Conducting a literature review: evaluating the quality of research methods used in an article “Comparison of a traditional and non-traditional residential care facility for persons living with dementia and the impact of the environment on occupational engagement” by Richards et al. (2015)

Reviewing the quality of the research experiment itself is an important part of a literature review, as well as considering the thematic content- if the research is flawed then sadly the article cannot be used as evidence 0in arguments anyway!  When considering how to structure an article review, it can be useful to refer to ‘checklist’ question guides such as those offered by Aveyard (2011), Crombie (1996) or CASP (2013).

I have chosen to review a research article titled “Comparison of a traditional and non-traditional residential care facility for persons living with dementia and the impact of the environment on occupational engagement” by Richards et al (2015). It is published in the Australian Occupational Therapy Journal which has an impact rating of 0.846 and is the official peer-reviewed journal of Occupational Therapy Australia (the professional association for OTs in Oz).

This research article aimed to understand how the environment (and specifically that of a non-traditional dementia home vs a traditional home setting) affected the occupational performance of the residents with dementia. The authors intend to gain data for this by observing the occupational engagement opportunities the residents have in both settings, and by discovering the views of the staff at each setting. It is a qualitative study and employed a non-standardised assessment tool, the REIS (Residential Environment Impact Survey) which was an appropriate way to acquire their qualitative data. The REIS generates data on four domains, based on those found in MOHO model.

The article was published in December 2015 and the authors were Kieva Richards [Lecturer, Dakin University], Rachel D’Cruz [Occupational Therapist], Suzanne Harman [Practice education facilitator at Deakin University] and Karen Stagnitti [Research professor at Deakin University]. No conflicts of interest were raised by the authors, however it states in the article that the non-traditional dementia home approached the authors and asked to carry them out the research, and the motivation behind this is not elaborated upon. This and the fact it omits information about how the study was funded could potentially raise some eyebrows around possible bias, since it’s possible the non-traditional dementia home was also funding the study. Participants were recruited via purposive sampling. The same researcher carried out the same part of the REIS assessments each time which is preferable to different people doing it, but more credible results could have been obtained by different researchers carrying out the REIS and averaging the results to help eliminate any individual bias the one researcher may have had in their interpretation of the environments. Views of the staff were obtained by a semi-structured interview, and the authors stated data saturation occurred when no new information emerged from the interviews.

The study was given ethical approval by Deakin University in Australia, and consent from the residents who had severe dementia,and presumably did not have capacity, was gained from their relatives.

The article did have a clear results section (CASP 2013) and the results from the REIS survey were presented in a descriptive format. The staff interviews were broken down thematically into the five themes that emerged from the study. The authors state that key quotes were taken from the interview transcripts to use in the analysis, but they do not state the decision process behind choosing which quotes were ‘key’, except that they were chosen according to what the authors interpreted as being key.

In the conclusion section of the article, the research question was answered as the authors found that a less clinical environment and more fluid interaction style between staff and patients increased occupational engagement with residents with moderate to severe dementia. The conclusion was generally that the non-traditional dementia home had a less structured timetable and less formal/clinical physical layout, meaning the interaction between staff and residents was more fluid and individual. This enabled the staff to respond to the residents in more individualised way which benefited the residents who were all functioning at different levels of occupational performance due to the nature of their illness. The author reached this conclusion because they observed a greater number of opportunities for occupational engagement and more personalised degree of care in the non-traditional home. These conclusions seem reasonable based on the results shown.

The limitations described by the authors were the small sample number and the rural location of the homes. The limitations would affect the ability to transfer the findings to practice however, since they are only applicable to similar rural, Western (possibly Australian), locations. As a result the article’s findings would not especially assist me with patient care. However as a local comparison study in Australia, the results may be useful but the sample size is too small and certain biases not addressed (such as funding) for it to be of any real use in extrapolating the findings to other populations. It could perhaps be used to add weight to other similar studies with the same findings, or some of the care techniques described used as a basis for implementing improved client-centred dementia care in similar rural Western environments. The authors recommend future studies should include measurement of more quantitative data such as medication amount or memory measures, which is a good suggestion.

++++++++++++++++++++++++++++

Sources:

Aveyard, H., Sharp, P. & Wooliams, M. (2011). A Beginners Guide to Critical Thinking and Writing in Health and Social Care. Maidenhead: McGraw Hill Open University Press

CASP (2013) www.casp-uk.net/#!checklists/cb36

Crombie, I.K. (1996). The Pocket Guide to Critical Appraisal. London: British Medical Journal Publishing Group

Richards, K, D’Cruz, R, Harman, S and Stagnitti, K (2015) Comparison of a traditional and non-traditional residential care facility for persons living with dementia and the impact of the environment on occupational engagement. Australian Occupational Therapy Journal 62: 438–448