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Analysis of the studies
The four quantitative studies were reviewed, and they were critically appraised by a Critical Appraisal Skills Program (CASP 2013) tool to determine validity, reliability and credibility of the studies (Appendix 1).
The four studies were utilised with reasonably strong evidence of methods (NHMRC 1999). Burns et al (2009) and Harris et al (2012) conducted their studies by using Randomised Controlled Trials and Richards et al (2005) utilised pre-test/post-test Randomised Controlled Trials, which is regarded to be the best design for quantitative studies (NHMRC 1999). Even though Sloane et al (2007) used a lower evidence level of method, namely the cluster-crossover design, it may be regarded as good for clinical trials because the design can carry out more than one intervention in a naturally developed population (Parienti & Kuss 2007). Parienti and Kuss also believed that using the cluster-crossover design can be considered more suitable than attempting a Randomised Controlled Trials in a clinical setting where Randomised trials are not feasible and the design was well suited in Sloane’s study (Parienti & Kuss 2007).
The sample sizes ranged from 40 to 147 participants. When a study shows positive treatment effects with a sufficient large sample, the strength of internal validity will increase (Law & MacDermid 2008). Case control studies can reasonably have small samples; whereas, a greater number of samples are required in Randomised Controlled Trial studies (Edwardes 2001). Sloane’s case control study had 66 participants and Richards et al (2005) recruited 147 people for Pre/Post Tests whereas Burns et al (2009) and Harris et al (2012) assembled 48 and 40 participants respectably for their Randomised Controlled Trials. With the sample size of four studies, possibly strengthened internal validity, the sample sizes were also justified by using a power calculation. It helps validate statistical analysis and generalise the findings (Greenhalgh 2006).
The four articles have clear purposes, and relevant literatures were reviewed in the articles. Burn et al (2005), Harris et al (2012) and Richards et al (2005) provided sufficient details of their interventions. Through which more likely to contribute to evaluating whether the experiments are useful and replicable and this in turn, increases the quality of the studies. However, the study by Sloane et al (2007) did not provide sufficient detail about procedures, setting, and did not describe experimenters who carried out the intervention and therefore the study is of lower quality.
The majority of studies did not justify the analysis methods with sufficient details. Richards et al (2005) did show the statistical significance of their finding; however, the rest three articles failed. When studies can be analysed with appropriate statistical tools, the value of the studies can be higher (Trochim 2006). However, all studies drew the positive outcomes.
5. Discussion
Although the four studies were supported by moderate to strong quality of the evidence, the studies of Burns et al (2009) and Richards et al (2005) deducted more conclusive findings than the publications of Harris et al (2012) and Slone et al (2007). A part from this, the four articles have presented the results disproportionately because the authors for each article concluded their fining as the interventions can replace sedative hypnotic tablets without supportive reasons. Although they revealed the positive outcomes of the interventions and even two of them show definitive results, the studies did not compare the effects of the sleeping tablets and the consequences of the interventions. However, the efforts to find out the non-pharmacological interventions alone have adequate merits, as the side effects of sedative hypnotic drugs have become an alarming issue today (Morin et al 2003).
6. Conclusion
As people with dementia are losing their ability to manage their sleep pattern and quality, health care providers or family caregivers should help them to enjoy optimal quality of sleep. Clinically, although negative effects of sleeping tables have been revealed, the medications have broadly been used due to health care providers’ lack of understanding of non-pharmacological interventions. This essay attempted to provide better and safer option for health care providers to update their knowledge and treat dementia impaired people with sleep disorders appropriately. However, this literature review identified that a lot more evidence based interventions need to be developed as there is a paucity of feasible enough non-pharmacological sleep intervention
