The study’s purpose is to assess the results of blood pressure measurement by different devices and the relation of these findings to arterial stiffness. The study purpose stated in the article is to analyze the differences between oscillometric blood pressure devices and a sphygmomanometer about the healthiness of the elderly population because “recent studies indicate that discrepancies in performance between these devices may differ between healthy and diabetic subjects” (Popele et al., 2000, p. 484). Therefore, the study purpose was stated clearly in the article.
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The literature reviewed for the research included reputable sources on the relevant topics such as comparison of blood pressure measurement results in diabetic adults, comparison of discrepancies between different blood pressure measurement devices, measurement of the blood vessel stiffness, and others. Leisure is probably the only area of occupational therapy used because all measurements were performed when a patient was sitting; so the measurements were taken “after 5 minutes of rest” (Popele et al., 2000, p. 485).
As the research was conducted concerning the population-based approach used by the Rotterdam Study that was the major study for this project, the study design can e considered as the ethnography. In other words, the primary purpose was to analyze the differences in the results of blood pressure measurement with different devices in diabetic patients including adults and elderly people. As for the ethics of the study, “The Medical Ethics Committee of Erasmus University approved the study, and written informed consent was obtained from all participants” (Popele et al., 2000, p. 484). The theoretical perspective was not identified while the method used focused on participant observation, “…all measurements took place during a follow-up examination between March 1997 and January 1999” (Popele et al., 2000, p. 484). The design used in the study included cohort as elderly patients with and without diabetes were assessed in terms of their blood pressure and arterial stiffness to track the relationship between these two parameters including arterial stiffness and blood pressure measuring device. As all the patients were elderly people, other illnesses and malfunctions typical of their age may have been influential for the outcomes of the research. However, the major factor of measurement was diabetes.
The process of purposeful selection was described; it included the first 1808 patients who participated in the follow-up examination mentioned above. The flexibility of the sampling method was demonstrated via the results of the measurements. The issue concerning the redundancy in sampling whether it was reached or not was addressed. The sample took place in groups while the main similarity between the groups was their age. The age range of the participants of the research included an average figure of 68 years for the non-stiff group and 83 years for the stiff group. The flexibility can be observed in the study design as only the first 1808 patients who have undertaken follow-up examination were monitored in terms of the blood pressure. The sample was described in detail sufficient for the analysis of parameters necessary for research: Age and healthiness of patients were indicated as well as stiffness of their blood and percentage of the male population in the group. Written informed consent was received from all participants of the study in the framework of ethics procedure while the study was approved by the Medical Ethics Committee of Erasmus University.
The follow-up outcome measurement was performed one-time using different blood pressure measurement devices using two minutes for each patient about no prior rest. In this respect, the patients’ anxiety could have influenced the results of the blood pressure measurement. The stiffness of arteries was measured with the help of carotid-femoral pulse wave velocity (PWV). These methods are appropriate for the present study as they enable the researchers to assess the difference between the results of measurements about the healthiness of the patient and the device used for measurement. The outcome measures were reliable and valid for all participants of the research.
The intervention was described in detail: the stiffness of arteries was assessed as well as the blood pressure was measured with the help of different devices for this process to find out if there were some differences. Contamination and co-intervention were avoided. The intervention cannot be replicated in the occupational therapy practice as it appears to be aimed at the medical measurement of arterial stiffness as an indicator of the difference in results obtained using the Dinamap oscillometric device compared to the sphygmomanometer. So, the focus of the intervention was the group of elderly people with and without diabetes. All participants of the research were assessed in terms of arterial stiffness and blood pressure. A group of researchers was conducting the intervention as a part of the larger project called the Rotterdam Study. The frequency of measures can be described as one time of arterial stiffness measurement and one time of blood pressure measurement without a prior rest with an interval of two minutes performed by different blood pressure measurement devices.
The results were statistically significant, they were reported in terms of statistical significance; the clinical importance of the results was that the difference is visualized in diabetic patients as it is influenced by arterial stiffness; no dropouts were reported. The data analysis was performed with the help of analysis of the measurement results received after performing the blood pressure measurement in patients of the study group in terms of differences between random-zero and Dinamap methods. The assessment of results was performed in an appropriate way for the study.
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Conclusions and clinical implications
The conclusions of the study were expected as previous research demonstrated the difference between results obtained from different devices and relation to diabetics. Though conclusions seem to be appropriate, they are not indicated as those with the help of appropriate headings in the text. The researchers indicated that more research is needed to find out the reasons why the measurement results obtained from the Dinamap oscillometric device for diabetic patients are higher than those for the same patients obtained with the help of a sphygmomanometer. The elements of the study were documented clearly concerning format requirements, sections and subsections were defined with the help of appropriate headings and subheadings. A clear conclusion with identification of gaps and limitations and suggestion of possible recommendations for further studies were missing. The trustworthiness of the findings can be supported with the help of the fact that this study comes as a part of the major one.
Popele, N. M. van, Bos, W. J. W., Beer, N. A. M. de, Kuip, D. A. M. van der, Hofman, A., Grobbee, D. E., and Witteman, J. C. M. (2000). Arterial stiffness as underlying mechanism of disagreement between an oscillometric blood pressure monitor and a sphygmomanometer. Hypertension, 36, 484-488.