4.9 in the number of days test group. In the control the patients did group, pain decreased from not report to work 69.2 8.0 to 15.7 10.0, and number of both at (P=0.001). Test TA: received pain relapse group received less regular DV: Pain, within 4 and 12 sessions (8.1 2.0) acupuncture number of pain weeks after compared to (10.1 2.0, P with confluent relapse and the treatment < .001) of control group. acupoints duration of the intervention There was also few RA: received absenteeism and pain

regular relapse (0.5 vs 1.4; P = .03) acupuncture and (4.0 vs 7.0; P = .04) with 12 weeks of follow up Combining routine with time acupuncture method can improve the benefits as well as the persistence of people with cLBP Appendix 2: Evaluation Table Iloth, K. (2014) Manheimer, E. (2015) None RCT: comparing the efficacy of trigger point acupuncture (TrP) with sham (SH) acupuncture Systematic and meta-analysis of RCTs assessing the efficacy of acupuncture for

the treatment for LBP N= 18 patients, 14 men and three women. IV: Trigger point acupuncture and sham acupuncture. They were randomized into two DV: Pain and groups shoulder function 33 randomized IV: acupuncture, control trials met the sham inclusion criteria and acupuncture, and were group other sham according to the treatment type of the method DV: Pain, overall used, the control status, used sham functionality, acupuncture, other return to work and sham treatment,

analgesic and no additional consumption treatment VAS and CMS Statistical Pain intensity before TrP therapy was found analysis treatment and after five to be more effective weeks of treatment with TrP for chronic shoulder decreased significantly pain (p < 0.001), should functionality also increased significantly after five weeks of treatment after TrP (p < 0.001), but a substantial change among the two groups at (p < 0.001) was found. MetaIn the short term, Acupuncture was analysis acupuncture was effective found to be effective in than other sham treatment relieving low back pain (SMD, 0.54 [95% CI, 0.35 to than other sham 0.73]; 7 trials. However, in treatment acute low back pain, the results were inconclusive.

Appendix 2: Evaluation Table Manyan None ga, T. (2014) Systematic and meta- 12 trials comparing IV: acupuncture and analysis acupuncture with sham sham DV: Pain and functional mobility White, A. (2012) Clinical control trial to evaluate the patient seen the first year in the service and their outcome N= 114 IV: acupuncture 90 were accessed And surgery in the clinic 41 DV: paint stiffness and patients were still wellbeing presence after one

year and 31 after two years MYMOP Meta-analysis Significant reduction of pain MD -0.29 at 95% with Cl -0.55 to -0.02, I2 0% for ten trials with 1699 participants. While using nine trials with 1573 patients, the results also showed significant improvement in functional mobility (MD -0.34 at 95% with a Cl of -0.55 to -0.14 and I2 of 70%) Statistical analysis MYMOP measurements revealed significant pain improvement after one month (4.2 (SD 1.2) to 2.9 (SD 1.4)). Stiffness also improved significantly (4.1 (SD 1.3) to 2.9 (SD 1.3)). Additionally, functionality also increased by (4.5 (SD 1.1) to 3.3 (SD 1.2)), but well-being did not change Appendix 3: Synthesis Table 1 Bahrami- 2 Iloth et al (2014) 3 Manheimer et 4 Manyanga

Taghamaki et al al (2015) et al (2014) X X 5 White et al (2012) (2014) Level I: Systematic review or meta-analysis Level II: Randomized controlled trial Level III: Controlled trial without randomization Level IV: Case-control or cohort study Level V: Systematic review of qualitative or descriptive studies Level VI: Qualitative or descriptive study (includes evidence implementation projects) Level VII: Expert opinion or consensus X X X

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