Critical Appraisal of the Research by Wang

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Introduction

Wang et al. (2012) undertook a multicenter, single-blinded, randomized controlled trial to investigate the usefulness of treating and managing severe migraine attacks. Migraine is a recurrent headache disorder when an individual experiences pulsating pain ranging from moderate to severe intensity and related symptoms of phonophobia, photophobia, vomiting, and nausea. Prevalence of migraine constituted 14.7% (19.2% in women and 6.6% in men) in America, 8-13% in Asia. For a long time, NSAIDs and triptans have been recommended for treating migraine. However, patients have always experienced side effects such as gastrointestinal and cardiovascular disorders. For this reason, Wang et al. (2012) researched the usefulness of acupuncture, a headache treatment method that has been in use in China for many years and is now gaining recognition in the entire world. The authors aimed to fill the knowledge gap regarding the effectiveness of acupuncture in treating severe migraine. The assumption was that there was a significant difference in the success probability between acupuncture and the established control group. The ability of acupuncture to exert analgesic effect as a result of the hypothalamic-pituitary-adrenal axis and the endogenous opioid was another hypothesis. Finally, sham acupuncture could produce different effects on pain irrespective of the sham point selected. Despite being inconspicuous, a viable research question would be if acupuncture can be used in the treatment of migraine. The current paper will thus attempt to conduct a critical appraisal of Wang et al. (2012).

Goodness Fit between the Research Design/Method and the Hypothesis

Wang et al. (2012) adopted a multicenter perspective, single-blinded, randomized, parallel controlled trial comparing verum acupuncture with sham acupuncture. Employment of this research design was very appropriate for the current study because the latter was scientific in nature. The research design was very applicable in proving the research hypothesis which aimed at showing the effectiveness of acupuncture as a treatment option. In randomized parallel controlled trial, different types of medical intervention are necessary, and Wang et al. (2012) acknowledged this fact by administering verum and sham acupuncture. In addition, randomized parallel controlled trial requires that subjects be assessed for eligibility and recruited before the intervention commences. Wang et al. (2012) observed this requirement by providing a baseline period of 28 days for screening. Therefore, the research has a respectable fitting between the study design and the hypothesis. Single-blinded, randomized, parallel controlled trial ensured that the process of validating the hypothesis was unbiased, and every subject was given a fair chance to be part of the study (Abramson & Abramson, 2008).

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Methods Used to Assign Participants to Groups

Wang et al. (2012) used different approaches to allocate individuals to groups. For one year, 150 individuals with severe headaches were recruited from outpatient acupuncture sections in five different hospitals. Recruitment was not concealed, but patients were told they would receive one of the two forms of acupuncture formula with an equal probability. The study was a cooperative effort of a group of acupuncture professionals and practitioners, methodologists, statisticians and neurologists, all of which helped in the allocation of individuals to groups. In order to successfully place individuals into groups, patients were recruited at baseline assessment, and they were required to record their headache diaries for screening. Those who met the set criteria were then allocated in a 1:1 ratio to sham and verum acupuncture. Since individuals were recruited from five different hospitals, physicians and assessors were required to undertake a special training to ensure consistency in the recruitment and placement of individuals into groups. Acupuncturists with at least twenty years’ experience recruited both the verum and sham . Blinded assessors undertook the responsibility of interviewing and collecting data from the patients.

Sample Size and Other Sampling Issues

For any research to be successful, involving the right sample size is crucial. Depending on the nature of the study, sample size can vary significantly (Abramson & Abramson, 2008). However, striking a balance between the sample size and sampling method is important. A large sample size can prove to be challenging; however, with an effective sampling technique, a small sample size can be very representative (Abramson & Abramson, 2008). Wang et al. (2012) research involved 150 patients with migraine sourced from different acupuncture departments in five different hospitals. A patient had to satisfy all the diagnostic parameters set by the International Classification of Headache Disorders. Other qualification for the samples included having migraine for more than 1 year, at least 1 attack during the last four weeks, being between 18 and 65, having no history of severe migraine treatment with drugs or acupuncture within the period of 24 hours after the start of the migraine attack. Other criteria used in sampling required no prophylaxis treatment with acupuncture or medication within the last three months. Randomization was conducted in affiliation with the Research Center for Clinical Epidemiology. The randomization process can be considered to have been effective because its random allocation sequence was unknown to the practitioners.

