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The essence of critical evaluation lies in a balanced appraisal which necessitates logical as well as objective identification of the systematic inquiry that underpins the study (Polit, 2017). This report analyzes the strengths, weaknesses and limitations of the qualitative study on ‘the yoga interventional program for patients with features of post-traumatic stress disorder’ to consider its applicability in practice. In this study, the title provides clear and concise description about the article and the abstract provides valuable insight about the study’s complexity. Jindani (2015) has given appropriate purpose with an achievable objective to understand the perceptions of PTSD-patients regarding KY program. They have given appropriate rationale and importance in proposing this study with a detailed background to the case study of marketing.
The clinical and research expertise can be discerned from the brief biographies of authors that provide information about academic qualifications, affiliations, current position as well as place of work (Boswell, 2017). In this study, the author Jindani has a PhD degree working at the Addiction & Mental-Health centre, Ontario, Canada which shows that the author is expertise in the field of Addiction and mental-health whereas the author Khalsa with a BA degree is from the University of Toronto’s Mult-Faith Centre for Spiritual-study & practice. They should have mentioned about their major specialty subject in their qualification. They have failed to provide their designation in their work place to trace out their expertise in the particular field of work, especially related to the current study. No conflicts of interest and competing financial interests were noted. They have acknowledged the Kundalini yoga teachers and study-subjects for their kind contribution to their study. Increased possibility for sampling bias is noted.
Objectives are the specific accomplishments that are developed to attain what the author is intended to study (Greenhalgh, 2017). Here, the researchers have stated a clear objective as ‘to understand the perceptions of individuals with post-traumatic stress disorder (PTSD) about the Kundalini yoga (KY) (trauma-sensitive) program’ is achievable and follows from the study problem.
PTSD that is characterized with re-experiences of traumatic events with physical and psychological-distress are often controlled by cognitive-behavioral and extended-exposure therapies (Resnick, 2012), but sometimes fail to control PTSD-features causing re-trauma. Yoga with mind-body practice is found to be beneficial for them, but only limited studies have explored their perceptions about participating in yoga-program (Alexander, 2013, Cramer, 2013). Absence of previous studies to explore the perceptions of yoga-treatment among PTSD-patients and presence of studies only to investigate the effect of yoga-therapy has motivated them to propose this study to understand the perceptions of PTSD-patients about KY-program.
Research design is the overall plan to solve the study’s problem (Hoffmann, 2017). Jindani (2015) has selected qualitative descriptive design to investigate the phenomenon (here, perceptions of PTSD-patients about yoga program) in an in-depth as well as holistic fashion by gathering a narrative-qualitative data. The text suggests that they have conducted RCT-trail between March & August- 2012 at the Toronto’s University by manipulating (KY program), control group and random assigning of samples. They have completed interviews within one-week after the RCT’s conclusion. They have appropriately selected 40 subjects, particularly those subjects attended eight-weeks of yoga-program for this qualitative study to rule-out their perceptions by inviting them for telephonic-interviews. This design will help them to achieve their objective as ‘to understand the perceptions of PTSD-patients about KY-program’.
Research methods which are the techniques used to structure a study as well as to collect and analyze data in a systematic-way, are the crucial part of the research-study (Gerrish, 2015). Inclusion-criteria that specifies the attributes of target-population and the exclusion-criteria that indicate the attributes that the study-participants should not possess, was adopted adequately, as suggested by Greenhalgh (2017). They have conducted the RCT-trial at Toronto’s University by randomly-assigning the samples to both the interventional (n=59) and the wait-list control (n=21) groups by giving equal probability to all the participants (Jindani, 2013). They conducted interviews within 1 week of RCT-completion by inviting all 40 subjects (males=9 & females=31); those who have completed their eight-weeks of KY program to attend telephonic interviews. Their sample size of 40 is too small for a qualitative study that it can create sampling bias.
They got ethical clearance from the Toronto University’s office with a protocol reference (#26992). They obtained informed-consent from all the participants to enable confidentiality (Polit, 2017). Text suggests that they have not indented any harm to the participants. They mentioned that scheduling conflicts as well as medical reasons were the major causes for subject dropout but has not given about their numbers.
