Critical appraisals of research articles allow for evaluating the quality of evidence presented in these papers to be further applied to practice. The article selected for the critical analysis provides the results of the study conducted by Murawski et al. (2018) on utilising an m-health intervention to affect sleep and physical activity in adults. Understanding whether the results provided in the selected article are accurate and credible is important to decide on using the presented interventions in the evidence-based practice.
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The purpose of this paper is to analyse and critically appraise the article by Murawski et al. (2018) as a paper providing the findings for a quantitative study. In this paper, the title, abstract, introduction, methods, results, discussion, and other information and sections included in the article will be analysed in detail.
Title and Abstract
In the discussed article, the title “Randomised Controlled Trial Using a Theory-Based M-Health Intervention to Improve Physical Activity and Sleep Health in Adults: The Synergy Study Protocol” clearly identifies a specific type of a quantitative study as a randomised controlled trial. The abstract that follows the title provides the purpose of a trial design and its summary and identifies methods and analysis, but there is no information on specific results and conclusions. Instead of these data, the researchers have provided the information on ethics and dissemination (Murawski et al., 2018). It is possible to state that the lack of a summary of the study results and conclusions does not allow for determining the effectiveness of the proposed interventions.
In the introduction to the analysed study, a substantial scientific background for the problem of improving physical activity and sleep in adults is presented. Furthermore, the researchers have also explained the rationale for their study indicating that there are no other studies on multiple behaviour interventions focused on physical activity and sleep, and this study is important to be conducted with reference to applying an appropriate app-based intervention (Buccheri & Sharifi, 2017; Murawski et al., 2018).
The researchers also formulated the objectives for the study, pointing at the necessity of testing the effectiveness of an app-based intervention, the role of using apps in changing behaviours, as well as alterations in health in the context of socio-demographic factors and a specific environment (Murawski et al., 2018). This approach is effective for organising introductions in this type of articles.
The selected trial design can be described as parallel, and the allocation ratio is 1:1, depending on the information provided in the article regarding randomisation. The researchers have not presented information on any changes in methods with the focus on the trial commencement (Copas et al., 2015; Murawski et al., 2018). Specific eligibility criteria for participants, as well as exclusion criteria, were described in detail.
It is stated that the participants for the study (n=160) were recruited from all regions in Australia without determining specific locations (Murawski et al., 2018). The overall description of a two-arm trial design and participants is detailed enough for this type of research.
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The description of interventions in the article is comprehensive because the researchers have provided sufficient details on what participants were expected to do with provided apps, as well as what information was added to or monitored with the help of these apps. The plan for interventions with the focus on the activities of test and control groups and required time periods are also described effectively to allow other researchers to replicate the study (Vohra et al., 2015).
Primary outcomes (physical activity and sleep quality) were planned to be assessed with the help of 3-month and 6-month assessments. These measures used for assessments were also mentioned by the researchers (Murawski et al., 2018). Scales for measuring secondary and process outcomes were described in detail is sub-sections of the article, as well as in tables.
The researchers stated their reasons for selecting 160 participants for the study in the Power and Sample Size section. They chose to refer to the 25% drop-out while selecting an appropriate sample size, and the reference to other similar studies demonstrated that choosing 80 participants for each group would be appropriate to address the expected effect sizes (Murawski et al., 2018). Randomisation has also been described by the researchers in a separate section according to the standards for reporting the results of randomised controlled trials (Fawkes, Ward, & Carnes, 2015). The participants were randomly allocated to groups after the baseline assessment.
Opaque sealed envelopes were used to organise the allocation sequence, to work as an allocation concealment mechanism, and to guarantee the randomisation with the focus on specific block sizes (four and eight). The random allocation sequence was completed by a researcher who was responsible for conducting allocation but who was not associated with this particular study. A project leader informed the participants regarding the group they should join (Murawski et al., 2018). The participants and project leaders were not blinded to the group assignment.
In order to compare the results of two groups related to both primary and secondary outcomes, the researchers reported using Generalised Linear Mixed Models to determine the difference in physical activity and sleep quality in adults from intervention and control groups.
The researchers also concentrated on using Pattern Mixture Modelling for conducting the required sensitivity analysis with the focus on the influence of missing data on determined outcomes (Egbewale, 2015; Murawski et al., 2018; Tango, 2016). These approaches to analysing collected data on the participants’ physical activity and sleep patterns can be discussed as effective to receive the findings required for addressing the objectives for this randomised controlled trial.
The article under analysis has no section titled “Results” because the purpose of this article is to provide the study protocol. The key focus of the researchers was on offering an appropriate synergy protocol for conducting similar investigations rather than on presenting actual findings of this research. The number of participants randomly assigned to the intervention group (n=80) and control group (n=80) is provided in the Methods section of this article.
