Question:

You will need to conduct a systematic literature review of the topic that is person-centred in your assessment task 2.

Your literature review must answer a clinical question using PICO (Patient / Population, Intervention/ Issue; Comparison intervention if needed; Outcome/ Outcomes).

Once you have determined your clinical question, search the literature using the University of Wollongong Library site and research-based journal article articles that specifically relate to your chosen topic. These articles must also be available to the marker of your assignment from the University of Wollongong Library.

They must be research articles. No descriptive literature reviews or Meta-analysis articles are accepted.

Once you have identified journal articles to review, write a general critique of the evidence.

These are the components of a critical review:

A brief description or summary of the evidence

Definition of the key terms by using appropriate resources

Critical Review of Evidence

Identification of strengths & weaknesses

Indicate the relevance and the impact of the findings related to the topic

Identifying the gap

You can then have a conversation about your clinical question using the information from the research articles.

You should also make use of appropriate research resources to support your discussion.

The discussion should summarise all the articles you have reviewed.

Answer to Question: SNPG917 Evidence Into Practice

Dysmenorrhea can be seen as a medical condition that affects women across borders and cultures. However, treatment and management options are not standardised and each research reports a different opinion.

Researchers agree that between 20%-95% of women who are in their reproductive years are at risk of developing dysmenorrhea. It is an issue that needs more attention, especially in an age of differentiated approaches to treatment.

Based on research, there is a greater number of women who suffer from dysmenorrhea. Some seek pain relief, while others use both conventional and non-conventional methods of treatment.

Conventional methods of managing dysmenorrhea such as non-steroidal-anti-inflammatory drugs are preferred by the majority of those in the population.

Recent research not only raises questions about the side effects of such methods but also points to physiotherapy as a possible non-invasive treatment with clinical significance.

This paper explores whether physiotherapeutic modalities can reduce the severity and duration of primary dysmenorrhea among young women, compared with a group of control subjects who were treated with traditional options.

This paper provides a review of literature supporting the research question.

Research Strategy

The strategy employed in the search to find relevant literature that is aligned with the research question and also provide a primary method replicated by Page (2008, 172).

The strategy was meant to lessen the tediousness of the search and give more time for analysis. This is critical in ensuring that the research question is answered.

PubMed was selected as the search tool to be used by the sourcing expert because it provided a comprehensive list and could link to other relevant databases according to the search terms.

To broaden the reach within the database, and to provide more options, it was necessary that the research question be broken down into searchable terms.

Search terms like “management of menorrhea”, managing dysmenorrhea”, “physiotherapy options in dysmenorrhea” or “acupuncture in managing women’s dysmenorrhea” were used.

The culling procedure involved an analysis of each topic followed by the abstract, and finally the discussion section of the paper.

It was important that the topic, abstract, and discussion segments all be analyzed. This ensured that the paper selected reflected the researcher’s intent and sought to answer the question.

Although the abstract provided a more detailed view of the contents, the discussion segment was vital in understanding the limitations and potential future hypotheses.

(Kannan und Claydon, 2014).

Summary

This study consisted of a systematic review that included random trials, meta-analysis, and a systematic review. It was designed to assess how women with primary male dysmenorrhea react to a range of physiotherapeutic treatments such as acupuncture (acupressure), yoga, and transcutaneous electric nerve stimulation (TENS) therapies.

The primary target group included women of all ages. Secondary outcomes were reductions of menstrual pain intensity and improved quality of life.

The study reviewed 222 references and ultimately settled on 11.

The meta-analysis confirmed statistical significance for acupuncture as well as acupressure, even though such results were more likely to be due to a placebo effect.

Significant pain relief was seen with heat, TENS, yoga and other interventions.

The study recommends that TENS, heat and yoga interventions are used more than acupuncture or pressure.

Definition of key terms

Acupuncture/Acupressure: Acupuncture/acupressure refers to the physiotherapeutic processes that stimulate by inserting needles or applying pressure on the skin. These actions can alter the individual’s perceptions and normalize or reduce pain (Baker 1975: 15).

