NURS 8710 Week 7 Synthesis Matrix Example Example

Findings Down the Side, Studies Across the Top: A Synthesis Matrix of Eleven Early Mobilization Studies and the Cells Nobody Filled

Student Name

College of Nursing, Walden University

NURS 8710: Doctoral Seminar I

Instructor Name

Month Day, Year

Findings Down the Side, Studies Across the Top: A Synthesis Matrix of Eleven Early Mobilization Studies and the Cells Nobody Filled

Why the Matrix Turns the Table Around

The evidence table built in week 4 has one row per study. Read down, it tells a reader what each study did and found. It cannot easily show what the studies together say about any one question, because the answer to each question is scattered across eleven rows. This matrix reverses the orientation. Findings run down the side and studies across the top, so that reading along a row shows how the whole set answers one question, and reading down a column shows how much of the review's ground each study covers. The approach follows the advice in nursing research texts to organize a review around concepts and findings rather than around authors (Polit & Beck, 2021), and it uses the same eleven studies as the evidence table.

Each cell carries one of four marks. S means the study supports benefit or safety on that finding; C means it contradicts benefit, either by finding no difference or by finding harm; M means mixed; and N means the finding was not examined or not reported in the study's published summary. A short parenthetical gives the direction or the reason.

The Matrix

Table 1 presents the matrix. Study labels are first author and year.

Table 1

Synthesis Matrix: Seven Findings Across Eleven Studies

Marks reflect each study's published summary; cells marked N may change when full texts are extracted.

Reading Along the Rows

Row 1, function at discharge, is where support concentrates. Four studies support benefit and one contradicts it, and the four supporting studies share a feature: their comparison groups received little structured mobilization. The one contradicting study is a small pilot in a different population.

Row 2, function at six months or later, runs the other way. Four studies contradict benefit and two are mixed; none supports it cleanly. The studies in this row are mostly the larger and later trials, and two of them compared doses rather than mobilization with usual care.

A published systematic review of active mobilization found a similar split, with greater muscle strength and a higher probability of walking without assistance at discharge but no consistent effect on function or quality of life later (Tipping et al., 2017). Rows 1 and 2 therefore do not conflict in the way they first appear to. They answer different questions, at different times, using different comparisons. The matrix makes that visible in a way the evidence table did not.

Row 6, adverse events, is highlighted because the conflict is genuine rather than a difference in measurement. Four studies report no or almost no adverse events, and the largest trial reports significantly more events in the intervention arm (TEAM Study Investigators, 2022). The smaller studies counted events during sessions, while the largest counted events potentially due to mobilization across the stay, which may account for part of the difference. But the largest trial also reported more serious adverse events with mobilization, and that finding cannot be explained away by counting method alone.

Row 4, length of stay, is the second highlighted row. Two studies support shorter stays, and four contradict it. The two supporting studies are the nonrandomized cohort and a surgical ICU trial; the randomized trials in medical populations do not support the claim. This row shows that the length of stay benefit sometimes cited for mobilization rests on the weakest designs in the set.

The Cells Nobody Filled

The N mark occupies more cells than any other, 44 of 77, and that is a finding in itself. Mortality, a central outcome for any ICU intervention, was examined in only two of the eleven studies' summaries. Dose was reported in only five, although dose is the variable most likely to explain the differences between trials. Function at discharge and function at six months were rarely measured in the same study, so the set cannot show directly whether early gains persist or fade. A review that reported only the filled cells would overstate what is known. The matrix will therefore be carried into the synthesis with its empty cells visible, and the gap statement in week 9 will draw on the rows with the most N marks.

Limits

The marks compress complex findings into four categories, which loses information about effect size and precision. A study marked S on function at discharge may show a large effect or a small one. The matrix is a tool for seeing patterns across studies, not a substitute for the evidence table or for the effect sizes, which the written synthesis will report.

References

Polit, D. F., & Beck, C. T. (2021). Nursing research: Generating and assessing evidence for nursing practice (11th ed.). Wolters Kluwer.

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

Tipping, C. J., Harrold, M., Holland, A., Romero, L., Nisbet, T., & Hodgson, C. L. (2017). The effects of active mobilisation and rehabilitation in ICU on mortality and function: A systematic review. Intensive Care Medicine, 43(2), 171-183. https://doi.org/10.1007/s00134-016-4612-0