The article by Peterson (2015) presents a clinical case of facial pain after whiplash. The patient, a 41-year-old woman, was treated primarily with deep neck flexor and proprioceptive training, which was proved to be effective. The patient was symptom-free for months after ten intervention sessions for eight weeks. The case report is accompanied by a systematic review aimed at establishing the background and the context of the studied health problem. Despite a large amount of material on related issues in the literature, the particular combination of background and symptoms of interest has not been described, i.e., the report provides a unique patient presentation. To critically assess the review, it is necessary to define its elements, evaluate the validity of its results, identify final results. Then one should discuss the applicability of the evaluation to actual nursing practice, analyze whether the objective was accomplished, and reflecting on the strengths and limitations of the review.
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The review provided for the case report included such elements as presenting general statistics, discussing impairments and health impact, and describing scarce examples of relevant academic articles. By referring to multiple sources, Peterson (2015) establishes that whiplash neck injury is the most common injury associated with car accidents. It is capable of damaging practically any structure in the cervical spine. In the context of facial pain, four articles have reviewed that address the trigeminal distribution of symptoms in cases of cervical spine injuries, such as whiplash. Further, the author supports different components of the case, including the conduction of patient examination, actual intervention, and the discussion of results, with a review of relevant academic sources.
The validity of results can be established by verifying sources used in a review and justifying its methods (Parahoo, 2014). A systematic review can either pursue answering a particular research question (or questions) or approach the existing materials with no focus but instead with a general-purpose to analyze what the materials present and detect differences and similarities (Aromataris & Pearson, 2014). Peterson (2015) uses a wide range of relevant sources to support theoretical and practical components of the case report. Suggested examination and intervention methods are discussed with referring to sources that recommend using those methods or questioning their effectiveness. Such an approach makes the review reliable and, combined with practical data presented in the case report, contributes to the validity of results.
Peterson (2015) concludes that regarding the presented facial pain case in the context of a cervical spine injury and the use of particular interventions based on such a perspective help reduce the pain under several available pain rating scales and lead to the “complete resolution of symptoms and return to function after 8 weeks” (p. 447). Besides a successful clinical case, the author creates a particular set of intervention instruments (deep neck flexor and proprioceptive training), contributing to both practice and theory of facial pain treatment and whiplash injury treatment.
The findings’ applicability to nursing practice is characterized by the insight into the context of the studied injury type and the description of clinical intervention employing specific methods explored both from the theoretical perspective and from observations in a given real-life case. The author provides an understanding of the outcomes of whiplash injuries and explains how facial pain can be regarded from this perspective and how treatment can be planned and implemented. Particular exercises are described, such as the cervical clock exercise and deep neck flexor progression (with upper extremity elevation or an exercise ball). Critical assessment of the case report and systematic review accompanying it suggests that the central aspect of the presented data’s applicability to nursing practice is the understanding of how the outcomes of a widespread injury can be addressed under clinical conditions with actual procedures (DiCenso, Guyatt, & Ciliska, 2014). This understanding is to assist nurses in providing quality care.
Published in the Physiotherapy Theory and Practice magazine, the review was funded by Informa Healthcare, a large international publisher. It generally declares its mission as providing “physicians with effective learning opportunities at a place and time that’s convenient to them that will help them improve the healthcare they provide patients” (“Informa Healthcare announces launch of new podcast-based platform,” 2012). The author reported no declarations of interest. The publication’s objective was to address a unique patient presentation of “cervicogenic headache in a trigeminal nerve distribution…experienced bilaterally after whiplash” (Peterson, 2015, p. 442). Based on the assessment above, the objective was accomplished, as the author managed to address the issue theoretically along with describing the clinical case in the context of available and potentially effective interventions.
One of the strengths of the review is that it presents an actual clinical case. It reveals such indicators as pain rating dynamics. That allows assessing the effectiveness of proposed methods in measurable terms without relying on the author’s understanding solely of whether the patient’s state improved or worsened (Ferreira-Valente, Pais-Ribeiro, & Jensen, 2012). Another strength is that the issue of interest, i.e., facial pain after whiplash, is explored from various perspectives through a review of a considerable body of academic sources. However, this exploration demonstrated certain limitations, too, as it was discovered that academic literature had not addressed the combination of causes and health outcomes observed in the exact studied clinical case. That is why the author stresses the necessity of further research to confirm the effectiveness of the proposed intervention.
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From a critical perspective, the review provided by Peterson (2015) to support the recommended theoretical framework and intervention methods manages to successfully address a unique patient presentation. Moreover, the findings are applicable to nursing practice, as certain treatment procedures are described, and their use is justified. The critical assessment included examining the review elements, the validity of its results, the objectives, and the strengths and limitations. It can be concluded that the author provided a sufficient review to address a clinical case that suggests effective intervention for a widespread injury type.
Aromataris, E., & Pearson, A. (2014). The systematic review: An overview. The American Journal of Nursing, 114(3), 53-58.
DiCenso, A., Guyatt, G., & Ciliska, D. (2014). Evidence-based nursing: A guide to clinical practice. St. Louis, MO: Elsevier Health Sciences.
Ferreira-Valente, M. A., Pais-Ribeiro, J. L., & Jensen, M. P. (2012). Validity of four pain intensity rating scales. Pain, 152(10), 2399-2404.
Parahoo, K. (2014). Nursing research: Principles, process and issues. New Delhi, India: Palgrave Macmillan.
Peterson, S. (2015). Differential diagnosis and treatment of bilateral facial pain after whiplash: A case report. Physiotherapy Theory and Practice, 31(6), 442-449.