(#2) Research Article Appraisal

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This week you will search the literature in the school databases for article within 5 years of today’s date, that are appropriate for your PICOT question below. 

1.  Are elderly patients having total hip replacement surgery compared to those having history of fall, require more intervention to prevent fall during time at hospital?

The article is a QUNTITATIVE research study.

  • Read the first few sentences of methods section of your articles to assess what type of article you have
  • Critique each article using the appropriate Appraisal Forms. The form takes you through a reflection on WHY was research done-HOW was research done and WHAT was found.
  • Review rubric carefully to ensure all questions have been answered. Points are deducted for articles not loaded or if incorrect type of article submitted.
  • All answers to questions are brief and only 1- 2 sentences. Example: What group produced the guideline? Answer: US Preventive Services Task Force develops recommendations about preventive services based on a review of high-quality scientific evidence and publishes its recommendations on its website and or in a peer reviewed journal
  • Avoid any copying and pasting 7 or more words of content from the article or another source. Use your own words to create your answers. APA is not required for content of answers on template
  • APA is only required for your citation on the template.


Appraisal Guide:

Findings of a Quantitative Study






What was the purpose of the study (research questions, purposes, and hypotheses)?

How was the sample obtained?

What inclusion or exclusion criteria were used?

Who from the sample actually participated or contributed data (demographic or clinical profile and dropout rate)?

What methods were used to collect data (e.g., sequence, timing, types of data, and measures)?

Was an intervention tested?  Yes   No

1. How was the sample size determined?

2. Were patients randomly assigned to treatment groups?

What are the main findings?


Is the study published in a source
that required peer review?  Yes   No   Not clear

*Did the data obtained and the
analysis conducted answer the
research question?  Yes   No   Not clear

Were the measuring instruments
reliable and valid?  Yes   No   Not clear

*Were important extraneous
variables and bias controlled?  Yes   No   Not clear

*If an intervention was tested,
answer the following five questions:  Yes   No   Not clear

1. Were participants randomly
assigned to groups and were
the two groups similar at the
start (before the intervention)?  Yes   No   Not clear

2. Were the interventions well
defined and consistently
delivered?  Yes   No   Not clear

3. Were the groups treated
equally other than the
difference in interventions?  Yes   No   Not clear

4. If no difference was found, was
the sample size large enough
to detect a difference if one existed?  Yes   No   Not clear

5. If a difference was found, are
you confident it was due to the
intervention?  Yes   No   Not clear

Are the findings consistent with
findings from other studies?  Yes   Some   No   Not clear

Are the findings credible?  Yes All   Yes Some   No

Clinical Significance

Note any difference in means, r2s, or measures of clinical effects (ABI, NNT, RR, OR)

*Is the target population clearly
described?  Yes   No   Not clear

*Is the frequency, association, or
treatment effect impressive enough
for you to be confident that the finding
would make a clinical difference if used
as the basis for care?  Yes   No   Not clear

Are the findings
clinically significant?  Yes All   Yes Some   No

* = Important criteria





APP F-2 Brown

Brown APP F-1

strength and balance were collected to measure changes in
physical outcomes, and participants completed questionnaires
and interviews to assess program acceptability. Ninety-eight
participants (mean age=64, 71% women) registered for the
program; 77 (85%) completed baseline and follow-up meas-
urements. Positive ongoing feedback was received, and attend-
ance was good. On average across all sites, there was
significant improvement in participant leg strength (time to
complete 5 repetition sit-to-stand: 14 s to 11 s, p<0.01), bal-
ance (timed single-leg stance: 5.6 s to 7.8 s, p<0.01) and gait
speed (timed 4 meter walk: 0.51 m/s to 0.94 m/s, p<0.01),
and a significant decrease in BMI (p<0.01). Participants
reported both the exercise and yarning components of the
program were enjoyable and valuable. The Ironbark program
was effective in improving fall-related measures; funding has
now been received for a large scale cluster randomized trial
to test its effectiveness in preventing falls. Collaboration
between Aboriginal community leaders, Aboriginal health and
community service providers facilitated development of a
unique, culturally appropriate program that addressed a variety
of health, social and cultural needs, translating knowledge into
action for positive change.


1,2,3Krit Pongpirul*, 3Ratanaporn Tamee. 1Chulalongkorn University, Bangkok, Thailand;
2Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; 3Bumrungrad
International Hospital, Bangkok, Thailand


To compare and improve the diagnostic ability of standard fall
risk scores in a healthcare facility with diverse patient back-
ground. Medical records of 200 adult inpatients who fell
(case) and the other 200 randomly selected inpatients who
were admitted on the same day (control) at Bumrungrad Inter-
national Hospital (BIH) during 2014–2016 were reviewed. All
data required for calculating the Hendrich II Fall Risk Model
(H, 7 items), STRATIFY Risk Assessment Tool (S, 5 items),
Morse Fall Scale (M, 6 items), and Johns Hopkins Hospital
Fall Risk Assessment Tool (J, 7 items) were extracted. Eight
non-clinical determinants proposed by the Fall Risk Committee
were also analyzed (B1-B8). The diagnostic ability of the
standard scores were assessed using Area under the Receiver
Operating Characteristic (AUC) analysis.