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Losses and exclusions are not reported in relation to the number of participants involved in this research (Murawski et al., 2018). The details regarding the recruitment strategy have been presented in the Methods section with the focus on exclusion criteria determined for the study (Walters et al., 2017).
The recruitment process lasted until 160 appropriate participants were invited to participate in the study. It was noted that all participants were asked to complete the baseline assessment, and those data were used to stop the recruitment process when 160 assessments were taken. However, there is no table presenting demographic and trial characteristics associated with the baseline assessment in the article.
In spite of the fact the numbers are planned to be analysed with reference to 80 participants in each group, there is no information on the conducted estimation and received outcomes at this stage of the study. The results associated with primary and secondary outcomes cannot be clearly determined in the paper in the numerical form or as tables (Ghert, 2017). There are no effect sizes reported with reference to the results of this study. The reader will not find the results of any analyses conducted in the context of this research with reference to the information provided in the Methods and Discussion sections. The researchers did not list any harms associated with conducting the study, but they described the ethical considerations and procedures to address any ethical problems or potential injuries as a result of participating in the study.
In their article, the researchers have discussed the expected outcomes of the study in the section titled “Discussion” with the focus on the strengths and limitations of the proposed research. It was noted that potential limitations included the study duration and the absence of focusing on each particular condition to influence physical activity or sleep quality (Murawski et al., 2018). However, what is more important is that the presentation of the study results have significant limitations while comparing the provision of findings with the criteria and protocols adopted for randomised controlled studies, but the researchers have not reported this aspect in the list of mentioned limitations (Losina, Ranstam, Collins, Schnitzer, & Katz, 2015).
It is also rather problematic to conclude regarding the generalisability of the prospective findings in terms of their external validity and applicability because there are no actual numerical data provided by the researchers (Li et al., 2018). It is almost impossible to state whether the results of the study are valid because the reader can refer only to the conclusions made by the researchers without opportunities to check actual findings.
Moreover, the interpretation of the results cannot be discussed as appropriate for this stage of the study because the researchers have not provided the numerical or statistical support for their conclusions regarding the efficiency of using the proposed Synergy Study protocol. Although the Synergy Study protocol is described in detail, its benefits for improving individuals’ physical activity or sleep quality along with other components of a healthy lifestyle cannot be stated clearly (Hays et al., 2016). It seems that the researchers failed to support the effectiveness of using the proposed intervention, and their conclusions are not based on actual results of the study and the analysis of individuals’ responses to assessment protocols.
The registration number for the study is reported to be given for the pre-results (ACTRN12617000376347). This article provides the Synergy Study protocol for the discussed randomised controlled trial, and this protocol can be viewed as full. It offers the specific rationale for conducting this type of a study with the focus on appropriate methods to be used to address the study objectives (Hays et al., 2016).
The Synergy Study protocol described in the article allows for presenting the details regarding the use of a specific app-based intervention to affect individuals’ physical activity and sleep quality. This study is supported by the National Heart Foundation of Australia, and this particular trial is also sponsored by the University of Newcastle (Murawski et al., 2018). The funders and sponsors have not influenced the completion of the study in any way. It is possible to state that the additional information on the development of this randomised controlled trial is presented in much detail.
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After completing the critical appraisal of the selected article presenting the information regarding a certain randomised controlled trial, it is possible to state that the paper presents only the protocol for the planned research. This research is registered as a randomised controlled trial prospectively, therefore, only pre-results of the study can be described in the article, and the key focus is on representing the selected methodology with the focus on interventions and the proposed Synergy Study protocol.
These aspects explain the fact that this article does not include the Results section, and all conclusions regarding the research findings are described as being forecasted. While analysing this article from the perspective of a paper presenting the findings of a randomised controlled trial, it is possible to state that it is incomplete. However, it is important to note that this article provides the detailed Synergy Study protocol as the part of completing a randomised controlled trial, and from this perspective, the data represented in the paper are sufficient.
Still, it is also necessary to state that the researchers’ conclusions about the effectiveness of the proposed Synergy Study protocol and interventions are unsupported and lacking the provision of evidence to prove the idea. The reason is that any conclusions about the effectiveness of the developed interventions reflected in the Synergy Study protocol can be made only after conducting the final stage of this trial.
At the current stage, the conclusions made by the researchers can be viewed as preliminary and requiring additional support and testing to decide regarding their credibility. The information provided in the article cannot be effectively applied to practice because this paper does not present evidence that the proposed intervention is appropriate to improve adults’ health through affecting their physical activity and sleep quality.
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