Individualized Physical Activity Intervention

Question: Discuss about the Individualized Physical Activity Intervention. Answer: Introduction: Randomization of treatments- In randomized controlled trial, participants are assigned to a treatment conditions at random and the unique factor is the type of intervention they receive. Moyle et al. (2014, pp.856-864) also conducted the research by randomization. Participants were randomized by a computer program to hide the allocation detail of participants. On that basis, the intervention groups received 10 min of foot massage and the control group received quiet presence. In RCT, the process are controlled to ensure that participants receive the same treatment unique to their group and same was observed in this study as block randomization was done to maximize the equality of the intervention and the control groups (Bothwell Podolsky 2016, pp.501-504). Accountability of patients- Moyle et al. (2014, pp.856-864) had analyzed the data collected from participants who received at least one treatment. 2-tailed test help to determine whether the impact of group was high in mood and agitation in dementia patient was higher in the control group or the intervention group. Detail about group- While conducting RCT studies, baseline imbalance often arise. Hence, it is necessary for the researcher to ensure that both intervention and control groups are equal at baseline. This means factors such as age, sex, class, education and fitness in both groups should not have an effect on the outcome (Singh et al. 2017). Moyle et al. (2014, pp.856-864) maintained the baseline balance in participants by means of recruiting participant on the basis of inclusion criteria. This included participant above the age of 65 years with moderate to last stage of dementia. They must be living in long term care, should have a history of agitation and Mini Mental State Examination (MMSE) should be less than 18. This inclusion strategy enhances the credibility of the study as participants particularly with agitation symptoms were selected for the trial. It would help greatly in generalization of the study. Treatment of groups- Treatment of groups equally in RCTs implies whether researcher has addressed the factors that might influence the performance of one group over the other. The review of the article reveals Moyle et al. (2014, pp.856-864) has considered this aspect during the sample recruitment stage. This is reflected by the exclusion process. Participant who had serious illness that might affect the foot anatomy and pain were not taken. If such participant would have been taken, the purpose of the study would not have been effectively fulfilled. During the intervention process also, the timing of intervention was considered important as dementia patients mainly develop restlessness in the afternoon. Hence, with this consideration, afternoon time was chosen for providing the intervention (Spector et al. 2016, pp.1055-1062). Effect of treatment- The reliability and credibility of a research study is understood by the treatment of outcomes and comparison of groups to develop a mean outcome. This reflect the rigour of research and the focus of the researcher to make the results reliable (Altman, D.G., 2015). In case of RCT trial for comparing impact of foot massage and quiet place on dementia patient, outcome measures of patient was assessed by means of Cohen-Mansfield Agitation Inventory (CMAI) Short Form and the Observed Emotion Rating Scale (OERS). The first was used to assess agitation and the latter was used to assess moods in both group post-intervention. No baseline imbalance was also observed as both CMAI and OERS had no difference at baseline between both groups. The mean and standard deviation of change score was developed by means of one-way ANOVAs (Moyle et al. 2014, pp.856-864). Estimate of treatment effect- The review of the results of the RCT study depicts no difference in group in baseline in terms of factors of age, gender, time and medications. The study findings revealed mean total CMAI increase in both groups but increase in verbal aggression was more in quiet presence (control) group. There was large observed variability between the groups which indicates that the there might be certain uncertainty which may have an impact on the accuracy of the result (Moyle et al. 2014, pp.856-864). However, still the result is reliable because variations were seen in acceptability of massage due to individual variation and not by the difference in tolerating the intervention. The treatment of intervention (foot massage) in the RCT trial finally proved that it cannot be utilized as a non-pharmacological intervention for dementia patients because foot massage die not lead to a long-term improvement in agitation and mood of patients (Schmidt Hunter 2014). Application of results- The RCT trial on dementia patient was considered important because over 90% of them experience behavioral and psychological symptoms of aggression, anxiety and depression during