Methodology Section Draft- Benefits of Physical Therapy for Lower Extremity Injuries
Lower extremity injuries are common in actions and activities involving explosive actions, such as sporting events (Ishøi et al., 2020). The majorly diagnosed lower extremity injuries include sprains, fractures, ligament tears, strains, and shin splints. These types of injuries majorly affect the muscles and joints of the lower extremities. Lower extremity injuries remain a significant issue of concern in healthcare and public health settings. Such injuries are linked to significant loss of mobility and trauma (George & Goode, 2020). Notably, these injuries cause or may increase current levels of pain with a risk for long-term complications and a negative impact on the quality of life of the affected individual. This makes it very important to explore ways that offer long-term benefits for the management of pain and lower extremity injuries.
There are multiple modalities for managing lower extremity injuries. The major modalities utilize medications and non-pharmacological methods. The management of pain in lower extremity injuries using medications, especially opioids, poses a risk of developing opioid addictions (George & Goode, 2020). Others, such as resting, the use of ice, and laying the patient in an elevated position, only provide a momentary easing of the pain related to the injuries. In this regard, this research hypothesizes that physical therapy provides significant benefits in pain management as well as in the reduction of the risk of injury. It is important to sufficiently explore these benefits in order to inform patient pain management decisions and resource allocation, eliminate the risk of recurrent injuries, and restore mobility and physical functionality. This section discusses the research methodology that will be utilized to explore current and existing literature to define the benefits of physical therapy in managing lower extremity injuries.
Research Methodology
The proposed study will utilize a systematic review methodology to explore the benefits of using physical therapy in the management of lower extremity injuries. Systematic review is recognized and appreciated as an important research methodology in healthcare research that supports the synthesis of evidence to inform care decisions. The utilization of systematic reviews as a research methodology involves the rigorous development of comprehensive summaries of information from multiple resources to answer a clinical question sufficiently (Sataloff et al., 2021). The systematic review methodology has been deemed the most appropriate research methodology to explore the benefits of physical therapy on lower extremity injuries based on a number of the advantages of utilizing the methodology in evidence development.
One major reason for selecting the systematic review methodology for the proposed study is because the methodology supports the review and summarization of vast evidence from multiple randomized controlled trials and other sources of evidence. This is an intervention systematic review, as discussed by Kolaski et al. (2023), since it explores the benefits of an intervention implemented in healthcare settings. The systematic review methodology will be able to provide a sufficient overview of the current state of literature and evidence to confirm or discard particular assumptions as well as draw conclusions on the presumed effectiveness, benefits, or harms of physical therapy over other treatment modalities in managing lower extremity injuries. Another reason the systematic review methodology is appropriate for the proposed research is because it helps overcome the ethical challenges associated with research on chronic pain (Reeves & Jones, 2022). Since a systematic review focuses on the review of already published evidence from research, it eliminates the need for human participants and, therefore, ethical challenges that would have otherwise been faced if human subjects were utilized in the study. The lack of human participants also eliminates the need for further financial and time resources that are required to carry out research involving human subjects. Additionally, the systematic review methodology is deemed appropriate for the proposed research as it follows a systematic process in the development of the clinical questions as well as the selection and inclusion of research articles for the review. Systematic reviews rate articles based on their level of evidence and methodological quality and utilize such ratings as the basis of inclusion and exclusion in the review (Veginadu et al., 2022). This eliminates any risk of bias, making it possible to develop the highest quality of evidence to support the drawing of conclusions related to the research topic.
The systematic review methodology follows a strict protocol, from the formulation of a research question to the development of the inclusion and exclusion criteria. The first step in the proposed research was to develop a research question that would guide the entire research process. In the proposed study, the main research question explores the benefits of physical therapy in the management of lower extremity injuries. This question forms the basis of the search strategy for research articles and the inclusion and exclusion criteria for the identified articles. The search strategy as a major protocol in systematic reviews will include three electronic database searches, including PubMed, EMBASE, and Cochrane Library. Key search terms and Boolean operators, as well as other database search features such as the type of article and year the article was published, will be utilized to enhance the search results. The inclusion criteria for the returned search results will include studies published within the last five years and in peer-reviewed journals. It will focus on studies evaluating the impact of physical therapy interventions on patients with lower extremity injuries, specifically randomized controlled trials, cohort studies, and observational studies. Other inclusion criteria include studies exploring specific physical therapy modalities such as exercise therapy, manual therapy, pediatric physical therapy, neurological physical therapy, geriatric physical therapy, orthopedic physical therapy, vestibular rehabilitation, and cardiovascular and pulmonary physical therapy. Articles will also be included based on the location of the study, with preference paid to articles published in countries where physical therapists provide primary care services, specifically in the U.S., Canada, The United Kingdom, and Australia. In addition, the articles will be manually reviewed, including the topic and abstract, methodology section, and conclusions, to ensure the comprehensiveness of the article’s relevance to the topic and research question. Articles will be excluded on the basis of a small sample, unclear methodology, and research protocols, and articles that are not directly related to the topic. Finally, the quality of evidence from the articles that meet the inclusion criteria will be further accessed, and data extracted and meta-analyzed to summarize the findings of included studies.
