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Critical Appraisal of a Research Article

When critically analyzing an article, one seeks to examine it in detail, weighing various aspects against recommended standards of presentation to determine its strengths and weaknesses. As such, a critical appraisal can be precisely defined as the process of systematically and carefully examining a given study or research to determine its trustworthiness as well as its relevance and value in a given context. In evidence-based clinical practice, it emerges as an essential skill that enables clinicians to find and utilize research evidence in a reliable and efficient manner. Everyone would like to have and enjoy the best health possible. To achieve this, there is need to have access to reliable information concerning what might be harmful or helpful when making healthcare decisions. Research involves data collection, collation, and analysis.  Therefore, the manner in which these processes are conducted determines if meaningful information is yielded or not. In  judging the trustworthiness of a given research, the processes are critically examined to ascertain quality and aspects like degree of bias, all of which dictate if the results obtained are true or not. In this construction, one presents a critical appraisal of the research article “Obesity and increased burden of hip and knee joint disease in Australia: Results from a national survey “, jointly authored by Ilana N. Ackerman and Richard H. Osborne. One must note that the professional capacities the two hold are enough to persuade one towards believing what they will present is of high quality. However, it would be wrong to make such an assumption without first analyzing their piece.

To begin with, the title is truly suggestive and informative of what the research is about. One gathers without much effort that the research concerns the problem of obesity in the context of hip and knee disease. Rather than leave the reader guessing as to which population is being investigated, the title informs that the study is conducted amongst people in Australia, and that the study is carried on a national scale. This is to say that it covers the whole country. From here, one can easily infer that the population being investigated is representative of the Australian countrywide population. In a word, the title clearly states what the study is about, and as such does not leave the reader in the dark.

As for the abstract, the authors have gone an extra mile of presenting it in terms of subtitles that give an outline of various aspects of the research. Even without reading the entire piece, the reader is able to have a full picture of the research problem, the main objective, and the research methods employed.  The research findings and inferences are also clearly stated.  In this regard, the authors give a vivid background of the study where they state that there is need for a research that involves more representative samples as that would help boost understanding of the broader impact of obesity in hip or knee joint disease beyond clinical circles. The background gives an outline of the main objectives of the study which are 1) to investigate associations between obesity and hip and knee joint preference and 2) to investigate the relationships between obesity and physical function, pain, stiffness, disease severity, and HRQoL among people suffering from the diseases mentioned above. They present that in as much as a number of studies (population-based) have been conducted in the U.S, there is need to understand how findings of such studies apply to other countries (Ackerman, & Osborne, 2012). In other words, the authors imply they are contemplating on a cruise to find out if what is already known as true in the United States can translate to a country like Australia. In this respect, one notices the notion of transferability in population-based research. If the findings of a given research were valid and reliable, then transferability would mean they apply to a wider context, beyond the population being investigated (Bloor, & Wood, 2006). By stating that there is need to understand how findings from other studies translate to other countries (beyond the United States) the authors are simply elevating their study in terms of transferability. As such, the degree to which results of any qualitative study can be transferred or generalized to other settings or contexts is important. For the detailed study to qualify as regards transferability, it is imperative that suitable research methods/designs be employed. In the abstract, the authors present that participants were randomly selected from the country’s federal electoral roll. It cannot be disputed that a document such as an electoral register is composed of citizens from all corners of the country. Therefore, one is persuaded to believe the findings of this study would be transferable to other contexts since the population sample being investigated is sufficiently representative. Various methods used in data collection and subsequent analysis have also been stated in the abstract. The authors inform that questionnaires were mailed to participants who would answer them and help identify doctor-diagnosed problems of hip and knee arthritis as well as hip and knee OA. By so doing, burdens presented by these conditions would be evaluated. Various validated questionnaires have also been highlighted in this section. They include Multi-Attribute Prioritization Tool, Assessment of Quality of Life Tool, and the WOMAC Index.  In determining the odds of OA and arthritis, it is stated that multiple logistic regression was utilized, and the models formulated considered demographic and socio-economic aspects.

The results have been presented in the abstract in summary form, yet detailed enough as not to leave out any aspect of the investigation. From the manner they have laid out, it is easy to draw inferences as concerns the different associations between obesity and the conditions under focus. The last bit of the abstract is about conclusions informed by findings of the research. Its organization is in such a manner that the reader can get the entire picture of the research by just going through it (the abstract).

In the introductory part of the construction, the authors make reference to related studies, giving credit to them. They even mention some presentations emanating from such (previous researches). They identify an appreciable gap as far as the previous studies are concerned, in that such have left a lot to be desired in terms of generalisability (Ackerman, & Osborne, 2012). A major point worth noting as regards the motivation for their research is that much of the current comprehension of obesity as it relates to the personal impact of OA and arthritis comes mainly from population-based studies conducted in the U.S. How such extends to other regions of the world is not known. In addition, another gap identified is that most past studies have focused on activity limitations, disability, and the functional status, ignoring the important aspect of how, for instance, such factors relate to obesity. More precisely, the authors set out a vivid motivation for their research: to investigate the associations between obesity and the stated conditions while factoring in other covariates that have not been considered in the past. Notably, most past studies have tended to place greater emphasis on Body Mass Index as the central covariate, ignoring others. The authors elevate their research by stating that they would go an extra mile to include more covariates to come up with more reliable, confirmable, transferable, and valid findings and subsequently more trustworthy inferences. This way, they provide a context for the research problem. Uncovering various all aspects of the research problem would be helpful in guidance to clinicians, ordinary individuals, and other stakeholders in clinical practice.

