Physical Activity in Pregnant Women: Bed Rest and Preterm Delivery

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Table of Contents

Abstract
Introduction
Methods
Results
Discussion/Implications for Practice
Overall Presentation and Final Summary
Reference

Abstract

This paper is a quantitative critique of an article written to assess the link between bed rest and preterm delivery. The first section explores the research problem, the justification of the study and its importance to nursing, the conceptual framework, and the organization of the literature review. The second part discusses the methods used for the research including the study design, sampling, study protocol, data collection instruments, threats to internal and external validity, and approval by the relevant instructional review board. The results section presents the sample characteristics, the type of data collected, data analysis procedures, and a brief summary of the findings. The discussion section shows how the authors relate the findings to the study’s purpose, limitations of the study, and implications for practice. The last section is an overall presentation and the final summary of the study.

Introduction

The research problem was clearly stated in the paper. According to the authors, bed rest or other forms of activity restrictions are common practices used among pregnant mothers to avoid preterm birth. However, there is insufficient data to support the efficacy of this practice. Therefore, the authors sought to address this problem by quantitatively assessing whether physical activity restriction would affect preterm birth, which underscores the research problem. The justification for this study is that bed rest is a widely used obstetrical practice despite the paucity of data supporting its efficacy. Reduced physical activity during pregnancy is associated with some deleterious effects such as depression and stress, which might affect the wellbeing of the unborn child. Therefore, this study is justified as it established whether pregnant women should be put on bed rest.

The study’s aim is stated, which was to assess whether physical activity is associated with preterm birth among pregnant women at high risk for preterm delivery. The authors did not give a theoretical or conceptual framework, but it could be implied from the study. Determining the association between bed rest and preterm birth would contribute significantly to evidence-based nursing practice among obstetricians, which underscores the conceptual framework. The framework is linked directly to the research purpose because they both seek to address the same issue of assessing the link between bed rest and preterm delivery. The research literature reviewed in the study is a mixture of both old and current sources even though the literature review section is missing. Throughout the paper, the authors referenced 33 sources, and 9 were published over 10 years before the publication of the current study. The rest were published after 2010, and thus they would be considered current.

The literature review is organized logically with sources used in areas where they offer relevant support to the claims being made. Additionally, the literature review adequately supports the need for the study. For example, the authors referenced past studies, which had not shown a statistically significant difference in the risk of miscarriage among pregnant women placed under bed rest and the control group. Moreover, the authors used the literature review to show that the current evidence does not refute or support bed rest as an approach to reducing preterm birth. Consequently, the authors used the literature review to highlight gaps in knowledge hence the need for the study.

Methods

The design used for this research was a prospective cohort study. The design fits the purpose of the study because it allowed the authors to observe the study subjects over a given period to determine the impact of activity level on preterm birth. In other words, the study design allowed the authors to meet the study’s objectives. The design is linked to the sampling method and statistical analysis by allowing the authors to select the appropriate participants – pregnant women with a high risk of preterm birth. The design is also linked to the statistical analysis as it allowed the analysis of the different data sets. The sample is adequately and clearly described in the article.

The sample size included 49 pregnant women, who were recruited at a tertiary care center from 2014 to 2016. The sampling procedure is discussed in detail. The inclusion criterion included women at high risk for preterm delivery specifically between 24 and 32 weeks of gestation. Additionally, for a pregnant woman to qualify as a participant, she was supposed to be diagnosed with a short cervix or cervical distension. Additionally, those admitted for assessment in the high-risk unit of the care center were considered. According to Zemet et al. (2018), the exclusion criteria included “1. Preterm labor; 2. Clinical signs or symptoms of chorioamnionitis; 3. Preterm premature rupture of membranes (PPROM); 4. Medically indicated preterm birth; 5. Pregnancies complicated with congenital anomalies or chromosomal abnormalities; 6. fetal death” (p. 3). However, the authors did not provide justification for the size of the sample.

The study protocol involved assessing the physical activity level among the selected participants using the smart-band activity tracker. The participants were required to wear the tracker continuously for at least a week and one weekend and a maximum of 3 weeks. A designated email account for every participant was created and synchronized with the tracker for monitoring. The participants were not given any specific information concerning the level of activity that they were supposed to have during the study. Data was not withdrawn from the email until the end of the study, and thus both the participants and researchers were blinded to the collected information. A smart band activity tracker was used as the instrument for data collection, and it measured the concept that it was intended to measure, which was the level of physical activity among the participants. The concept definition is consistent with the operational definition of physical activity.

