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Running head: Article Critique
Article Critique: Qigong Massage Treatment for Sensory and Self-Regulation Problems in Young Children with Autism: A Randomized Controlled Trial Casey Walker Touro University Nevada School Of Occupational Therapy
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Article Critique Silva, Schalock, Ayres, Bunse and Budden (2009) researched the effectiveness of qigong massage treatments on reducing the negative impacts of sensory impairment, digestion and sleep on young children with autism in hopes to reduce the prevalence of autistic symptoms. They composed a research study by inviting young children with autism that were currently seeking early intervention services to participate in receiving a Chinese medicine method technique for physiological healing, called qigong massage. Qigong is a part of Chinese medicine that manifests in different forms such as meditation, massage, breathing exercises, etc. Its primary focus is the betterment of one’s health and over the past decade has gained popularity amongst the western world. According to search done by Silva et al., (2009) qigong has shown to benefit physiological systems and reverse such ailments as coronary heart disease, asthma, hypertension, immune deficiencies, diarrhea and chronic pain (Silva et al., 2009, p. 424). Based on these previous findings, Silva et al. (2009) thought that it would prove to be beneficial in reducing the autistic symptoms in young children. To test this hypothesis, they invited children that were receiving early intervention services, aged 3 to 6 years old to participate in the study. After running the children through an elimination process based on specific criteria, 46 children were chosen (Silva et al., 2009, p. 425). The treatment being studied was Qigong Sensory Treatment (QST), which was delivered in two steps. Techniques of the massage were taught to the parents of the child participants and they delivered the massage each day. Secondly, there is 10 hours of direct contact with a trained early intervention personnel (Silva et al., 2009, p. 424). The researchers designed “a multisite, randomized, controlled trial� (Silva et al., 2009, p. 426) for their study. The participants were randomly assigned to either a control waitlist group or a QST intervention group with the exception of five
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participants that were changed to the QST group because their siblings were involved with the study as well and to prevent diffusion, the researchers felt that siblings should be in the same group. Measurements were taken pre and post intervention and then again five months after treatment. The researchers used specific tests to evaluate performance in the following areas: “sensory impairment, system impairment, abnormal behavior and social and language delay- in two contexts, home and school” (Silva et al., 2009, p. 426). After analysis of the data the researchers confirmed that the results of the study showed significant improvements in all areas and impressively across multiple contexts (Silva et al., 2009, p. 423). Most importantly, “this randomized controlled trail confirmed the hypothesis that the QST intervention reduces the severity of autism” (Silva et al., 2009, p. 430). Merit Autism is a condition that is growing in diagnosis and unfortunately does not have enough information known about it. Moreover, there are very little studies that are available for occupational therapists, specifically, to reference for information on how to successfully reduce autistic symptoms and give good quality care to individuals experiencing it. Since this is the sad condition for our profession, Silva et al.’s (2009) research study was of pressing value and proves to be beneficial in the field of occupational therapy. In addition to this research meeting the pressing needs of the field, it discovered novel and imperative information to healthcare practitioners and parents who are attempting to help young children deal with their autism in effective manners (Silva et al., 2009). The findings of Silva et al. (2009) proved that use of QST in the treatment of children with autism increases the social development and makes the physiological state of the individual more comfortable.
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Part of the success of the study was due to its feasible research method design. It was designed wisely so that individuals could participate and the quality of the research found would be valid and reliable. By testing individuals who were already receiving treatment, the researchers could count on them participating in the intervention that was being tested and it made finding the sample significantly easier. By incorporating the intervention into treatment sessions they were already receiving, it was feasible to get the intervention to the children (Silva et al., 2009, p. 429). Furthermore, by training the parents to perform qigong massage techniques on the child the resources for the research were lessened which increased the feasibility of the study. Further analysis of the feasibility of the study is depending on the devotion of the parents to the treatment because it was required that it be performed daily, which is now always feasible for some families. One of the greatest positive attributes of the study was the good ethical value. There were no aspects of the study design that were unethical in nature. Moreover, the researchers sought and obtained approval for the study from the Western Oregon University institutional review board (Silva et al., 2009, p. 425). Having such a good ethical basis helps to make the study valid. Last, but not least, the article was very interesting. Part of what makes the work done by Silva et al. (2009) that much better is the fact that they chose to study something that was remarkable, not only to healthcare practitioners but also to the families of children with autism. This is something that can be taught to parents and can be incorporated into their daily routines and will make significant differences in the occupational performance of their children (Silva et al., 2009). What could be more motivating to them?
