Running head: Critical Appraisal of Research Critical Appraisal of Research Part 4B: Critical Appraisal of Research Walden University: NURS-6052. October 13, 2019 Part 4B: Critical Appraisal of Research Given my examination, the best practice that rises out of the exploration I checked on is Evidence-Based Practice (EBP), whereby in a clinical setting, it is considered as a fundamental component for guaranteeing that patients are given quality care just as treatment services. EBP is viewed as reasonable just as meticulous use of clinical practices that depend on current evidence. Also, medical care experts, with the help of EBP, can settle on successful decisions in connection to medicinal services operations. EBP depends on various pieces of evidence that incorporate qualitative just as quantitative research, controlled preliminaries, case reports, expert opinion, and scientific standards. In this specific case, the clinical practices dependent on EBP help with giving better care just as treatment benefits as per patient values alongside clinical aptitude (Forrest, 2008). EBP depends on evidence gathered from qualitative research. Consequently, the quantitative analysis assumes a significant role in collecting data about current practices to be effected for the improvement of clinical skills and in gathering the patient's values. The research examines that are ineffectively structured, and inadequate reporting is contended to influence quantitative analysis crosswise over various spheres that incorporate medicinal services, future research, decision making, and health policy. In such manner, distinguishing reporting rules including diagnosis test studies (STARD), observational studies (STROBE), meta-analyses of observational studies (MOOSE), consolidated criteria for reporting qualitative research (COREQ) and randomized controlled trials (CONSORT) were used in these peer-reviewed articles. Recognizing that clinicians have time constraints but then need to give the ideal care to their patients, the evidence-based methodology offers clinicians an advantageous technique for discovering current research to help in making clinical decisions, answer patient questions, and investigate alternative therapies, strategies, or materials. With a comprehension of how to viably use EBDM, professionals can rapidly and helpfully remain current with scientific discoveries on points that are essential to them and their patients. References DiBardino, D., Cohen, E. R., & Didwania, A. (2014). Meta‐analysis: multidisciplinary fall prevention strategies in the acute care inpatient population. Journal of hospital medicine, 7(6), 497-503. Forrest, J. L. (2008). Evidence-based decision making: introduction and formulating good clinical questions. J Contemp Dent Pract, 1(3), 042-052. Haines, T. P., Hill, K. D., Bennell, K. L., & Osborne, R. H. (2017). Additional exercise for older subacute hospital inpatients to prevent fal ...

1. Running head: Critical Appraisal of Research
Critical Appraisal of Research
Part 4B: Critical Appraisal of Research
Walden University: NURS-6052.
October 13, 2019
Part 4B: Critical Appraisal of Research
Given my examination, the best practice that rises out of the
exploration I checked on is Evidence-Based Practice (EBP),
whereby in a clinical setting, it is considered as a fundamental
component for guaranteeing that patients are given quality care
just as treatment services. EBP is viewed as reasonable just as
meticulous use of clinical practices that depend on current
evidence. Also, medical care experts, with the help of EBP, can

2. settle on successful decisions in connection to medicinal
services operations. EBP depends on various pieces of evidence
that incorporate qualitative just as quantitative research,
controlled preliminaries, case reports, expert opinion, and
scientific standards.
In this specific case, the clinical practices dependent on EBP
help with giving better care just as treatment benefits as per
patient values alongside clinical aptitude (Forrest, 2008). EBP
depends on evidence gathered from qualitative research.
Consequently, the quantitative analysis assumes a significant
role in collecting data about current practices to be effected for
the improvement of clinical skills and in gathering the patient's
values. The research examines that are ineffectively structured,
and inadequate reporting is contended to influence quantitative
analysis crosswise over various spheres that incorporate
medicinal services, future research, decision making, and health
policy. In such manner, distinguishing reporting rules including
diagnosis test studies (STARD), observational studies
(STROBE), meta-analyses of observational studies (MOOSE),
consolidated criteria for reporting qualitative research
(COREQ) and randomized controlled trials (CONSORT) were
used in these peer-reviewed articles.
Recognizing that clinicians have time constraints but then need
to give the ideal care to their patients, the evidence-based
methodology offers clinicians an advantageous technique for
discovering current research to help in making clinical
decisions, answer patient questions, and investigate alternative
therapies, strategies, or materials. With a comprehension of how
to viably use EBDM, professionals can rapidly and helpfully
remain current with scientific discoveries on points that are
essential to them and their patients.

3. References
DiBardino, D., Cohen, E. R., & Didwania, A. (2014).
Meta‐analysis: multidisciplinary fall prevention strategies in the
acute care inpatient population. Journal of hospital
medicine, 7(6), 497-503.
Forrest, J. L. (2008). Evidence-based decision making:
introduction and formulating good clinical questions. J Contemp
Dent Pract, 1(3), 042-052.
Haines, T. P., Hill, K. D., Bennell, K. L., & Osborne, R. H.
(2017). Additional exercise for older subacute hospital
inpatients to prevent falls: benefits and barriers to
implementation and evaluation. Clinical Rehabilitation, 21(8),
742-753.
Hempel, S., Newberry, S., Wang, Z., Booth, M., Shanman, R.,
Johnsen, B., & Ganz, D. A. (2017). Hospital fall prevention: a
systematic review of implementation, components, adherence,
and effectiveness. Journal of the American Geriatrics
Society, 61(4), 483-494.