The authors presented information on the reliability and validity of the instrument used for this study. The validity of the tracker was determined using 20 pregnant women in the US, who were not involved in the current study. To assess the validity of the tracker, “Absolute step-count measurements were compared using the Wilcoxon Signed-Rank Test. The relative agreement between pedometer-derived step-counts and smart-band activity tracker was examined by determination of the Spearman rank correlation coefficient” (Zemet et al., 2018, p. 4). To address threats to internal and external validity inherent in the study design, the participants and the researchers were blinded to the collected data. Additionally, the participants were not required to follow a certain routine, but lead their normal day-to-day lives. The Institutional Review Board at the Sheba Medical Center approved the study and all the participants provided written informed consent, but the authors did not indicate any ethical concerns. The study is described with enough details for replication especially given that the design allowed for the appropriate hypothesis testing. Additionally, the instrument used was validated and reliable to give ascertainable results.

Results

The characteristics of the sample are described adequately. For example, the specific conditions that all participants were required to meet before being admitted for the study are described in detail in the inclusion-exclusion criterion. The research questions were not stated; however, the research purpose was addressed in the article. The data collected was on the physical activity of the selected participants. The physical activity was measured by recording the number of steps taken by the involved women per day. Information about when the participants delivered was also recorded. Several data analysis procedures were used to answer the research questions. First, the Shapiro-Wilk or Kolmogorov-Smirnov tests were used to determine the normality of the data. Additionally, the Student’s t-test and Mann-Whitney U tests were used to compare unrelated variables, while The Chi-square and Fisher’s exact tests compared categorical variables. Pearson and Spearman’s rank correlations were used to determine the correlation between variables. Finally, logistic regression analysis was used to “determine which factors were significantly and independently correlated with preterm delivery” (Zemet et al., 2018, p. 4).

Tables and graphs were used to present data. For example, a graph was plotted to show the relationship between physical activity (the number of steps) and preterm and term births. The text supplements the data in the tables by discussing the meaning of different variables as presented. Tables were also used to summarize the text’s contents for better understanding and interpretation of the data. The results showed that bed rest does not have any effect on preterm delivery. This finding implies that pregnant women placed under bed rest are at risk of experiencing the negative effects associated with the same, such as depression, stress, and anxiety, without getting any alleged benefits of preventing preterm birth.

Discussion/Implications for Practice

The authors related the findings to the study’s purpose. The results showed that there is no link between bed rest and preterm births, which was the purpose of the study. The findings of the current study are consistent with results from previous studies. For example, two studies from the Cochrane review had shown that reduced physical activity does not contribute to preterm birth. Another Cochrane review involving 1266 participants had shown the same results. The authors did not discuss findings that conflict with previous work. However, the authors noted that such studies were missing in the literature.

On limitations of the study, it involved a small sample size and the participants were drawn from a single care center, thus the results may not be generalizable in other populations. Additionally, the study was observational and thus it precluded comments on causality in the association between preterm births and the level of physical activity. The new research that emerged from this article is the need to carry out a large-scale study to establish the association between physical activity and preterm births. This new study is important given that over 95 percent of obstetricians recommend bed rest to pregnant women without enough evidence on the importance of that practice. The current research might not be potentially used in nursing practice because it was a pilot study involving a small number of participants.

Overall Presentation and Final Summary

The title accurately describes the type of the study (quantitative assessment), major variables (physical activity and risk of preterm birth), and target population (pregnant women with high risk for preterm delivery). The abstract accurately represents the study. The authors divided the abstract into different sections, such as objective, methods, results, and conclusion, with each summarizing the respective information of the article’s body contents. The report is logically consistent, as it starts by stating a research problem and gives detailed information on how the research was carried out to accomplish the set objectives. The writing style is clear and concise, as the authors used simple language that can be understood by readers from diverse backgrounds.

Reference

Zemet, R., Schiff, E., Manovitch, Z., Cahan, T., Yoeli-Ullman, R., Brandt, B., … Mazaki-Tovi, S. (2018). Quantitative assessment of physical activity in pregnant women with sonographic short cervix and the risk for preterm delivery: A prospective pilot study. PloS One, 13(6), 1-13. Web.

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