The overall mean age was 54.22 years, female 45.25%,
Asian 47.00%. The cases were older (58.88 vs 49.57;
p<0.001) and male (61.64% vs 35.91%; p<0.001). More
Middle Eastern patients (67.48%) fell than other ethnic ori-
gins (Caucasian 54.43%, Asian 36.17%; p<0.001).

Five B determinants were significantly associated with fall
event: admission on the arrival day vs within 6 days after
arrival (B1: 100% vs 39.24%; p<0.001), anticipated surgery
with sedation (B2: 28.66% vs 63.79%; p<0.001), first admis-
sion (B3: 37.13% vs 68.71%; p<0.001), personal caregiver
dependency (B4: 48.40% vs 75.00%; p=0.012), and inter-
preter need (B5: 65.57% vs 43.17%; p<0.001). The AUC of
the scores were: H 84.97%, M 77.91%, J 57.29%, and S
49.26% whereas the AUC of the B sub-scores were: B1
75.78%, B2 33.25%, B3 34.75%, B4 47.00% and B5

59.50%. Adding B1 and B5 to H improved the AUC from
84.97% to 91.47% and 85.29%, respectively.

Diagnostic ability of fall risk scores is context-specific and
could be improved by adding contextual determinants.


1,2Richard GD Fernandez*, 2Joan Ozanne-Smith, 2Raphael H Grzebieta. 1La Trobe
University, Melbourne, Victoria, Australia; 2Monash University, Melbourne, Victoria,


Hip fracture remains a major cause of death and disability
among older persons. Anatomical and biomechanical design
considerations for shunting-type hip-protectors were investi-
gated to address low user compliance among older-persons.

Aims were to assess the hip muscle morphology as a load-
attenuating medium during shunting: determine the material
properties of skeletal muscle; and assess shunting-type hip-pro-
tector function in lateral falls.

Low and high hip fracture risk groups were identified
based on BMI. A three dimensional map was developed to
measure muscle thickness at 15 points and volume (of gluteal
and quadriceps) using CT. A new method was developed to
measure material properties of skeletal muscle under fall con-
ditions by impacting muscles in the in-situ state, substituting
ovine for human specimens. Biomechanical kinematic data, the
effect of specimen size and impact velocity were also analysed.
Finite element simulations were then conducted to evaluate
hip-protector function.

Significant differences in muscle thickness were revealed
between hip fracture risk groups. The strong relationship of
muscle thickness to subjects’ body mass allowed development
of mathematical models that estimate the maximum muscle
thickness and muscle thickness based on location, both from
subject mass. An average 17% increase in muscle volume was
quantified for an equivalent 10 kg increase in subject mass.
Males exhibited 3%–23% increased volume over females
depending on the muscle. Material properties of skeletal
muscle revealed an average Young’s Modulus of 0.06 MPa.
Fall simulations quantified peak loads shunted to the iliac
bone, greater trochanter and femoral shaft.
Findings Suggest reducing protector size for greater wearer
acceptance may cause injury elsewhere, especially for lean
individuals at high fracture risk. Rather, hip-protector design
should be based more on individual body constitution to
increase effectiveness and comfort, and therefore user compli-
ance. Muscle size should be maintained to allow effective use
of preventive strategies within normal anatomical limits.


1Risto Honkanen, 1Nadia Afrin*, 2Heli Koivumaa-Honkanen, 3Heikki Kröger. 1Clinical
Research Center, KMRU (Kuopio Musculoskeletal Research Unit)/UEF, University of Eastern,
Finland; 2Psychiatry; 3Surgery, Kuopio University Hospital, Kuopio, Finland