4. Spiva, L., & Hart, P. (2014). Evidence-Based Interventions for
Preventing Falls in Acute Care Hospitals.
CHECK ON THE HIGHLIGHTED PART
In as well as a top-level strategy usually prioritizes the financial
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inviting and retaining of the best talent, development of new
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talent are part of the priorities. Although the business leaders
and managers are the ones that own the people and the
requirements of the organizational strategy, the human resource
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Whereas the general goals and the main enterprises are critical,
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fact, the failure of most organizations occurs when they lack
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changes that must take place to align the organization around
the strategy. Human resource can be of significance when it
comes to determining the aspects of the organization that have
to be taken care of, the impact, and the actions that will need to
be taken to ensure success.

5. Evaluation Table
Use this document to complete the evaluation table requirement
of the Module 4 Assessment,Evidence-Based Project, Part 4A:
Critical Appraisal of Research
Full citation of selected article
Article #1
Article #2
Article #3
Article #4
Hempel, S., Newberry, S., Wang, Z., Booth, M., Shanman, R.,
Johnsen, B., & Ganz, D. A. (2017). Hospital fall prevention: a
systematic review of implementation, components, adherence,
and effectiveness. Journal of the American Geriatrics
Society, 61(4), 483-494.
DiBardino, D., Cohen, E. R., & Didwania, A. (2014).
Meta‐analysis: multidisciplinary fall prevention strategies in the
acute care inpatient population. Journal of hospital
medicine, 7(6), 497-503.
Haines, T. P., Hill, K. D., Bennell, K. L., & Osborne, R. H.
(2017). Additional exercise for older subacute hospital
inpatients to prevent falls: benefits and barriers to
implementation and evaluation. Clinical Rehabilitation, 21(8),
742-753.
Spiva, L., & Hart, P. (2014). Evidence-Based Interventions for
Preventing Falls in Acute Care Hospitals.
Conceptual Framework
Describe the theoretical basis for the study
None
multidisciplinary fall prevention interventions in acute care
hospital
None

6. Inclusion of prospective controlled-design studies reporting the
effectiveness of fall prevention programs in hospitals.
Design/Method Describe the design
and how the study
was carried out
Systematic review using a qualitative method
Used qualitative method where the bibliographies of all
systematic reviews and meta-analyses were hand searched a
meta-analysis reviews
Randomized controlled trial, subgroup analysis.
Cluster randomized study
Sample/Setting
The number and
characteristics of
patients,
attrition rate, etc.
U.S. acute care hospitals
Acute care settings
5038 total participants. 1958 Male and 3080 Female. Patients of
a metropolitan sub-acute/aged rehabilitation hospital
Acute Care Settings
Major Variables Studied
List and define dependent and independent variables
Participants Studies reporting in-hospital falls for intervention
groups and concurrent (e.g., controlled trials) or historic
comparators (e.g., before-after studies).
The belt, older people,
Dependent - Falls, independent - exercise,
Dependent- the relative risk of a fall per occupied bed day

7. (RR(fall)) and independent - the relative risk of being a faller
(RR(faller))
Measurement
Identify primary statistics used to answer clinical questions
Incidence rate ratios (IRR, ratio of fall rate post intervention or
treatment group to the fall rate pre-intervention or control
group) and ratings of study details.
Electronic fall prevention tool kit which triggered automatic
ordered interventions.
multifactorial interventions including exercise to prevent
inpatient falls in older adults
The primary outcome was patient falls per 1000 patient-days
adjusted for site and patient care unit. A secondary outcome was
fall-related injuries.
Data Analysis
Statistical or
qualitative
findings
Meta-regressions analysis
Effect sizes (odds ratios) and 95% confidence intervals were
derived for individual studies and then combined across
research reports using a random-effects meta-analysis.
Intervention group participants in this subgroup analysis had a
significantly lower incidence of falls than their control group
counterparts (control: 16.0 falls/1000 participant-days,
intervention: 8.2 falls/1000 participant-days, log-rank test: P =
0.007). However few differences in secondary balance, strength
and mobility outcomes were evident.
Hospitalization further increases risk of falls
Findings and Recommendations
General findings and recommendations of the research
Study shows better reporting of outcomes, implementation,
adherence, intervention components, and comparison group

8. information is necessary to establish evidence on how hospitals
can successfully prevent falls.
Fall prevention strategies have a significant but small effect on
fall rates despite the use of complex, multidisciplinary
interventions. Additional randomized trials are needed to
examine the possible benefits of multidisciplinary fall
prevention strategies in the acute inpatient setting.
This exercise programme provided in addition to usual care may
assist in the prevention of falls in the sub-acute hospital setting.
The authors found that precautionary care including a falls
safety champion reduced the occurrence of injurious falls by
58.3% (n=36).
Appraisal
Describe the general worth of this research to practice. What are
the strengths and limitations of study? What are the risks
associated with implementation of the suggested practices or
processes detailed in the research? What is the feasibility of use
in your practice?
Adherence methodologies are of specific significance for long
haul changes
A broad eligibility criterion was incorporated in the study and
questions were clearly reviewed and addressed.
Participants had their balance, strength and mobility assessed
upon referral for the exercise programme and then again prior to
discharge.
The use of a fall prevention tool kit in hospital units compared
with usual care significantly reduced rate of falls.
General Notes/Comments
N/A
N/A
N/A
N/A
Levels of Evidence Table
Use this document to complete the levels of evidence table

