ID 10935160

CRITICAL APPRAISAL

WILLIAM, 2005

ABSTRACT & INTRODUCTION

Abstract section provides a balanced, informative summary of what was found and
what was done, for instance, the aim, number of participants, outcomes, and study
conclusion. However, it did not include information about the method that the
researcher approached.

In the Introduction section, the description of the patients has not contained enough
details to plan the clinical question because researcher does not provide a sufficient
context for a reader to follow all arguments and justifications. The research question
is stated but not specified enough because it did not mention the noise injury
concept, which increases the chance of inter-researcher confusion. The author
discussed his reason for focusing on the "real world" setting and explained the
scientific background and rationale for the reported investigation. Only a previous
study (Rice et al., 1987) is used to confirm the community setting, so it is considered
as an extension of previous research.

The author did not find every primary research article that might answer the research
question, and he did not select the best article available to answer the question.
Moreover, he did not justify his choice of the article, especially since the case of
listing level use of PSP is controversial. The author should justify his choice by
comparing the validity of research papers. Overall, the Introduction has identified the
gap in current knowledge by establishing relevance to it (e.g., this apparent risk/no
risk conflict gave rise to the current project.)

METHODS

In the method section, there are no subheadings, however still easy to follow. Also,
the paper did not present key elements of study design early. However, the
researcher has disclosed the reasons for choosing a quantitative observational
design (e.g. an objective measurement of the actual levels to which regular users of
PSPs set their players.) so that it is appropriate for the study's aims.

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The primary outcome of interest, "level of noise exposure", appears to measure

accurately using KEMAR torso and head fitted with a Zwislocki because it shows the
performance of an earpiece. In addition, it satisfies ANSI. Data collected via
questionnaire was an appropriate way to address the research aims. The ethical
approval of the questionnaire was not mentioned. Nevertheless, it may not be
considered a pre-request to publishing in the journal. According to the measurement
tool of background noise level, the researcher did not mention the measurement tool
while collecting the data, which will decrease research transparency. However, the
researcher insured why he chose a high environmental noise level and mentioned
the background noise level measurement (e.g. to represent the upper level of
exposure.)

Sample was picked by convenience and reported as being a random sample. Such a
sample of this type will not be representative and cause serious selection bias. Also,
information bias is susceptible because there is a tendency for participants to
provide what they assume to be socially acceptable answers rather than the truth.
Especially regarding Self-reporting hearing loss questions in the questionnaire (e.g.
Do you feel you have a hearing loss?)

The author did not use a statistical method to control confounding in the analysis so
that residual confounding may be present. Researcher described the location,
setting, and relevant dates, including periods of exposure and recruitment. The
Selection criteria were only one criterion but no information about the statistical
powers. The information reported regarding the subject was age, gender and
occupation. The author should examine the homogeneity to ensure if the samples
from each site will reflect the actual population of the study. The sample size (n=55)
was adequate because the primary outcome was measured is clearly defined.
However, he did not outline the p-value for significance.

RESULTS

The results section is easy to follow because no missing details, and it is logically
structured. Moreover, there is a relatively straightforward statement of findings in the
analysis. Figures 1, 2,3 and 5 present the distribution of participants in parallel to the
findings (e.g. 25% of the population classified as "at-risk level" as stated in figure 2

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thirteen participants above 85 dB). On the other hand, figures 4 and 6 could be more
appropriate to findings if he supports them with scatterplot figures because he used
a statistical relationship between variables (correlation). Furthermore, he did not
mention the correlation coefficient formula. Quantifying an association between two
variables using the correlation coefficient only tells half the story because it only
estimates the strength of a relationship in samples; consequently, he has to link it by
conducting a statistical significance test.

The researcher did not bring up the value of Pearson's correlation coefficient to
make an inference about the value ρ based on r (e.g. the calculated noise exposure
level concerning the number of years shows no statistically significant correlation).
The research mentioned that he excluded participants. However, that may affect the
accuracy of the analysis. The researcher should use a sensitivity analysis to enclose
different scenarios of inferences (e.g., the three subjects with frequent tinnitus were
not included).

DISCUSSION

The first paragraph of the discussion is highly linked to results. However, no

discussions are made for and against the researchers' suggestions. Moreover, there
are no supporting discussions, including the concept of correlation between the
variables in the results section and no reinforcing of results where the investigator
states from similar studies and other relevant evidence. The researcher has not
discussed the credibility of his findings to reduce intrinsic biases. In addition, there
are no comments about respondent validation.

CONCLUSION

The conclusion drawn from the study is nonrepresentative to the finding because it
concentrates on one group who falls above the level of risk without addressing
where other participants listening levels were and how long do they listen as the
research question addressed. The value of this research is limited due to the
selection of the sample, and the applicability (external validity) of the study findings
cannot be used more generally.