Transcutaneous Electrical nerve stimulation (TENS). This non-pharmacological physiotherapeutic method uses low-voltage electric impulses through electrodes attached around established loci. It is used to relieve pain or establish pressure points (Kwon, Reid 1997: 959).

Primary Dysmenorrhea refers to menstrual pain that is not due to an identifiable organic condition.

It’s more common in young women, especially those of reproductive age.

Prostaglandins can cause painful myometrial contractions. Proctor and Farquhar (2006), 1134. Davis, Westhoff, 2001: 3.

Critical Review

Kannan, Claydon (2014; 15-19), present evidence that was consistent with expectations. This can be attributed to their breadth, depth, and presentation of data and explanations to the public.

The paper provides detailed and thorough evidence on the flow and characteristics of the included trials as well as the effect of intervention.

The authors included graphs and tables with their explanations. They then detailed how each set presented its findings.

The evidence presented is extremely informative and clearly supports the research question.

Both Strengths and Limitations

The study has many strengths that support the evidence, and so build credibility and credibility of the argument and conclusion remarks (Kannan-Claydon, 2014:20).

They include the use by two independent reviewers who analysed and reconstructed data from 11 papers. Results of the reviewed papers were supported statistically and crucial insights were provided into contextualizing the placebo effects that can inadvertently distort outcome.

The result of the amalgamation of differently structured and even oriented studies could have had a negative impact on the argument.

The search did not include any “grey literature” which might have offered more insight to the positive results.

Relevance and Impacts

This review sheds new light on the possibilities for physiotherapy to be used in the treatment of dysmenorrhea.

The statistical significance difference between the sham trials, and the use of both Acupressure and acupuncture is a setback for therapists who often rely on these techniques.

Kannan & Claydon (2014 : 20) discuss that acupuncture & acupressure were ineffective and offer little to no reliable benefits.

The findings of the study, however, suggest that heat, TENS, and yoga are better ways to manage dysmenorrhea.

Knowledge Gap

According to the paper, yoga, TENS and heat all have significant effects on dysmenorrhea management. This is why it implicitly recommends such interventions.

Notable is the fact that both TENS and acupuncture were disqualified. This was due to the absence of clinically relevant results when compared with sham trials. This suggests that acupuncture may not be as effective.

It would be worthwhile to compare the results of yoga, TENS, heat, and other promising interventions for the management of dysmenorrhea with those from carefully designed “sham” experiments.(Yang et al., 2017)

Summary

The research paper details the results of a pragmatic randomized clinical trial. This trial compared moxibustion’s effectiveness against conventional drugs (ibuprofen).

With only 133 participants completing the program, the research revealed that there were 152 participants.

Pain relief was significantly reduced in both the experimental and control groups. The difference between the two approaches is clinically significant.

The statistical differences between the groups were not significant (P=0.76), even though for three months moxibustion remained effective.

While the results of this study suggest that both physiotherapy (moxibustion), and conventional drugs may be effective in relieving dysmenorrhea symptoms in young women, caution should be used when interpreting them.

Definition of Key Terms

Moxibustion (Chen, et al.): The process of pain relief is achieved by burning dried leaves from the herb Artemisia vulgaris. This is done in an attempt to induce neural impulses using acupuncture points. 2011: 227).

Blinding or Randomization: Randomization involves bringing on board randomly selected individuals within the target population. This is to reflect the diversity and richness of the entire population.

Blinding, on other hand, conceals where participants are located relative to the experimental group or the control group. (Karanicolas Farrokhyar und Bhandari 2010, 345).

Visual Analogue Scale (VAS), a research measurement tool that measures non-numeral phenomenological variables such as pain. It is used to measure phenomenological values other than numbers (Chrichton, 2001: 706).

Critical Review

The data from the random control trial, which was conducted by the authors, would be more extensive than usual because it was three months long. Additionally, the accompanying explanations explain how complete the data are, how many mishaps occurred and how the data relate to the research question.