9. requirement of the Module 4 Assessment,Evidence-Based
Project, Part 4A: Critical Appraisal of Research
Author and year of selected article
Article #1
Article #2
Article #3
Article #4
Hempel, S., Newberry, S., Wang, Z., Booth, M., Shanman, R.,
Johnsen, B., & Ganz, D. A. (2017
DiBardino, D., Cohen, E. R., & Didwania, A. (2014).
Haines, T. P., Hill, K. D., Bennell, K. L., & Osborne, R. H.
(2017).
Spiva, L., & Hart, P. (2014).
Study Design
Theoretical basis for the study
Systematic review using a qualitative method
systematic reviews and meta-analyses
Randomized controlled trial, subgroup analysis.
Cluster randomized study
Sample/Setting
The number and
characteristics of
patients
U.S. acute care hospitals.
Information on number of fallers, number of falls, fall rate (per
1,000 patient days), and number eligible to fall.
Sample sizes were not reported but the number of 1,000-patient
days in treatment groups ranged from 4.3 to 160.3.
5038 total participants. 1958 Male and 3080 Female.

10. Comparing patient fall rates in 4 urban US hospitals in units
that received usual care (4 units and 5104 patients) or the
intervention (4 units and 5160 patients).
Evidence Level *
(I, II, or III)
Level V
Level VII
Level 1
Level 1
Outcomes
A critical analysis of the qualitative studies surrounding the use
of interventions placed to reduce the number of elderly falls in
the hospital.
Fall prevention strategies had a statistically significant but
small effect on fall rates despite the use of complex,
multidisciplinary interventions.
Provides a meta-analysis
from randomized controlled
trials involving exercise
The review addressed a clear question and used broad eligibility
criteria.
General Notes/Comments
N/A
N/A
N/A
N/A
* Evidence Levels:
· Level I
Experimental, randomized controlled trial (RCT), systematic

11. review RTCs with or without meta-analysis
· Level II
Quasi-experimental studies, systematic review of a combination
of RCTs and quasi-experimental studies, or quasi-experimental
studies only, with or without meta-analysis
· Level III
Nonexperimental, systematic review of RCTs, quasi-
experimental with/without meta-analysis, qualitative,
qualitative systematic review with/without meta-synthesis
· Level IV
Respected authorities’ opinions, nationally recognized expert
committee/consensus panel reports based on scientific evidence
· Level V
Literature reviews, quality improvement, program evaluation,
financial evaluation, case reports, nationally recognized
expert(s) opinion based on experiential evidence
Outcomes Synthesis Table
Use this document to complete the outcomes synthesis table
requirement of the Module 4 Assessment,Evidence-Based
Project, Part 4A: Critical Appraisal of Research
Author and year of selected article
Article #1
Article #2
Article #3
Article #4
Hempel, S., Newberry, S., Wang, Z., Booth, M., Shanman, R.,
Johnsen, B., & Ganz, D. A. (2017

12. DiBardino, D., Cohen, E. R., & Didwania, A. (2014).
Haines, T. P., Hill, K. D., Bennell, K. L., & Osborne, R. H.
(2017).
Spiva, L., & Hart, P. (2014).
Sample/Setting
The number and
characteristics of
patients
Same as above
Same as above
Same as above
Same as above
Outcomes
Studies had to report on the outcome of inpatient falls.
Fall prevention help should be considered along patient’s
cultural differences.
Properly implemented fall prevention strategies and
interventions are important for older adults
Falls cause injury and death for persons of all ages, but risk of
falls increases markedly with age.
Key Findings
Meta-regressions showed some evidence of the importance of
adherence levels to reduce falls
Fall prevention strategies have a significant but small effect on
fall rates despite the use of complex, multidisciplinary
interventions.
This exercise programme provided in addition to usual care may

13. assist in the prevention of falls in the sub-acute hospital setting
The analysis of this study show that fall prevention strategies
according to risk category and insufficient to prevent falls,
especially low risk patients.
Appraisal and Study Quality
Population control study
Random control study
Cohort review study
True experiment evidence from the RCT
General Notes/Comments
Feasibility of the entire study through examination of
recruitment, Eligibility,
Protocol, adherence and
missing data
Comprehensively reviews literature thus efficient in
boosting the knowledge of
clinical experts on about the
Clinical issue. Generally
ineffective unless supported by other sources
Comprehensively reviews literature thus efficient in boosting
the knowledge of clinical experts on about the clinical issue.
Being a level one evidence with favourable outcomes, it
helps to solve the clinical question and provides a
comprehensive answer to the study question
Critical Appraisal Tools Worksheet Template

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