Capella 4030 Assessment 3 PICO (T) Questions and an Evidence-Based Approach
PICO(T) Questions and an Evidence-Based Approach
This assessment uses the PICO(T) question approach to delve into a severe healthcare issue of stroke. It explores evidence-based practices to find the best treatment for affected patients. Nurses have used this strategy to find evidence-based practices for various healthcare problems by using PICO(T) questions on particular diseases. PICO(T) stands for Population, Intervention, Comparison, Outcome and Time-frame. A particular affected population with disease is chosen with two interventions to be compared to draw a specific outcome within a limited time window. Evidence-based data are used to evaluate the effectiveness of the proposed interventions, and conclusions are drawn respectively.
PICO(T) Question for Stroke
A stroke, also known as a brain attack, is a cardiovascular-associated health problem in which the blood supply to the brain is impeded or the vessel supplying blood to the brain bursts. This results in brain damage, or part of the brain may die. Every year, about 795,000 people experience a stroke in the U.S. Stroke can be divided into two types, i.e., ischemic and hemorrhagic (CDC, 2023). In ischemic stroke, the blood vessel is occluded by a clot, blocking the adequate oxygen supply to the brain and causing deprivation. Ischemic strokes account for 87% of all strokes and are the most common type. A hemorrhagic stroke occurs when the blood supply to the brain bursts and floods the surrounding tissue with blood (Stroke Awareness Foundation, 2019). This PICO(T) question for our research is as follows:
In adults over 50 years (P) who have experienced an ischemic stroke, is early rehabilitation and physical therapy (I) better as compared to delayed or no rehabilitation (C), within the first six months (T) after the initial stroke event to improve functional recovery (O)?
Various benefits can be obtained by exploring prospective preventive interventions for stroke using a PICO(T) approach. For instance, the PICO(T) question will encourage using evidence-based practices for stroke management and enlighten nurses on the appropriate treatment of stroke patients in the given population. Moreover, this will lead to making informed clinical decisions based on substantial data and targets achieving potentially desired health outcomes for patients. Additionally, it will give an idea of adopting a specific strategy or treatment plan for a particular duration due to the time frame given in the PICO(T) question.
Sources of Evidence for Answering PICO(T) Question
Various sources of evidence are applicable in answering a PICO(T) question for ischemic stroke. These include multiple databases, journals, and other organizational websites. The databases available to answer the PICO(T) question are Google Scholar, CINAHL, PubMed, ScienceDirect, and Capella University. The Journals with in-depth research articles on stroke are the International Journal of Stroke, Journal of Stroke and Cerebrovascular Diseases, Stroke, and Journal of Stroke. Lastly, the American Stroke Association, American Heart Association, World Stroke Organization, Stroke Awareness Foundation, and the Centers for Disease Control and Prevention are some of the eminent organizations working for a similar cause of reducing the impact of stroke on the population at-risk and improving stroke care by various means.
These sources of evidence can direct beneficial research on the proposed PICO(T) question and facilitate drawing the evidence-based conclusions best suited to our stroke population. The criteria or rationale used to determine the potential to answer the PICO(T) question is evaluating whether the source is clinically relevant and the organizations are authorized. Furthermore, the research articles used should fulfill the CRAAP criteria where their currency is checked based on the year the article was published, and the topic’s relevancy is evaluated, followed by its authorization, accuracy of the claims, and the purpose of the study. This criteria will enable the researchers to filter out reliable and valuable evidence from the pool of resources to ensure credible and best practices are integrated into patient care.
Findings from Articles or Other Sources of Evidence
Some of the evidence-based findings that support our PICO(T) question to initiate early rehabilitation are;
- According to Selves and colleagues (2020), initiating gait recovery techniques in stroke patients in the early rehabilitation phase (48 hours to 3 months) is crucial to prevent long-term disability. Guidelines by the American Heart Association support this study, which is based on predictive factors for gait recovery, including trunk control and hip extension capacity. Based on these factors, post-stroke patients must be evaluated to initiate gait and physical therapy further. In moderate stroke, mobilization should be started within 24 hours to acquire beneficial results and immediate functional physical recovery. The gait recovery techniques include treadmill training with or without body weight support, robotic-assisted therapy (RAT), and Virtual Reality (VR). Additionally, self-rehabilitation programs where patients practice walking have proven to improve daily life activities and reduce the burden of care for assisting caregivers.
