Quantitative Research: Critical Appraisal

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Quantitative Research: Critical Appraisal
Introduction
Lower limb varicose veins are a serious health problem that often limits patients’ mobility and leads to poor quality of life. From leg ulcers to edema and calf pain aching, the disease’s progression and manifestation are well understood. Surgical surgery is a common way of addressing lower limb varicose veins, where the aim is to remove the veins. However, such a surgical procedure is not without the risk of hematoma, bleeding, post-operative pain and edema among other complications. General deterioration of the skin around the surgical wound site is also a common problem, but even more worrying is the risk of post-thrombotic syndrome. These complications can have a huge negative impact on the patient’s quality of life. Compression stocking therapy is considered necessary following venous surgery. The therapy informs the current PICOT question: In patients with lower-limb varicose veins, does compression therapy compared to standard care help in improving treatment outcomes during hospitalization period? This paper provides a critical appraisal of two quantitative research studies that have been encountered in literature in the course of exploring compression stalking therapy in the context of treating lower limb varicose veins.
Background of Study
The studies being analyzed are:
• Kath, W., Bruning, G., Langenbruch, A., & Augustin, M. (2016). Postoperative quality of life, satisfaction, and skin condition after varicose vein surgery: Dependency on compression stocking use and aloe vera additive. Phlebologie-Stuttgart, 45(6), 363-369.
• Kinoshita, M., Kurosawa, Y., Fuse, S., Tanaka, R., Tano, N., Kobayashi, R., Kime, R., & Hamaoka, T. (2019). Compression stocking suppressed reduced muscle blood volume and oxygenation levels induced by persistent sitting. Appl. Sci., 9(9), 1800.
Against the backdrop of the seriousness of lower limb varicose veins as a public health problem, research has sought to explore the use of compression stocking therapy to reduce the risk of post-thrombotic syndrome and other complications that may follow venous surgery. Kath et al., 2016) sought to identify the benefits of skin care products incorporated into compression stockings and investigate the impact of the effectiveness of compression stocking in management of varicose veins. As regards the significance of this study to nursing practice, it would increase understanding on whether aloe vera products can have beneficial outcomes in compression therapy, while also identifying the appropriate length of compression stockings for realization of optimal patient outcomes (Kath et al., 2016).
On their part, Kinoshina et al. (2019) sought to analyze “the effects of 3h of constant sitting on skeletal muscle oxygenation in the lower extremities, using near-infrared time-resolved spectroscopy” as well evaluate the effects of compression stockings (p. 1). Indeed, this study would be significant to nursing since it would investigate and illuminate, by use of near infrared time-resolved spectroscopy, the relationship between lower limb (skeletal muscles) oxygen dynamics and extracellular water as well as limb circumference. They found out that 3 h of sitting led to increased and decreased extracellular and intracellular water respectively (in the lower extremities), hence a decreased in the levels of skeletal muscle blood volume and oxygenation.

Support of Nursing Practice Issue
The significance of both studies and their support for the current nursing practice issue is not in doubt. Both studies illuminated the role of compression therapy in improving and managing outcomes after varicose vein therapy. The intervention can help minimize and array of side effects and/or complications like postoperative bleeding, pain, edema, and hematoma (Kath et al., 2016). The authors also showed that the length of the compression stocking does not play a significant role in determining the effectiveness of compression stockings but oleo vera can reduce the risk of pruritus. Similarly, Kinoshina et al. (2019) showed that compression stocking therapy suppressed the negative effects of prolonged sitting, for instance reduced levels of blood volume and oxygenation in lower limbs. Indeed, the studies directly address the subject of the PICOT question by presenting evidence on the role played by compression stocking therapy in improving and managing outcomes in the treatment of lower-limb varicose veins.
Methodology
Kath et al. (2016) used a convenient sample of 160 participants to investigate the effectiveness of addition of aloe vera to compression stockings as well as the effectiveness of length of the compression stockings. The participants were randomly divided into four groups (of 40 participants each) with different types of stockings in each case. The compression stockings included thigh-length stocking; thigh length stocking with aloe vera; knee-length stocking (length A-D) and a knee length stocking with Aloe vera group (Kath et al., 2016). The authors measured the quality of life using the Freiburger questionnaire of quality of life in veinous disease (FLQA-vs). They also evaluated the benefit to patients using the patient benefit index (PBI-v. Additionally, a free text questionnaire was used to investigate subjective parameters.
On the other hand, Kinoshita et al. (2019) used a sample of 11 healthy men to quantitatively analyze the effects of 3 hours of constant sitting on skeletal muscle oxygenation in the lower extremities. The researchers used a near-infrared time-resolved spectroscopy to measure oxygenation levels, more precisely capturing oxygen saturation as well as contextual oxygenated hemoglobin changes.
Clearly, the researchers in both studies employed different methodologies informed by what was being investigated. Whereas Kath et al. (2016) employed standardized instruments (FLQA-vs and PBI-v) to collect data, Kinoshina and colleagues (2019) used near-infrared spectroscopy, a technique that has been shown to be convenient in measuring oxygenation levels in tissues. For Kath et al. (2016) using standardized instruments offered a benefit in terms of validity and reliability since, usually, such data collection tools validated and standardized, implying they are reliable in measuring what they are intended to measure. However, being quantitative research tools, they require large sample sizes and they may not be as in-depth as desired. As for the near-infrared spectroscopy, it has been shown to be “both convenient and non-invasive” (Kinoshina et al., 2019: p.2). Additionally, this method is safer (as opposed to laser pointers) since it uses incoherent light sources. However, the method is limited by depth sensitivity and may require time-domain approaches to increase depth sensitivity (Boas & Francheschini, 2009).
Study Results
In their study, Kath and colleagues (2016) established that compression stocking reduces the degree of hematoma and bleeding. However, the length of the compression stocking does no play a significant role in this regard. Therefore, thigh length compression stockings do not show superior effects compared to knee length compression stockings (Kath et al., 2016). The researchers also found that addition of aloe vera to the compression stockings is helps reduce the risk of pruritus.
On their part, Kinoshina et al. (2019) found out that 3 hours of sitting resulted in increased extracellular water as well as decreased intracellular water in the lower extremities; culminating in reduced levels of blood volume and oxygenation. The authors uncovered that using compression stockings was effective in suppressing the aforesaid negative effects. In a word, both studies showed that compression stocking therapy helps improve and manage outcomes following surgery to remove lower-limb varicose veins. In other words, this intervention minimizes side effects and/or complications such postoperative bleeding, pain, edema, and hematoma following varicose vein surgery.
Ethical Considerations
For any study involving human participants, it is imperative to consider any ethical issues that may arise by, more importantly, adhering to established ethical guidelines. One ethical consideration concerns participation whereby researchers ought to ensure that participants’ involvement/participation is the research is through informed consent. This way, it becomes certain that no one has forced the participants to take part in the study. Another consideration is to gain ethical approval from relevant institutions/bodies, which is a green light to conduct the study. Seemingly cognizant of these ethical considerations, Kinoshina et al. (2019) sought the approval of the Medical Ethics Committee of Tokyo Medical University and ensured they conducted their study as per the Declaration of Helsinki. Additionally, the researchers, after explaining to participants all important aspects of the study, obtained participants’ informed consent prior to conduction of the study. Similarly, Kath and colleagues (2016) obtained signed informed consent from all 160 participants. The researchers also obtained institutional approval to conduct the study.