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Clarity of the Research Question Part of a good, written research article is the clarity of it. Most significantly, the research question that was being studied is at the heart of the paper and ultimately the main subject. If the main purpose of an article is not clearly stated and defined the overall value of the work presented goes down. Impressively, Silva et al. (2009) performed this task eloquently. There was no a question or deliberation what the article and research study’s purpose was. Not only was it clearly stated in their abstract, but it was also re-stated throughout the paper (Silva et al., 2009). This is important to have it reiterated throughout the paper so that there is clear understanding for the readers. Furthermore, it keeps the focus of the paper in direct light and assists the reader from getting lost in the research and statistics jargon, which although it plays an important and invaluable role in the research paper, can be trying on the reader. Last, it is important to continue to tie in each part of the study, the research design, methods, testing and results back to the purpose of it all. This gives clarity and reason to why each step was taken. This higher order of organization and thinking helps to validate the researcher’s work. Research Design Silva et al. (2009) chose to run their research in a randomized control trial method that took place at two locations. The 46 children that were chosen to participate in the study were selected after being critiqued and evaluated based in inclusion criteria (Silva et al., 2009, p. 425). This research design involved the random assignment of the participants into two groups; a control waitlist and a QST treatment intervention group (Silva et al., 2009, p. 424). This is the ultimate research study design for optimal internal and external validity so the researchers were on the right track with their attempts at the best research study possible to test the effectiveness
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of QST in children with autism. One problem is that they did not do this in a blind or double blind manor, as seen in their alterations that were made in five of the children’s assignments. They changed the group of five of the children because they were had siblings in the trial and the researchers felt that they needed to be a part of the same group (Silva et al., 2009, p. 424). They did this to help decrease the threat of diffusion; however, it makes it so that the study was not completely randomized. Each has their benefit. Second, the two-site usage in this study could be a weakness because there is less control in the study; however, it is evident that this is a strength in this study design because it adds dynamics to the research and helps to validate the QST intervention benefits across multiple contexts (Silva et al., 2009). Overall, the researchers did a good job at evaluating the internal and external validity of their research design and made the best possible choices. Execution of the Research Design Silva et al. (2009) conducted their research as planned and state in the introduction. The method of teaching the parents to administer the intervention as part of the treatment, in conjunction with the trained early intervention personnel, added some interesting aspects of this study. On one hand, it was harmful because of the variety of different individuals that were involved with the administration of the treatment. The lack of control over the intervention administration can cause harmful effects when evaluating the results of the study and can cause confounding factors that may inhibit the sturdiness of the study’s foundation. On the other hand, the feasibility of having parents of the children be taught to effectively administer the intervention is a very positive feature of this intervention and research. It makes the treatment more of a reality for many patients. It is inexpensive and can be incorporated into the treatments of a large variety of children experiencing autism. This allows the treatment intervention to
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reach a large population; this makes this research very valid, relevant and pertinent in the real world (Silva et al., 2009). Data Collection The data collection methods of Silva et al. (2009) were appropriate for the goals of the research study. They chose to take tests before, after and five months after the intervention. They used standardized tests for each category that they were testing. The article showed that the researchers had a good understanding of each of the tests, what they would report and the reasons why each were picked. Most notably, they explained that the since the Pervasive Developmental Disorders Behavior Inventory (PDDBI) was a good analysis of behavior, it was not specific to autism, which lead them to the inclusion of the Autism Behavior Checklist (ABC) (Silva et al., 2009, p. 425- 426). In addition, they gathered data from both the parents and the teachers. This allowed them to evaluate the effects in a variety of contexts. Last, the researchers were able to identify areas of the research that were not tested in any of the standardized testing procedures that were available and to meet this demand they created the Sense and SelfRegulation Checklist to make up for the lack of a standardized parent questionnaire that would serve the purpose of evaluating multisystem impairment (Silva et al., 2009, p. 426). This provided a complete analysis of the areas of performance that they had purported to study. Silva et al. (2009) were able to successfully follow the data collection methods that they had set out to do. They videotaped some of the treatment sessions to enhance their findings and increase the evidence that was found (Silva et al., 2009, p. 427). They effectively obtained scores from all of the tests prior to the beginning of the intervention and immediately after the final massage treatment at the end of the five month intervention. Additionally, they took