Capella 4030 Assessment 3
- Another article by Dehem and colleagues (2019) highlighted the efficacy of upper-limb robotic-assisted therapy in the early rehabilitation phase after a stroke. The authors emphasized the need for robotic-assisted therapy (RAT) due to ineffective intensive interdisciplinary rehabilitation in patients who suffered from stroke. The RAT uses the robot (REAplan) for exercise that lasts for 45 minutes, involving a game of paretic hand movement along a particular trajectory and going through different checkpoints similar to golf. The robot guides the patients with assistance as required. Combined with conventional therapy, RAT therapy in the early rehabilitation phase is more effective than conventional therapy alone in improving functional recovery of gross motor skills and upper limb activity while enhancing patients’ social participation.
- Furthermore, an evidence-based research article by MacKay-Lyons and colleagues (2019) recommends aerobic training in stroke patients to improve rehabilitation and overall physical fitness that enhances patients’ social and psychological lives. The authors further recommend that the intensity of aerobic exercise will be determined by the severity of the stroke, response to exercise testing, health status, and frequency of planned exercise. Moreover, at least eight weeks of aerobic exercise will be needed to acquire clinically meaningful training results with enhanced physical activity, with each session lasting for more than 20 minutes. This source is the most credible, highlighting aerobic exercises for stroke patients with intricate guidelines. Moreover, the journal “The Physical Therapy and Rehabilitation Journal” is a renowned journal with impact factor 4, thus dictating the credibility fo the resource.
Decision-Making on PICO(T) Question Using Findings
Based on the findings from evidence-based resources, the decision on the given PICO(T) question states that rehabilitation and physical activity soon after the stroke in adult patients over 50 improves functional recovery within six months. Furthermore, this requires using RAT and other advanced technologies in addition to conventional care therapy. Moreover, the session lasted more than eight weeks to see meaningful and valuable results of better physical activity in stroke patients. The findings from MacKay-Lyons and colleagues (2019) are the most suitable or likely to lead to positive outcomes as aerobic exercises are easy to practice, and detailed guidelines are provided in the article on implementing aerobic exercises in patients with stroke.
In this assessment, the healthcare issue explored via the PICO(T) question is ischemic stroke. The PICO(T) question analyzes whether rehabilitation and physical therapy improve functional recovery in the early phase after a stroke. Various databases and sources of evidence were utilized that fulfilled the CRAAP criteria and clinical relevance. Furthermore, articles on rehabilitation after stroke were analyzed, and conclusions were drawn on which decision was made. The decision was based on findings that early rehabilitation with various strategies, such as RAT and aerobic therapy, improves the functional ability of patients who have experienced stroke.
CDC. (2023). About stroke | cdc.gov. https://www.cdc.gov/stroke/about.htm#:~:text=Close
Dehem, S., Gilliaux, M., Stoquart, G., Detrembleur, C., Jacquemin, G., Palumbo, S., Frederick, A., & Lejeune, T. (2019). Effectiveness of upper-limb robotic-assisted therapy in the early rehabilitation phase after stroke: A single-blind, randomised, controlled trial. Annals of Physical and Rehabilitation Medicine, 62(5), 313–320. https://doi.org/10.1016/j.rehab.2019.04.002
MacKay-Lyons, M., Billinger, S. A., Eng, J. J., Dromerick, A., Giacomantonio, N., Hafer-Macko, C., Macko, R., Nguyen, E., Prior, P., Suskin, N., Tang, A., Thornton, M., & Unsworth, K. (2019). Aerobic exercise recommendations to optimize best practices in care after stroke: AEROBICS 2019 update. Physical Therapy, 100(1). https://doi.org/10.1093/ptj/pzz153
Selves, C., Stoquart, G., & Lejeune, T. (2020). Gait rehabilitation after stroke: Review of the evidence of predictors, clinical outcomes and timing for interventions. Acta Neurologica Belgica, 120. https://doi.org/10.1007/s13760-020-01320-7
Stroke Awareness Foundation. (2019). Stroke facts & statistics. https://www.strokeinfo.org/stroke-facts-statistics/#:~:text=Someone%20has%20a%20stroke%20every