A36 Injury Prevention 2018;24(Suppl 1):A1–A278

Objective To access does falling history predict falls and frac-
tures in postmenopausal women.
Introduction Falling tendency and low BMD are risk factors
for fractures in the elderly. The purpose of this study was to
evaluate if fall history is a predictor of postmenopausal falls
and fractures. In addition, if fall risk predicts fractures differ-
ently according to type of fall and site of fracture, this associ-
ation will also be estimated.
Methods Prospective cohort study. Falls were asked in postal
enquiry of the population-based Kuopio Osteoporosis Risk
Factor and Prevention (OSTPRE) Study in 1999 and 2004.
Fractures in 1999–2004 were asked in 2004. A total of 8656
women responded to the fall and fractures questions. Women
with falls were classified as occasional fallers (1 fall/year) and
frequent fallers (2+falls/year). Odds Ratios (OR) was com-
puted with logistic regression.
Results Women were 57–66 years old at baseline. Falling his-
tory predicted future falls with an OR of 2.59 (p<0.001)
even more frequent future falls (OR=4.59, p<0.001). Falling
history also predicted fractures with an OR of 1.39
(p<0.001). Fracture predictions according to different sites
(wrist, hip and ankle) in association with falling history have
been tasted and there were no significant differences were
observed. The results remain statistically significant after
adjustment with several confounding factors.
Conclusions Fall history is a stronger powerful predictor of
future falls than fractures in postmenopausal women.

Parallel sessions

Wednesday 7 November 2018 9:00–10:00

PA 16 Road traffic injury


Niranga Amarasingha*. Sri Lanka Institute of Information Technology, Malabe, Sri Lanka


Compared to other vehicle drivers, motorcycle riders vulner-
able road users as they have lack of protection in the case
of a crash. Therefore, motorcycle riders are often associated
with high injury risks in the case of crashes. Also, it is
widely recognized that motorcyclists have a particularly high
crash risk, but our knowledge of the mechanisms avoiding
this crash risk is incomplete. Different factors affecting the
motorcycle crashes consisting environmental, road, vehicle,
and human elements. However, literature produced mixed
results on the importance of different factors. These inconsis-
tencies may be because differences in traffic composition at
the road, driver behavior, vehicle, and road factors in differ-
ent geographical areas studied. Other reasons may be differ-
ence methodologies for data collection or different statistical
methods for data analysis. Hence, it is important to con-
ducted more studies using different estimation techniques and
data from different geographical areas to provide a more

complete picture on the safety effects of these factors. The
present research investigates the risk factors of crashes
involving motorcycles and contributory causes using data
from Sri Lanka. The binary-logistic regression technique was
used to model the severity of motorcycle crashes in Sri
Lanka during the five-year period from 2009 to 2013. Vari-
ous characteristics such as environment, roadway, driver, and
vehicle are analysed investigating the Odds-ratios so that
potential countermeasures can be developed to improve road-
side safety. More frequent crash conditions for motorcycle
crashes occurred while driving on rural roadways, driving
during week days, and driving newer motorcycles. Dry road
surfaces, clear weather conditions predominantly character-
ized motorcycle-crashes. This study adds detailed information
about characteristics of motorcycle crashes and measures to
improve motorcycle safety in Sri Lanka to the transportation
safety literature.


1Francisco Ramon Mojarro*, 2Elisa Hidalgo Solorzano, 2Maria de la Luz Arenas Monreal.
1Mexican Red Cross, Mexico City, Mexico; 2National Institute of Public Health, Cuernavaca,


Objective To design and implement an educational initiative to
reduce driving speed with local law enforcement (LLE) of the
city of Cuernavaca, Morelos.
Methodology A quasi-experimental study was carried out
using both quantitative and qualitative methodologies. The
quantitative portion was obtaining Cuernavaca’s driving speed
prevalence using a laser speed detection device; a legislation
review about speed limits and the application of a ‘knowl-
edge’ survey on speed limits, driving speed and safe driving
to LLE. The qualitative portion was semi-structured inter-
views to LLE to explore their risk perception of driving
speed and the correct application of legislation. All portions
of the study served as inputs for the design of an educa-
tional initiative (using the Precede-Procede methodology)
aimed at strengthening the technical capacities of LLE to
apply the current regulations.
Results 47% of the vehicles observed were driving above the
speed limit. The knowledge survey indicated that LLE identi-
fied speed as a risk factor for RTI, however they don’t have
technical knowledge on speed control and safe driving; we
also found that current legislation stablishes appropriate speed
limits (40 km/hr urban areas and 20 km/hr in school areas).
24 LLE officers participated in the initiative; the findings
coincide with the information obtained from interviews, the
capacity of officers to enforce regulation on speed is dimin-
ished due the lack of speed measurement equipment and their
reduced technical capabilities.
Conclusion The speed prevalence, analyzing legislation, obtain-
ing information from interviews and implementing the initia-
tive, helped documented ‘speed’ in the LLE’s working context
and to identify their limitations that hinders the application of
speed regulation. For a local speed control strategy to be suc-
cessful in reducing RTI, a modification of this context is


Injury Prevention 2018;24(Suppl 1):A1–A278 A37

© 2018 2018, Published by the BMJ Publishing Group Limited. For permission to use
(where not already granted under a licence) please go to


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