Talwar Articles Review Preview Of Articles

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Talwar Articles Review Preview Of Articles

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Talwar Articles Review Preview Of Articles

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The case reviews are based on two clinical trial studies for the purpose of mental psychosis treatment. The studies are utilising the use of music therapy for rehabilitation treatment and restoration of mental ability for therapeutic measures among the schizophrenia patients. In the Talwar study, it bases its argument on the principle that music therapy improves the mental health status among the schizophrenia, and it evaluates its effects in the psychotic mental health state of the patients. In the Young study, it argues on restoration of social functioning of the mental state through rehabilitation therapy. It uses music as a form of psychosocial therapy for mental health. The study’s background states that music therapy has been effectively been used to minimise negative symptoms to patients. The study evaluates the use of music therapy in lowering the symptoms and social disabilities associated with chronic schizophrenia among patients.
In Yang study, it used selection criteria in admitting sample respondents, those who met the criteria were recruited in the study, employing CCMD-2 criteria of 1987. In Talwar study, the samples were recruited from in-patients in one of the hospital among the four hospitals in the study area. The sample was a representative of larger population. Talwar study has more strength in the sampling procedure in that it randomly selected patients admitted with schizophrenia, unlike in the Yang, the diagnostic criteria is too old for assessment and recruitment, more patients will be biased left out of study. The sampling chosen is robust enough to equalize the effects of expectation unlike from the other study; it risked being biased in the recruitment.
Participant’s evaluation in the in clinical research is essential to eliminate business in the recruitment and treatment of the sample respondents. In randomised control trials, samples can encounter difference in terms of race, colour, cultural values, and changes in self awareness of the intended program and self perception recognition due to inert influences like self mentoring. However utilization of random assignment and selection should be balanced enough to counter act. It serves the purposes of equalization effects of non- processors that might affect the outcome of the two studies.
In the Talwar study, patients who met the criteria of the study were approached and their consent sought through a written consent. Study procedure used inclusion and exclusion criteria, and those patients who met inclusion standards were included in the study. Thereafter the randomisation procedure ended whereby patients were treated to therapy care or routine alone, block randomisation stratification for the hospital was followed. The randomisation ratio used was 2:3, therapy: routine care with music sessions included. The treatments given were not equal hence could be a subject of biased results later during c study results. Follow up schedule was then initiated after 3 months of randomisation. To ensure that randomisation evaluation procedures were free of any biasness, an independent evaluator was used. Studies conducted have shown that effective randomisation in a study is effective for determination of causal effects of treatments, (Suvama, 2010). Randomisation is always pronged with biasness hence this study utilized an independent evaluator to conduct the follow up interviews.
Attrition biasness in randomised controlled studies is the systematic error in the loss of participants in the study. The patients might withdraw from the study due to personal reasons such as unfair treatments, efficacy issues and intolerable effects of music. In the Talwar study 27% of the respondents did not turn up for the study, this is larger portion which bring biasness in the study because the differing characteristics is correlated to the trial outcome being measured. Study done by Schulz and Grimes, (2002) argues that any loss of upto 5% or below should be a worry issue, while loss of between 5%- 20% should bring a lot of concerns. However in this study it is 30% which gives worry to evaluate validity of the results obtained, (Hewitt, David, Torgerson, Dumville, 2006). The Yang study is having greater advantage due to attrition loss being 3% which is way below the standard measure to worry. Thus results obtained from this study are presumed to be more valid and acceptable.
Expectation effect on the observer is a reactivity process which a researcher cognitive biasness has an effect on the influence to the participant subjects in the treatments. It commonly refer to observation effects about outcomes f the study. It has been studied and shown to affect the diagnosis and decrease the internal validity when subjects behaviour is not according to expectations of the researcher, (Kobak et al., 2010). In the Talwar study, blinding ratters was used to conduct the interview so as to limit researcher’s selective approach in the collection of data. This protocol is effective in the process of the entry criteria, visit number and improvements expectations. In the Yang study, there was no use of independent ratters hence subject to expectation biases and affect the diagnostic treatment and results validity.
The treatment of the groups in the Talwar study was given preferential access, by empowering the patients to play with the instruments was a way in which positive treatment could be used. The difference that can be observed in the groups is that, treatment group was given facilitation and guidance in the therapy of music play while in the control group no support give as they were left alone without the services of a therapist and music treatment given at the trail process. A repeat of this study, matching and stratification will be deployed to manage the preferential treatment that might occur between the therapist and the patients, (Austin, 2013).