Data-collection involves collection of appropriate data to draw solutions as per objectives (Grove, 2015). They have administered intervention to KY-group that was designed by Jindani (psychologist), war-veteran and KY-teachers with 7 KY-groups taught by 3-KY teachers. They adopted Kundalini Yoga (KY) that integrates the endocrinal and nervous E-business systems (including breathing-exercises, postural and meditational aspects) by using trauma-sensitive yoga guidelines. They have given a 90-minute group-practice program every week for 8-weeks to groups with size of 3 to 8 subjects to cultivate self-efficacy, relaxation and self-awareness skills along with a 15-min home-practice of breath-work, mantras, postures & mudras. They collected data about KY-program through semi-structured, digitally recorded telephonic interview for 30 to 60 minutes among PTSD-patients. This technique enables subjects to express themselves and enhances reliability and comparability of narrative data (Gerrish, 2015). Interviews were transcribed into verbatim and were analyzed through qualitative-thematic-analysis.
Qualitative thematic-analysis that is known for tracing needful data about topics that are little known is utilized in this study (Polit., 2017). It enables development of new themes that serves as an appropriate analytical-method. They have identified 3 themes as newer awareness, Kundalini Yoga-program and self- observed alterations with varied sub-themes. They have well-presented the demographic characteristics and themes in a table and flow-chart format for clear understanding of the quotes.
Findings indicate that the study-subjects have noted changes in aspects of health & well-being, life-style, psycho-societal integration, & self-perceptions related to world which is adequate to understand the perceptions of PTSD-patients about KY-program. They have presented certain practical suggestions about trauma-based programming. The findings could be limited by smaller sample size, absence of active controls and need for intrinsic motivation to complete 8-week program.
This critical appraisal report carefully analyzed the merits and demerits of the research-study on ‘the perceptions of yoga-program by PTSD-patients’ to enhance its applicability in clinical-practice. This research-study is noted to meet the PICO-element provided in the clinical scenario and question. P (Population/problem)- patients with PTSD features; I (Intervention)- KY-program C (Comparator)- Nil; O (outcome)- changes in perceptions of PTSD-patients about KY-program.
The researcher’s recommendations include: 1). There is increased need to adapt alternative as well as empowering (Yoga/self-managing) methods in trauma management. 2). Body-based interventions can be practiced along with trauma-management and can also serve as a precursor for reflective-treatments (JIndani, 2015). 3). Consistent with treatment-based researches, subjects suggested that a group yoga therapy can be highly effective. 4). Participants found improvements in areas of health- & well-being, life-style, psycho-social integration with perceptions about self.
Evidence-based practice involves utilization of best-available evidence to make clinical judgments in client care (Polit, 2017). The findings provide a clear understanding that the yoga-treatment given for 8-continuous weeks improves the perceptions of patients in several aspects. They have included patients with varied disease-related PTSD which also shows the effectiveness of Yoga-therapy in improving the self-perceptions.
It is the only study that yields high-quality evidence by supporting the use of KY in improving the health & well-being, perceptions about world as well as lifestyle in PTSD-patients. This will help the health-professionals with clinical expertise to adopt the study-findings to motivate PTSD-patients to practice KY yoga. This evidence will also improve the PTSD-patient’s self-values based on their preferences. This evidence with scientific merit can be utilized to motivate Tasso to practice KY to improve his well-being. There are no organizational and individual barriers that could affect the implementation of recommendations in practice.
This critical appraisal carefully evaluated the strengths and weakness of methods employed in this study. Despite certain limitations, the use of achievable objective, adequate sampling plan, appropriate research-design and apt analytical techniques suggest that the study-findings are more reliable and could be used as a best-available evidence to practice. Generally, the management plan for trauma involves incorporation of treatment plan with psychological (mind-body) practices. It is evidenced in this study suggesting that yoga therapy is highly beneficial in improving daily-care skills, physical, emotional and societal health & well-being of PTSD-patients (Jindani, 2015). Thus, evidence from the current study indicates that yoga-therapy along with trauma-management plan, can benefit PTSD-patients as Tasso to overcome their features and to improve their quality-of-life.
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