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measurements five months after the intervention was completed in efforts to analyze the “maintenance and stability of treatment outcomes” (Silva et al., 2009, p. 427). This created a thorough and complete picture of the true effects of the QST treatment. Conducting Analysis Prior to reporting the results of their findings, Silva et al. (2009) conducted a thorough analysis of the data that was collected. They utilized a multivariate analysis of covariance (MANCOVA), a post hoc univariate analysis of covariance (ANCOVA) and “Bonferroniadjusted individual t-tests” (Silva et al., 2009, p. 427), as well as, paired t- tests, a correlation analysis and a MANOVA. Each analysis method was thoughtfully chosen and used to systematically complete a well-rounded analysis of all of the research findings, compare and contrast findings and determine whether the changes were statistically significant (Silva et al., 2009, p. 427). The researchers eloquently explained the analysis process and the reasoning why each method was conducted. This allowed the reader to be aware of why they used certain tests, but more importantly, insight into the discovery of the exact reason for each of the results. For instance, the correlational analysis led them to know the percentage of changes in the outcomes that were accounted specifically by “changes in the sense and system impairment” (Silva et al., 2009, p. 427). The analysis’ method of conduction was achieved in a beneficial and effective fashion. It was effective in completely evaluating all the areas that Silva et al. (2009) wanted to study and felt were necessary to include in their study of the effectiveness of QST. They felt that they had to test a lengthy list of areas of performance to be able to confidently report improvements based on their intervention and their analysis of the data was conducive to that goal. In the final
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analysis of their reported measures, the researchers were extremely thorough and they did not leave any string left untied; therefore, no weaknesses in their approach can be reported (Silva et al., 2009). Author’s Interpretation of Their Research Findings\ Due to the lengthy analysis and data collection process, the researchers had a very clear picture of what their intervention had caused (Silva et al., 2009). Most impressively, the authors’ interpretation and discussion of their findings was articulately expressed. Not only did they make general conclusions based on a summary of all of the individual findings, but they also took the reader through each of the findings in each of the areas of performance that they evaluated and explained what the analysis of the data had found and what it meant (Silva et al., 2009, p. 430- 431). This ability to explain their findings and the significance of them in each individual area of performance improved the quality of their study greatly. It made the findings of the study easily disseminated to the public. Moreover, the findings were laid out in a clearly defined way so that the reader, be it a healthcare practitioner or a parent or family member of a child with autism, can understand, interpret and utilize the information appropriately. This is the most important component to conducting a good research study; the ability to effectively share the findings in a feasible and usable way so that the positive effects that were discovered can be shared. This allows the study results and the work by Silva et al. (2009) to make a difference in the lives of those living with someone or someone experiencing autism and the associated challenging symptoms. Suggestions For Future Studies
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No one is perfect. As always, this is the case for Silva et al. (2009). It is important to state that there is room for improvement in all things because no one is perfect; however, these researchers did a fabulous job and came pretty close. If the study was to be replicated, it should include more participants and it should have a more even number of boys and girls. Although 46 participants is a great number for a sample and lends itself to increasing the validity and reliability of the study, increasing the sample size will starkly increase in the generalizability of the findings. By increasing the number of girls in the study, it would decrease some of the possible threats to the internal validity of the study, as well. Performing this study on children with autism that are not already seeking services would add an additional component to be considered and it would provide another method of confirmation that the improvements found are a direct effect of the QST treatment. This would increase the proof of this treatment and send a strong message to the public that this method of intervention needs to be implemented into the programs for all children with autism because of its great effects of reducing autistic symptoms and providing an opportunity for children with autism to successfully “improve his or learning from the social environment and overcome some or all of his or her developmental delays� (Silva et al., 2009, p. 439). Conclusion In the final analysis of Silva et al.’s (2209) Qigong Massage Treatment for Sensory and Self-Regulation Problems in young Children With Autism: A Randomized Controlled Trial, it can be concluded that the research is reliable, valid and should be integrated into the evidencebased practice of occupational therapists in the community. More research should continue to be conducted to further solidify these findings but the work done by Silva et al. (2009) should be commended. Their relevant and novel findings of the effects of QST on the reduction of autistic
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symptoms in young children are significant in the occupational therapy field and all therapists should take note of their findings. These findings were proven through a good research design and interpreted through a detailed analysis of the data. Furthermore, they are discussed in detail and explained clearly so that the effects of QST on the different areas of performance are individually broken down, discussed and understood. The good work completed by Silva et al. (2009) has done justice to all individuals who live with or know someone with autism and should be commended for their efforts.
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References Silva, L. M. T., Schalock, M., Ayres, R., Bunse, C., & Budden, S. (2009). Qigong massage treatment for sensory and self-regulation problems in young children with autism: A randomized controlled trial. American Journal of Occupational Therapy, 63(4), 423-432.