Sampling Protocols
As a systematic review, the proposed research will utilize the inclusion criteria to review and select the articles to be included in the review. The main inclusion criteria are articles focused on studying individuals with lower extremity injuries who have undergone physical therapy interventions. Although the scope of this population may be wide, purposive sampling employed within the articles to be reviewed is considered a major inclusion criterion. A purposive sampling technique is considered essential in this case, as the sample population would bear the characteristics that are relevant to the study (Andrade, 2020). This sampling technique, as a part of the inclusion criteria, will ensure that the sample population in the included articles has directly experienced or has had experiences with physical therapy in managing lower extremity injuries. In addition, this selection criteria based on the sampling methods of the articles to be included in the review will ensure homogeneity of the sample in terms of the condition being studied and the intervention received. A homogenous sample and intervention as eligibility criteria for articles included in a systematic review have a significant effect on the internal validity of a systematic review (Amir-Behghadami & Janati, 2020). This homogeneity across the population samples and interventions explored in the included articles will ensure the findings of these studies are relevant and applicable in sufficiently answering the research question of whether physical therapy is beneficial in the management of lower extremity injuries.
Data Collection
Data will be extracted from all the articles that meet the final inclusion criteria. The extracted data for the proposed study will consist of both quantitative and qualitative information related to the impacts of interventions related to physical therapy in managing lower extremity injuries. The extracted information and data will include data on the authors of the article, the year it was published, and the region in which the study was conducted. Data extraction will also include the characteristics of the sample population, the number of participants in each study, the nature of the study, including methodology and research design, the physical therapy intervention explored in the study, intervention measures, and the duration it was explored. It will further include outcomes of the intervention in relation to managing lower extremity injuries. A mixed methods systematic review, that is, extraction of both quantitative and qualitative data, has been considered based on the nature of the proposed research. The study aims to explore and determine the benefits of physical therapy on lower extremity injuries. These include quantifiable outcomes such as days lived with pain, experiences such as levels of satisfaction, and patient-reported experiences with pain. A mixed methods approach in systematic reviews is allowed when the quantitative data or when an intervention within the setting of study provides only a narrow perspective of its efficacy and effectiveness, and the inclusion of the qualitative data provides a wider perspective on knowledge, attitudes, and behaviors related to the intervention (Sataloff et al., 2021). Regardless of the utilization of the mixed methods, the extraction of data from the included studies will adhere to the methodology protocols of systematic reviews to ensure the reliability and validity of the synthesized evidence.
Data Analysis
The extracted data will be analyzed using the data analysis methods appropriate for each data type. The quantitative data extracted from the studies will be analyzed using statistical methods of data analysis. The quantitative data analysis will help determine the significance of the effects of the physical therapy intervention and its effectiveness in managing lower extremity injuries. A metanalysis technique will be utilized to synthesize effect sizes across studies and assess the heterogeneity of results. Each of the studies that will be included in the review and contribute to the findings and drawing of conclusions will assessed using a rating system developed by Gusenbauer and Haddaway (2020).
Gusenbauer and Haddaway’s rating system allows researchers to comprehensively evaluate the methods employed by authors of each of the studies included in the reviews; thus, it informs the findings on the benefits of physical therapy in managing lower extremity injuries. For the qualitative data extracted from included qualitative studies, the data analysis will employ a thematic analysis to help identify major themes and patterns. The thematic analysis will include transcribing any qualitative data extracted from the included articles and employing coding the data to identify concepts and categories. These codes will then be classified and further analyzed until major themes emerge from the data. The use of qualitative analysis methods is to further explain the meaning of the quantitative data and other observations that relate to the benefits of physical therapy interventions in managing lower extremity injuries.
Validity
Systematic reviews have a higher validity as they rigorously attempt to eliminate bias during the development of the review by assessing the strengths and weaknesses of the literature reviewed (Sataloff et al., 2021). The proposed study is also valid as it has been designed based on the population, intervention, outcomes, and study (PICOS) framework, as discussed by Amir-Behghadami and Janati (2020). At the beginning of the study, a PICO(T) question was developed based on the literature review and identified justification for the research. Additionally, systematic reviews utilize thorough step-by-step protocols that focus on the topic of the study, search strategies, article screening, and extraction of data that give the methodology (Bandara & Syed, 2023). Further, the protocols in a systematic review improve the rigor of the search process, which further minimizes the risk of selection bias. This means that the conclusions that are drawn are based on the findings of the systematic review guided by the available evidence on the benefits of physical therapy interventions on lower extremity injuries. Also, a systematic review method promotes a more open and transparent data extraction and synthesis using two or more reviewers. In the proposed study, the data extraction and synthesis will be done by two independent reviewers to address each grievance. Moreover, the validity and reliability of the systematic review method are also improved by its adherence to ethical principles of research. The proposed study will ensure adherence to essential considerations to ensure the integrity and fairness of the research process. Ethical considerations will include reviewing the application of ethics principles in the original research and ensuring the researchers adhere to all ethics principles in healthcare research.