In the Talwar study, table two test the hypothesis relating to changes in primary and secondary experimental groups and control groups at two distinct periods were the same at baseline and at 3 months. The p value in the table is 0.045, thus allows us to reject the null hypothesis statement stated. The statistical power of the study was adequate and effective in rejecting any false null hypothesis of the study.
In Yang study the effect of treatment is strong in that it shows significant difference in the outcomes of the study between the control and treatment groups. While in Talwar study it showed association of difference after three months of treatment. In Yang study the, therapist used for treatment were experienced musicians who had the skills of how to coach and effectively teach the patients how to sing and use the musical instruments whereas in the other there was no such treatment to the respondents.
The application of music treatment in Yang study is that, the mode of application of the music was based on an individual basis and personal coaching applied to the patients. The therapists themselves were musician hence rich expertise in the application of the music through the different process which include participation, emotional and expression sequence which allows full participation of the respondents in the study. In the Talwar study the subjection of music to the patients was done in therapy sessions lasting for 45 minutes once in a week with music therapy who were not necessarily musicians by profession.
The therapist function was to support the patients emotionally during the musical process which was not in-depth compared to the Yang study which was more intensive and patient captivating. Such treatment protocol is not feasible in acute care management plan because the patient’s characteristics are significant of negative symptoms such as mood disorders and cognitive impairments. This displays can lead to damage relationships between the care giver or the therapist and the patient, (Husnoo, Goonoo & Abbas, 2012).
To generalize findings of any research is a crucial aspect. Important factors such as internal validity of the study tools , play key role in generalizing the findings, (Kukull, Walter & Mary, 2012),Talwar study findings cannot meet this criterion since the sample size respondents was far much wide with 31% of the respondents being non responsive thus affected the validity of the results. In Yang study the results can be generalized to other settings since the validity of the results is measurable and that the sample respondents were responsive. The findings of both studies have not given conclusive evidence on the use of music therapy to actually give treatment to schizophrenia management of patients. Neuroleptic treatments diminishes the effects of symptoms and prevent the occurrence of relapses among patients, (Frances et al., 2017), hence music therapy is unlikely to be a replacement of the therapy.
In both the studies one outstanding gap is that the effectiveness of music therapy needs to assessed, as none has outline how effective the therapy is improving the state of the schizophrenia patients. Modification of the study design would analyse the use of the quasi-experimental designs to assign specific respondents into a study to asses them specifically regarding to the therapy. In this design, it estimates the causal impact on intervention without randomly assigning the target population. The researcher will control the variables but utilising the same criterion in experimental on exclusion and inclusion procedures, (Dinardo, 2008). At some point in this research process, control over the treatment assignment may be applicable, however this design may be subject to internal validity , it will based on the researcher’s own interest on what is measured. Difference in groups can be observed, and its occurrence will be due to chance and choice changes in the characteristics at post intervention will be equivalent to intervention applied. The outcome will be dependable variable of the intervention.
Austin, P.C., 2013. The performance of different propensity score methods for estimating marginal hazard ratios. Statistics in medicine, 32(16), pp.2837-2849.
Dumville, J.C., Torgerson, D.J. and Hewitt, C.E., 2006. Reporting attrition in randomised controlled trials. BMJ: British Medical Journal, 332(7547), p.969.
Frances R Frankenburg , 2017. Schizophrenia Treatment & Management. Online Access on 14/05/2017. https://emedicine.medscape.com/article/288259-treatment.
Husnoo, N., Goonoo, M.S. and Abbas, S., Practical management of aromatase inhibitor-induced bone loss in breast cancer patients.
Kobak, K.A., Leuchter, A., DeBrota, D., Engelhardt, N., Williams, J.B., Cook, I.A., Leon, A.C. and Alpert, J., 2010. Site versus centralized raters in a clinical depression trial: impact on patient selection and placebo response. Journal of clinical psychopharmacology, 30(2), pp.193-197.
Kukull, W.A. and Ganguli, M., 2012. Generalizability The trees, the forest, and the low-hanging fruit. Neurology, 78(23), pp.1886-1891.
Schneider, J., Börner, D., van Rosmalen, P. and Specht, M., 2016. Can You Help Me with My Pitch? Studying a Tool for Real-Time Automated Feedback. IEEE Transactions on Learning Technologies, 9(4), pp.318-327.
Schulz, K.F. and Grimes, D.A., 2002. Unequal group sizes in randomised trials: guarding against guessing. The Lancet, 359(9310), pp.966-970.
Suvarna, V., 2010. ‘Consort 2010: A Standard for Reporting Clinical Trials Revised Anew?. Perspectives in clinical research, 1(3), p.87.
Talwar, N., Crawford, M.J., Maratos, A., Nur, U., McDERMOTT, O.R.I.I. and Procter, S., 2006. Music therapy for in-patients with schizophrenia. The British journal of psychiatry, 189(5), pp.405-409.
Yang, W.Y., Li, Z., Weng, Y.Z. and Zhang, H.Y., 1998. Psychosocial rehabilitation effects of music therapy in chronic schizophrenia. Hong Kong Journal of Psychiatry, 8(1), p.38.

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