Critical appraisal checklist for Case Reports

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Article Title: Hossain KMA, Hossain MA, Mamin FA, Rahman E, Afroz N, Sonia NJ, Khan SA.
Physiotherapy management of chemotherapy induced peripheral neuropathy in a gynecological
condition through clinical reasoning process: A case study. Edorium J Disabil Rehabil
2018;4:100045D05KH2018.

Reviewer: Raneen Allos

For each question in the table below, mark yes, not, unclear, or not applicable
Yes No Unclear NA
1. Was the background and foreground information X
sufficient?
2. Was the patient’s demographics and history clearly X
described and presented as a timeline?
3. Did the case report articulate sufficiently clinical X
impression?
4. Were diagnostic tests or methods clearly described? X

5. Did the case report provide the second clinical X

impression?
6. Was the intervention(s) or treatment procedure(s) X
clearly described?
7. Were the post-intervention clinical outcomes clearly X
described?
8. Were the case report findings clearly described? X

9. Does the case report provide takeaway lessons? X

10.
Give your assessment of study credibility below

Overall credibility of article results per your assessment on the scale of 0-10, with 0 –“I don’t see any
value in this case report for my future practice” to 10 – “I will definitely try to use this intervention
in a similar patient” I give the report a 8
Explanation of Case Report Critical Appraisal

Brief and structured summary of the article in a form of Abstract

• The patient was a middle aged woman who was diagnosed with uterine cancer. She
underwent a hysterectomy as well as chemotherapy and radiation sessions. The patient has
residual back pain, lower extremity pain and weakness, and was diagnosed with peripheral
neuropathy due to her cancer treatment.
• The authors of this article used physical therapy interventions in order to treat the
participants pain and muscle weakness. The interventions included a strengthening program
for the lower extremities, pelvic floor, and back, aerobic exercises, stretching, and others.
The case report followed as the participant attended eight sessions for a month and then a
home exercise program for another month.
• Almost every assessment that the participant was tested on showed improved results after
the 4th week, and then even more so three months after the beginning of the study. Her pain
decreased, pelvic floor strength increased, balance improved, single leg balance time
improved, and most important her quality of life measure increased. The only test that
stayed the same was the manual muscle tests for gastrocnemius, quadriceps, hamstrings, and
hip abductors/adductors.
• These outcomes helped the authors come to the conclusion that physical therapy
interventions are beneficial for peripheral neuropathy symptoms post uterine cancer
treatment. These results may provide for future treatments of physical therapy and cancer
patients to try and alleviate symptoms sooner.

Then, provide explanation for each question below, in several full and concise sentences. The whole
document must be single-spaced, written in 12 font, should be of sufficient length between 1,000-
1,500 words. When checking your paper for plagiarism, have in mind that all BOLD text is
copyrighted by JBI©, and most likely show close to 100% match by iThenticate or SafeAssign

1. Was the background and foreground information sufficient?

Yes, the amount of information provided by the researchers was sufficient. It was relevant to
the purpose of the study and it provided enough background to understand the article.

2. Was the patient’s demographics and history clearly described and presented as a
timeline?

Yes we received information on the patients personal life, occupation, health history, problem
list, and limitations. The study used relative dates to describe the time the patient spent in her
cancer treatment as well as the time it took for the study.

3. Did the case report articulate sufficiently clinical impression?

Yes the clinical impression of the patients diagnosis was clearly stated. The patient had
bilateral paraesthesia, difficulty walking or standing for longer than ten minutes, back pain,
and general weakness. The primary problem was the root cause of these symptoms, peripheral
neuropathy, which is common after chemotherapy in 30-50% of people.1 This diagnosis was
relevant to the study because they wanted to see if physical therapy helped this particular
patient if it could help others with residual peripheral neuropathy secondary to chemotherapy.
 4. Were diagnostic tests or methods clearly described?

Yes the article included a chart (Appendix-1) that had a description next to each one and how
it was performed.

5. Did the case report provide the second clinical impression?

The case report did not provide a second clinical impression. The research was performed in
Bangladesh, which could be why it was not included as a part of the research

6. Was the intervention(s) or treatment procedure(s) clearly described?

The Appendix included details on how the researchers provided the interventions to the
participant. It was written almost as a home exercise program so I believe other researchers
would be able to replicate it. For example, one of the interventions is the McKenzie Extension
Protocol” and it includes “10 repetitions, 2 hourly for 7 days, and then 10 repetitions, thrice a
day for two weeks.” The only thing is that the descriptions are wordy, but I believe this article
might have been translated into English so things were lost in translation.

7. Were the post-intervention clinical outcomes clearly described?

The outcomes were measured with standardized tests such as the Burg balance scale and
manual muscle tests. The outcomes are provided in Table 1 comparing the results from the
baseline, midline, and post-tests. Validity and reliability seem to be established well in this
article.

8. Were the case report findings clearly described?

The discussion section does not report adverse effects or discuss what could have been done
differently. The study ties back that peripheral neuropathy affects many people after
chemotherapy, and that many women who undergo treatment for uterine cancer present with
these symptoms. They suggest that further studies should be done as this area of study is fairly
new to Bangladesh.

9. Does the case report provide takeaway lessons?

Yes the case report presents with takeaways summarizing why the participant underwent the
treatment and the reason for wanting to learn more about these interventions.

Additional consideration

Additional considerations may be that this study was not done in the United States, so I’m unaware
of how much research on this subject is done here.
Why you should or should not use this evidence?

I think this evidence could be used to replicate this study for other chemotherapy subjects who suffer
from peripheral neuropathy. The patient in the study regained strength and decreased pain, two things
that were hindering on her personal and professional life. If a patient presents with peripheral
neuropathy after chemotherapy I believe that physical therapy would be a good place to start to try
and alleviate their symptoms.