Conclusion
In conclusion, the systematic review methodology proposed for investigating the benefits of physical therapy in managing lower extremity injuries is robust and valid. The systematic review methods support comprehensive literature search, inclusion and exclusion criteria, data extraction, and synthesis of evidence from multiple studies. The methodology also ensures adherence to ethical principles and more transparency in the systematic review process, which improves the validity and reliability of the findings of the study. Due to the multifaceted nature of the outcomes related to the application of physical therapy, a mixed methods systematic review will be utilized in the proposed research.
References
Amir-Behghadami, M., & Janati, A. (2020). Population, intervention, comparison, outcomes and study (PICOS) design as a framework to formulate eligibility criteria in systematic reviews. Emergency Medicine Journal, 37(6), 387. https://doi.org/10.1136/EMERMED-2020-209567
Andrade, C. (2020). The inconvenient truth about convenience and purposive samples. Indian Journal of Psychological Medicine, 43(1), 86–88. https://doi.org/10.1177/0253717620977000
Bandara, W., & Syed, R. (2023). The role of a protocol in a systematic literature review. Journal of Decision Systems. https://doi.org/10.1080/12460125.2023.2217567
George, S. Z., & Goode, A. P. (2020). Physical therapy and opioid use for musculoskeletal pain management: Competitors or companions? Pain Reports, 5(5), E827. https://doi.org/10.1097/PR9.0000000000000827
Gusenbauer, M., & Haddaway, N. R. (2020). Which academic search systems are suitable for systematic reviews or meta-analyses? Evaluating retrieval qualities of Google Scholar, PubMed, and 26 other resources. Research Synthesis Methods, 11(2), 181–217. https://doi.org/10.1002/JRSM.1378
Ishøi, L., Krommes, K., Husted, R. S., Juhl, C. B., & Thorborg, K. (2020). Diagnosis, prevention and treatment of common lower extremity muscle injuries in sport – grading the evidence: A statement paper commissioned by the Danish Society of Sports Physical Therapy (DSSF). British Journal of Sports Medicine, 54(9), 528. https://doi.org/10.1136/BJSPORTS-2019-101228
Kolaski, K., Logan, L. R., & Ioannidis, J. P. A. (2023). Guidance to best tools and practices for systematic reviews. Systematic Reviews, 12(1). https://doi.org/10.1186/S13643-023-02255-9
Reeves, K., & Jones, N. (2022). Ethical challenges in chronic pain. Primary Care – Clinics in Office Practice, 49(3), 497–506. https://doi.org/10.1016/j.pop.2022.01.002
Sataloff, R. T., Bush, M. L., Chandra, R., Chepeha, D., Rotenberg, B., Fisher, E. W., Goldenberg, D., Hanna, E. Y., Kerschner, J. E., Kraus, D. H., Krouse, J. H., Li, D., Link, M., Lustig, L. R., Selesnick, S. H., Sindwani, R., Smith, R. J., Tysome, J., Weber, P. C., & Welling, D. B. (2021). Systematic and other reviews: Criteria and complexities. Journal of Otolaryngology-Head & Neck Surgery, 50(1). https://doi.org/10.1186/S40463-021-00527-9
Veginadu, P., Calache, H., Gussy, M., Pandian, A., & Masood, M. (2022). An overview of methodological approaches in systematic reviews. Journal of Evidence-Based Medicine, 15(1), 39. https://doi.org/10.1111/
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Question 
Methodology Section Draft
Exercise Content
Using the Methodology Section instructions provided in Week 5, create the initial draft of the Methodology section. Follow the outline submitted in Week 5 and incorporate the feedback provided. Reminder: sources must be within the past 5 years, so no older than 2019. You can submit twice if you wish to receive a score from SafeAssign and time to fix any originality issues. The last submission is the version that will be graded. Review the rubric before submitting.
Methodology Section Draft- Benefits of Physical Therapy for Lower Extremity Injuries
As always, use APA 7 formatting. Utilize the APA 7 Manual and the Writing Studio for assistance.
Submission Format:
Cover Page
Title
Introduction to Methodology Section
Body
References
For this submission, you do not need an abstract or summary.
Use the Methodology Outline attached below to create this methodology section draft. Use the same 10 references in the attachment below.