Validity and Reliability of Instrumentation

Instrumentation significantly contributes the success of a research study. It is a course of action; that is, the process of using the instruments. Validity is the ability of research instruments to measure or determine what they are intended to measure (Abramson & Abramson, 2008). On the other hand, reliability aims at ensuring that the instrument used in research provides the same results each time it is employed. In Wang et al. (2012), several instruments and scales were used to accomplish the research objectives. A visual analog scale (VAS) with scores of 0 to10 meaning no pain and worst pain respectively was used to measure primary outcome among the participants. Another scale, Short-Form of McGill Pain Questionnaire (SF-MPQ), was used to determine secondary measures. A visual analog scale was able to measure pain disparity among the patients and show the consistency. The SF-MPQ scale also showed consistency in assessing secondary measures. For the research study, a scaling instrument was advantageous. It enabled the researchers to assess different range of migraine. However, if the researchers had adopted more scales or instruments, more information regarding the effectiveness of the acupuncture might have been discovered. In so doing, the research would have been more credible.

Presentation and Analysis of Results

Wang et al. (2012) utilized different methods of data/results presentation. The researchers used tabulated formats to present the study results, thus making it easy for any reader to perceive the information. In addition, the scholars used flow chart diagram to present the research process, samples, activities, and results adding to the simplicity of summarizing the entire research study. Bar graphs have also been used to present research findings making a good summary of VAS scores at baseline and VAS scores within 24 hours. The use of different methods in presenting and analyzing results makes the research study credible and easy for any reader to understand (Abramson & Abramson, 2008).

The Extent to Which the Conclusions Made Is Justified by the Results

The main aim of the study was to show that acupuncture can be used as a great alternative to treatment and management of migraine. The research study concluded that acupuncture can be used as an effective means of treating and managing migraines, relieving the pain and preventing relapses, which are common among those using NSAIDs and triptans. In addition, Wang et al. (2012) concluded that verum acupuncture was capable of reducing pain to a greater extent than sham acupuncture. Such conclusions are not just mere assumptions; they were proved by the study results. Using the two scales, VAS and SF-MPQ, the score of 5.7 ± 1.4 in pain reduction was recorded in verum acupuncture and 5.4 ± 1.3, in sham acupuncture. “The mean SF-MPQ summary scores significantly decreased from 10.8 ± 4.3 to 4.1 ± 3.6 in verum acupuncture group and from 9.6 ± 3.7 to 6.4 ± 4.0 in sham acupuncture group” (Wang et al., 2012). As seen from these two scores, both types of acupuncture treatment considerably reduced the score (pain score in patients). Therefore, as concluded by the authors in regard to the research results, acupuncture can be used as a remedy for migraine.

Ethical Issues in the Research

Ethical consideration is a key issue that calls for researchers to seek permission from the respondents and all other relevant authorities (Abramson & Abramson, 2008). The study by Wang et al. (2012) was a medical research; consequently, the conformity with principles set by various medical institutions was necessary. Therefore, conducting their research, Wang et al. (2012) observed the principles set by the declaration of Helsinki and sought permission from the Research Ethical Committee of Beijing Hospital of Traditional Chinese Medicine. Participants also filled informed consent forms to undertake the research.

Research Improvement

Although the sample size was small, the current research was able to prove its hypothesis. However, improvement can be made by engaging a larger number of respondents. This will make the research credible and representative of bigger number of population (Abramson & Abramson, 2008). Wang et al. (2012) research was also quantitative. Although using quantitative research is justifiable at times in medical research, embracing qualitative research would also have unearthed underlying factors that could significantly affect the results. Finally, the research could be enhanced by developing tools or other scores used in the treatment of severe migraine with the capability of assessing a pain lasting more than two hours.

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