NURS 8710 Week 1 Literature Review Purpose Post Example

Week 1 Discussion: Initial Post

A Review Is Not Proof of Reading: Three Early Mobilization Trials Written Up Twice, Once as a List and Once Around Their Disagreement

I came into this seminar thinking a literature review shows a committee how much I have read. I now think its job is narrower and harder: to tell the reader what the studies, taken together, settle and what they leave in dispute. The easiest way to show the difference is to write the same three studies both ways. My review question is whether early active mobilization helps adults receiving mechanical ventilation in intensive care, and the three studies are trials I will rely on all term.

Version 1, a sequential summary. Schweickert et al. (2009) randomized 104 ventilated adults at two university hospitals to physical and occupational therapy during daily sedation interruption or to usual care and found that 59% of the intervention group returned to independent function at discharge, compared with 35% of controls. Moss et al. (2016) randomized 120 patients to an intensive or a standard physical therapy program and found no difference in physical functional performance at one, three or six months. In the TEAM trial, 750 ventilated adults were randomized to increased early mobilization or usual care, and the number of days spent alive and at home over the following six months did not differ (TEAM Study Investigators, 2022), with more adverse events in the mobilization group. More research is needed.

Version 2, organized around the disagreement. The three trials disagree about whether mobilizing ventilated patients improves recovery, and the disagreement is easier to read once one asks what each intervention was compared with. In the trial that found a large benefit, the control group received therapy only when the clinical team ordered it, so the trial compared early, structured mobilization with very little (Schweickert et al., 2009). In the two trials that found none, the comparison group already received meaningful therapy: a standard program in one (Moss et al., 2016) and, in the other, whatever level of mobilization each participating ICU normally provided, which averaged almost nine minutes a day against about twenty-one in the intervention arm (TEAM Study Investigators, 2022). Read this way, the trials may not contradict each other. They may show that moving from almost no mobilization to some produces benefit, while adding more on top of an already active baseline does not, and may add risk. The question the disagreement leaves standing is the one my own unit faces: where does our usual care sit on that curve?

The change between the two versions is not length or vocabulary. Version 1 reports each study in its own sentence and ends with a request for more research. Version 2 uses the same facts to make a claim about why the studies differ, and ends on a question that only the combination of studies could raise.

My claim: a review earns its place by explaining disagreement, not by listing findings. Does anyone see a reading of these three trials that version 2 misses?

Reply to Yesenia

Yesenia, you argued that version 1 has a place, because a committee member needs to know what each study found before reading an argument about them. I agree that the reader needs those facts, and I would not hide them. Where I disagree is about where they belong. An evidence table carries each study's findings one by one, and the narrative can then do what the table cannot. If the narrative also lists studies, the review says everything twice and argues nothing. Would you accept the table as the place for sequential facts, so that the text is free to compare?

Reply to Owen

Owen, you questioned my reading of the comparison groups, pointing out that the TEAM trial also enrolled a much larger and sicker population than Schweickert et al. and measured a different outcome at a later time. That is a fair challenge, and it weakens the neatness of my version 2. A six-month count of days alive and at home is a very different outcome from independent function at discharge, and a benefit visible at discharge could fade by six months. So there may be two explanations at work, the baseline in the control group and the timing of the outcome, and the three trials alone cannot separate them. I will carry both into my synthesis rather than presenting one as settled. Which do you think matters more?

References

Moss, M., Nordon-Craft, A., Malone, D., Van Pelt, D., Frankel, S. K., Warner, M. L., Kriekels, W., McNulty, M., Fairclough, D. L., & Schenkman, M. (2016). A randomized trial of an intensive physical therapy program for patients with acute respiratory failure. American Journal of Respiratory and Critical Care Medicine, 193(10), 1101-1110. https://doi.org/10.1164/rccm.201505-1039OC

Schweickert, W. D., Pohlman, M. C., Pohlman, A. S., Nigos, C., Pawlik, A. J., Esbrook, C. L., Spears, L., Miller, M., Franczyk, M., Deprizio, D., Schmidt, G. A., Bowman, A., Barr, R., McCallister, K. E., Hall, J. B., & Kress, J. P. (2009). Early physical and occupational therapy in mechanically ventilated, critically ill patients: A randomised controlled trial. The Lancet, 373(9678), 1874-1882. https://doi.org/10.1016/S0140-6736(09)60658-9

TEAM Study Investigators and the ANZICS Clinical Trials Group. (2022). Early active mobilization during mechanical ventilation in the ICU. New England Journal of Medicine, 387(19), 1747-1758. https://doi.org/10.1056/NEJMoa2209083