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Introduction
The article, Physical Examination Findings Among Children and Adolescents With Obesity: An Evidence-Based Review, by Armstrong, S. et al. seeks to address the issue of physical examination of children who suffer from obesity, a harmful condition which affects a third of US children (Armstrong, et al., 2016, p. 1). Researchers evaluate the current evidence on the value of targeted physical examination of children and adolescents who suffer from obesity and include their own recommendations based on the data available.
The research question and the main issue researched in the review, the founding of the review
Childhood and adolescent obesity is an increasingly recognized public health problem which spread like an epidemic in the past several decades. Despite recent efforts to reduce childhood obesity, at least 12.7 million children and adolescents in the US are obese (Ogden, Carroll, Kit, & Flegal, 2014, p. 806). Childhood obesity is also associated with a variety of health complications including coronary heart disease, musculoskeletal disorders, and depression, which can lead to future disability and lower quality of life (Health Risks, n.d.).
Although there were clinical recommendations concerning the screening and counseling of obese children and adolescents, evidence-based research of physical examination was limited. Armstrong and her colleagues aimed to analyze the available physical examination findings and use them to create a framework for the clinician which can help to manage obesity and related diseases. Specifically, the researchers gathered and evaluated evidence on key physical examination elements, such as dental caries, elevated resting heart rate, papilledema, etc., to assess their prevalence and answer the question what information can they provide to the clinician in relation to managing childhood obesity as well as improving the patients quality of life. No external funding for the review was provided (Armstrong, et al., 2016, p. 10).
The elements of the review, its results, and its validity
There are the following elements to this review:
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Abstract;
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Background;
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Methods;
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Analysis of the evidence;
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Summary;
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Acknowledgments;
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Disclaimer.
The researchers used the following process to gather evidence: they searched PubMed and Cochrane databases for English-language articles which contained relevant terms such as obesity and were published since 1975 (Armstrong, et al., 2016, p. 1). Only articles which described clinical exam or exam findings in association with obesity were included. The final results of this evidence-based review are as follows.
Obesity contributes to a variety of conditions, which can be diagnosed through a physical examination at the early stage in order to prevent complications and improve the quality of life (Armstrong, et al., 2016, p. 2). These conditions include hypertension and tachycardia, papilledema, dental caries, Acanthosis Nigricans, skin conditions such as hirsutism, acne, intertrigo, and pannus, and any abdominal pain.
Due to the correlation between height velocity and increased BMI, it should be carefully monitored (Armstrong, et al., 2016, p. 2). The same applies to tonsillar size, which should be examined to avoid associated complications. Gynecomastia should be monitored since it can be treated non-surgically only until the age of 18 (Armstrong, et al., 2016, p. 5). The assessment of musculoskeletal conditions is needed when pain or abnormalities are present.
The abnormalities include slipped capital femoral epiphysis, genu valgum/varum, pes planus, scoliosis, and gait (Armstrong, et al., 2016). The psychological health of children and adolescents with obesity should be carefully monitored due to the evidence which supported the connection between depression and increased BMI. There was insufficient data to support the routine examination of such elements as neck circumference, Cervicodorsal Hump, and inconspicuous penis. Therefore, these elements of physical examination are of limited value (Armstrong, et al., 2016).
The strengths and limitations of the review, the accomplishment of the objective
The biggest strength of this evidence-based review is the approach toward data collection. The search query used by the researchers, the choice of two reputable databases, and a wide time range meant the evidence was scientifically valid and statistically significant due to the large sample size. The all-encompassing approach meant that many different examination elements were included in the review. This fact makes Physical Examination Findings Among Children and Adolescents With Obesity: An Evidence-Based Review a comprehensive resource on the topic of physical examination of children and adolescents with childhood obesity, includes the analysis of underlying conditions causes and provides strategies for prevention based on the evidence available.
Since a large pool of valid, relevant studies was examined, the scientific validity of the results is high. In addition, when describing particular conditions and their symptoms, the researchers provide insight into whether they are a side effect of a particular medication or the result of another underlying condition. The weakness of this evidence-based review lies in the limited goal pursued by the researchers. Although a large pool of data was analyzed, no actual screening recommendations were provided.
The researchers did not use the large pool of data to create actual clinical guidelines. Nonetheless, the team of researchers did achieve its objective of analyzing the available data and using it to formulate clinically relevant recommendations, albeit their work is the first step towards future research of the value of different physical examination elements of children and adolescents suffering from obesity.
Critical thoughts of the review, the implementation of its findings in my work as a registered nurse
I believe that the evidence-based approach is applicable not only for health services research but also for making educated diagnostic decisions. The evidence-based approach means using the best available clinical evidence to make informed decisions (Romana, 2006). The role of a nurse is essential when diagnosing obesity and related complications in children and adolescents, and in order to provide better quality diagnosis, I have to consult the current best evidence on which physical examination elements are to be performed routinely, and which are of limited significance. All nurses are committed to further advancing medical science by implementing research evidence in their work (LoBiondo-Wood, & Haber, 2014, p. 7).
This fact means that as a nurse, I must be a knowledgeable consumer of research and use it in medical practice. The information from Physical Examination Findings Among Children and Adolescents With Obesity: An Evidence-Based Review is scientifically valid and could help me during the physical examination of children and adolescents suffering from obesity. I could implement the researchers findings by consulting their evidence when assessing a particular complication in a patient with obesity. The information provided in the review will help me better understand the need for further evaluation and treatment if a particular symptom is present. The evidence-based review also helps raise awareness on the issues of childhood obesity and the associated complications.
Conclusion
The review succeeds at providing a comprehensive analysis of the best available data to evaluate the current clinical practice of physical examination of children and adolescents suffering from obesity. The researchers provide their expert opinion on which elements of physical examination are of value and use clinical evidence to support their arguments. The researchers also highlight which elements of physical examination are of limited value and should be routinely performed in pediatric practice.
References
Armstrong, S., Lazorick, S., Hampl, S., Skelton, J., Wood, C., Collier, D., & Perrin, E. (2016). Physical Examination Findings Among Children and Adolescents With Obesity: An Evidence-Based Review. Pediatrics, 137(2), 1-15. Web.
Health Risks. (n.d.). Web.
LoBiondo-Wood, G., & Haber, J. (2014). Nursing Research: Methods and Critical Appraisal for Evidence-Based Practice. Amsterdam, Netherlands: Elsevier Health Sciences.
Ogden C., Carroll M., Kit B., Flegal K. (2014). Prevalence of childhood and adult obesity in the United States, 2011-2012. Journal of the American Medical Association, 311(8), 806-814. Web.
Romana, H. (2006). Is Evidence-Based Medicine Patient-Centered and Is Patient-Centered Care Evidence-Based? Health Services Research Journal, 41(1), 1-8. Web.
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