the progression of the disease. These symptoms increase the suffering of not just the patient but also their family members. Moyle et al. (2014, pp.856-864) wanted to analyze the efficacy of foot massage as an intervention for reducing mood disorder because of high prevalence of side-effects in anti-psychotic medications. Hence, there is an increased attention to designing non-pharmacological intervention that leads to a relaxation response in patients. Foot massage was considered as a relaxing intervention for dementia patient by the researcher as it would lead to calming sensation by the production of oxytocin (Kapoor Orr 2017). The study fining showed little improvement in mood due to foot massage and it was inconsistent with other research findings. There is an indication of unfam iliar treatment staff that might have affected the result. However, reduction in alertness was seen in patients and this can contribute to future research when investigating mood in response to certain episodes of aggression (Moyle et al. 2014, pp.856-864). Therefore, this research article does not provide strong support regarding the benefit of foot massage as an intervention for dementia patient. However, more rigorous research into factors promoting relaxation in foot massage may lead to a positive application in dementia patient. Consideration of clinically important outcomes- The researcher has tried to maintain the rigour of the study by focusing on factors that might affect the result. For instance, there was no difference in baseline data of both groups. Other confounding variables were also considered such as timing of intervention to maximize the efficacy of the outcome. However, still the study has certain limitations. This includes the unfamiliarity of the participants with massage assistant and this might have had an impact on the outcome. Hence, if the researcher has paid attention to factors that enhance relaxation during the foot massage, the outcome would have been better. It can be clinically applied once the research approach is more rigorous to identify all relevant factors affecting results. Benefits of the trial- Despite certain limitations in the study, the benefits of the RCT study is the manner in which the case analysis was conducted. This reduced any kind of selection bias and helped in increasing the generalizability of the results. Though, complete benefit from foot massage was not seen, however still certain positive symptoms were observed in participants. For example, their alertness level decreased increasing the probability of relaxation during the intervention. The foot massage participants were less alert compared to the quiet presence participants groups. Hence, such symptoms will dementia patient to become calm while receiving the foot massage. In randomized controlled studies, treatment effect is determined by the primary and secondary outcome measures of the study. The review of the randomized controlled tust on impact of physical activity intervention on family care givers of dementia patient reflects ways to analyse the treatment effects. In this case, primary outcome measures include mental status of participant which was evaluated by means of mini mental state examination score and the standardized tool to measure perceived burden, depressive symptoms and positive effects (Farran et al. 2016). Hence, depending on different objectives of research, it would be interesting to know how researchers validate the treatment effect if variability in the study is high. The justification of the above question is given by considering lot of outcomes of the intervention in relation to its impact on the patient or caregiver selected for the study. For example, in a research study where the aim was to reduce cardiovascular disease risk in patients with bipolar disorder through Life Goals Collaborative Care (LGCC), the clinical importance of the outcome was determined by self management outcomes such as changes in blood pressure and changes in physical health related quality of life (Kilbourne et al. 2013). It would be necessary to research the other ways that can enhance the clinical reliability of the intervention studied in RCT. Reference Altman, DG 2015, Clinical trials: Subgroup analyses in randomized trials [mdash] more rigour needed,Nature Reviews Clinical Oncology,12(9), pp.506-507. Bothwell, LE Podolsky, SH 2016, The emergence of the randomized, controlled trial, New England Journal of Medicine,375(6), pp.501-504. Kapoor, Y Orr, R 2017, Effect of therapeutic massage on pain in patients with dementia,Dementia,16(1), pp.119-125. Karanicolas, PJ 2010, Practical tips for surgical research: blinding: who, what, when, why, how?, Canadian journal of surgery,53(5), p.345. Moyle, W Cooke, ML Beattie, E Shum, DH ODwyer, ST Barrett, S 2014, Foot massage versus quiet presence on agitation and mood in people with dementia: A randomised controlled trial, International journal of nursing studies,51(6), pp.856-864. 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