The evidence is comprehensive and easy to understand in most cases. It can be classified into the recruitment and flow of the study, background characteristic. This also provided evidence about the text group that was crucial for the outcome. Secondary and primary outcomes were also included.

When necessary, the evidence is presented in complex tables or explained with words and statistical inferences.

Both Strengths and Limitations

It uses sound methodologies to investigate a phenomenon not adequately studied, or that has been studied using inefficient study designs. This is a key strength of this study.

It offers valuable insights into the topic of moxibustion. Future research inquiries can also be conducted without contamination by often unjustly compared therapeutic approaches like acupuncture (Yang, et al. 2017: 11).

The study does not cover a few key areas that would challenge its authority, and lack reciprocity.

These limitations include limiting the menstrual scale to COX and VAS which are more subjective than objectives, the lack a blinding approach for participants which could have adverse effects on authenticity of the outcome, as well as the restriction of the test population to college students (Yang, et al. 2017: 13).

Relevance and impact

There is less information available about the clinical implications of moxibustion as an intervention for dysmenorrhea. This study could help to expand this knowledge and pave the way for more research.

The topic is still understudied and there are no comprehensive studies. This study would add to the knowledge base by including the results of primary research.

They encourage you to carefully analyze the findings, as they indicate that moxibustion works well in managing dysmenorrhea. However, it is not conclusively effective.

Knowledge Gap

Yang et.al.

Yang et.al. 2017: 12-13 acknowledge that moxibustion can help with dysmenorrhea. It does this by “rewarding” brain physiology, which triggers pain control and alleviation processes.

It is possible to expand the knowledge gaps that result from such insinuations and could further inform research inquiries regarding the moxibustion interventions.

It is possible that further research will be required to validate the hypothesis and improve the way therapists approach women suffering from dysmenorrhea.

Conclusion

Dysmenorrhea affects a large number of women in their reproductive age group. Therefore, it is important to investigate ways to reduce the pain.

There is no single treatment or management method for dysmenorrhea. Because of this, there are likely to be many options for women depending upon their geography, cultural background, knowledge, and access.

Many women prefer non-steroidal antiinflammatory drug, even though they may not be as effective.

Kannan (2014: 15-19), a study by Claydon, suggests heat, TENS, and yoga. Yang (2017:12) recommends moxibustion, which is a more effective treatment.

Both studies have their limitations, and there is still much to learn about the validity of their findings.

Refer toBaker, C.J., 1977.

Acupuncture in physiotherapy.

Australian Journal of Physiotherapy. 23(1). pp.15-20.

Chen M. Chen R. Chen Xiong J. Yi F. Chi Z. Zhang B. Zhang B.

Heat-sensitive moxibustion is effective in the treatment lumbar disc sheniation. Study protocol for a controlled randomized trial. Trials, 12(1), p.226.Crichton, N., 2001.

Visual analogue Scale (VAS).

J Clin Nurs., 10(5), pages 706-6.Davis, A.R.

Westhoff, C.L.

Treatment with oral contraceptives and primary dysmenorrhea of adolescent girls.

Journal of Pediatric and Adolescent Gynecology. 14, pp. 3-8.

P. Kannan and Claydon L.S., 2014.

A systematic review has shown that physiotherapy may be able to relieve the pain of menstruation in women with primary dysmenorrhea.

Journal of Physiotherapy. 60(1). pp.13-21.

Karanicolas P.J. Farrokhyar F. & Bhandari M. 2010, 2010. Blinding: Who, what, when, why, how?

Canadian Journal of Surgery. 53(5). p. 345.Kwon, J.S.

Reid, R.L. Dysmenorrhoea.

Journal SOGC (19(9), pp.955-962.Page, D., 2008.

The bibliographic database haystack. Systematic literature searching.

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Proctor M. and Farquhar C., 2006.

Diagnosis, management and treatment of dysmenorrhoea.

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Yang, M. Chen X. Chen X. Bo. L. Lao. L. Chen J. Yu S Yu Z. Tang H. Yi L. Wu X. Yang J.

A controlled randomized trial of Moxibustion as pain relief in primary dysmenorrhea.

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