Arguably, one thinks the literature review as presented is somehow shallow and has not been exhaustively appraised. Considering the phenomenon under focus, one is of the view that the authors have not done enough to discuss the voluminous literature available on obesity, arthritis, and OA. In fact, it would have been better if they had dedicated a whole section or subheading to a review of the available literature, in opposition to incorporating it into the background. The background would be satisfactory if it only gave what one would call a ‘launching pad’ for the study.

 Imperatively, the authors have done well in supporting their presentations with secondary sources. This is important since it not only gives credit to and acknowledges other people for their work, but also acts as supportive evidence of what is being stated.  The reader comes across a cited source and connects the point to the same source. That way, he or she appreciates the work of an author and can dig for more related information from the quoted piece. For instance, reference is made to the Australian Bureau of Statistics (2007) when presenting certain statistics in the Australian context.  This not only shows that what is being stated is factual, but that it is also reliable and can be validated.

 As already implied, the aim of the research is made clear from the onset where the authors state they seek to explore the associations between obesity and arthritis, and those between obesity and pain, stiffness disease severity, and HRQoL in Australia. This is relevant to the research problem since by seeking to explore these phenomena is Australia, a vivid comprehension would be achieved as to how findings of related previous studies can be transferable beyond borders of the United States (where most studies have been concentrated). The methodology picked upon is indeed suitable since through random sampling, the researcher is better-positioned to address the aims of the study with minimal bias (Longhofer, et al., 2013). This boosts validity and reliability since by randomly selecting participants, the researcher has no control over who is selected. By emailing questionnaires to participants, they would give first hand information concerning the phenomenon under investigation. As it were, a qualitative approach is the best in investigating human experiences.  This implies that based on the information respondents would give, it would be possible to make correct and accurate inferences , meaning the overall trustworthiness of the study would be improved ( Bryman, Burgess, 2009). One must agree the authors have adequately explained their methods of data collection and analysis.  The analysis aspect has factored in socio-economic and demographic factors as these shape people’s lives differently. Indeed, considering the numerous covariates that have been employed in analyzing the data, one must agree the analysis has been rigorously done.

It is important that any research involving humans take into account ethical issues that may emerge (Gregory, 2008). In the context of this research, it was possible that some participants would not be willing to participate, a development that can be usually explained by number of factors. For instance, a prospective respondent would decide not to participate either because they think their conditions are part of their private lives that should not be discussed or just because they do not have time to take part in the study. Therefore, forcing anyone to participate in the study would be unethical. To take care of such emerging ethical issues, the questionnaire constituted a consent, and was approved by the The University of Melbourne Human Research Ethics Committee. Thus ,informed consent  ensured all those participating did so willfully and were comfortable discussing private aspects of their live.

 The findings of the study have been vividly presented. The most important aspects of these findings are the associations between obesity and the various conditions. For instance, it is reported that there was a higher preference of arthritis and OA in obese patients. As for pain, it was more in patients (of the various conditions) with obesity, much the same way disease severity and stiffness were greater. HRQoL was also lower in obese patients with hip OA and hip arthritis (Ackerman, & Osborne, 2012). These findings are very important since they serve to fulfill the central objective of the study. They are the basis upon which the authors draw inferences and recommendations.

The authors must be given credit for relatively exhaustively discussing the findings of their study in relation to the research aim. In their discussion, they point out that population-based sampling frame is a key strength for generalisability, and that what they have unearthed is informatively imperative to clinicians and other stakeholders in the health docket.  In analyzing the findings, it is clear the authors are guided by the research’s main objective, since they lay bare how obesity influences various conditions in patients. Considering the percentages (as reflected in the findings) of patients reporting various levels of pain, stiffness, and the other conditions, one can say the findings are indeed credible. This is ascertained when one considers previous presentations as contained in available literature.

The authors have done a commendable job in pointing out the limitations of their research. For instance, they have stated that a major limitation was the low response rate. Respondent participation depended on the nature of approach, and preference of such was likely to change from one individual to the other. In addition, cultural differences as they emerge in different segments of the population played a role in influencing participation, just as age did. In addressing the limitation in terms of age, the authors include age as a covariate in their ANCOVA analyses and as a predictor in their regression models. The other limitations are brushed off by assuming that those who accepted to participate were adequately representative of Australia’s national population.

To conclude, one must agree the authors’ conclusion follows logically from the study’s findings. They state their study shows that obesity is linked to increased of hip and knee disease, an inference arrived at on grounds of the greater impairment and higher prevalence of the key indicators. They use these findings to make recommendations to concerned parties. More precisely, they call for public health interventions that consider obesity and overweight as intervention targets for individuals suffering from hip or knee joint disease. Overall, the authors have presented a great piece. The strengths and weaknesses are as they emerge in this construction. Indeed, the manner they have laid out their study starting from the abstract to the conclusion is quite commendable. However, one thinks the literature review was not exhaustively done. That is usually imperative since it enables the reader to comprehend how similar or different given findings would be those from other studies in a similar context. The research design adopted was suitable since even the random sampling technique ensured the sample being investigated was adequately representative of the country’s national population. Reliability was improved by addressing a very important aspect of the study’s limitations. Overall, in as much as the authors have done a good job, one is of the view that there is need for more evidence-based clinical practice, and the surest way of ensuring that is to exhaustively explore the numerous phenomena emerging in medicine. Therefore, more people ought to invest their time and resources in similar or related research, just as Ilana and Richard have done.