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Lampiran : bagian critical appraisal dalam EBM

JBI Critical Appraisal Checklist for Quasi-Experimental


Studies
(non-randomized experimental studies)

Reviewer : kelompok 6 Date : 17 Desember 2018

Author Year Record


Number

Yes No Unclear Not


applicable
1. Is it clear in the study what is the ‘cause’ and
what is the ‘effect’ (i.e. there is no confusion
about which variable comes first)?
Apakah jelas disebutkan dalam studi mengenai
√ □ □ □
apa sebab dan akibat nya ?
2. Were the participants included in any
comparisons similar?
Apakah subjek penelitian yang terlibat itu serupa
(diambil dari populasi yang sama)?
√ □ □ □
3. Were the participants included in any
comparisons receiving similar treatment/care,
other than the exposure or intervention of
interest?
Apakah subjek penelitian yang terlibat
mendapatkan perlakuan atau asuhan yang sama
√ □ □ □
disamping pemberian intervensi pada kelompok
perlakuan dan kelompok control ?
4. Was there a control group?
Apakah ada control grup ?
√ □ □ □
5. Were there multiple measurements of the

□ □ □
outcome both pre and post the
intervention/exposure? √
Apakah ada pengukuran berulang pada hasil pre
dan post test pada kedua kelompok ?
6. Was follow up complete and if not, were

□ □ □
differences between groups in terms of their
follow up adequately described and analyzed? √
Apakah follow up dilakukan sampai selesai ?
kalau tidak, apakah perbedaan hasil dari follow
up yang tidak dilanjutkan tersebut dijelaskan dan
dan dianalisis secara rinci / adekuat ?
7. Were the outcomes of participants included in

□ □ □
any comparisons measured in the same way?
Apakah pengukuran hasil penelitian pada kedua √
grup (pelakuan dan control) diukur dengan cara
yang sama ?

□ □ □
8. Were outcomes measured in a reliable way?
Apakah hasil penelitian diukur dengan √
pengukuran yang reliabel ?

□ □ □
9. Was appropriate statistical analysis used?
Apakah penelitian tersebut menggunakan analisa √
statistika yang tepat ?

Overall appraisal: Include √ Exclude □ □


Seek further info

Comments (Including reason for exclusion)

Jawaban yes telah dijelaskan dan dianalisis di bagian telaah jurnal, untuk poin 5
jawaban no, karena dalam penelitian tidak dilakukan pengukuran berulang secara
pre test dan post test, namun dengan pengukuran sekali selama post test (setelah
diberi intervensi) menggunakan partograf. Untuk poin 6 jawaban unclear karena
subjek penelitian yang tidak selesai di follow up dan mengalami drop out tidak
dijelaskan secara rinci mengenai alas an dan penjelasan subjek tersebut drop
out.Secara keseluruhan, jurnal tersebut masih mengandung hamper seluruh poin
penelaahan dan dapat diterima (diaplikasikan) namun dengan evaluasi lebih lanjut.
Explanation for the critical appraisal tool for Quasi-Experimental Studies
(experimental studies without random allocation)
How to cite: Tufanaru C, Munn Z, Aromataris E, Campbell J, Hopp L. Chapter 3:
Systematic reviews of effectiveness. In: Aromataris E, Munn Z (Editors). Joanna
Briggs Institute Reviewer's Manual. The Joanna Briggs Institute, 2017. Available
from https://reviewersmanual.joannabriggs.org/

Critical Appraisal Tool for Quasi-Experimental Studies


(experimental studies without random allocation)

Answers: Yes, No, Unclear or Not Applicable

1. Is it clear in the study what is the ‘cause’ and what is the ‘effect’ (i.e.
there is no confusion about which variable comes first)?
Ambiguity with regards to the temporal relationship of variables constitutes a
threat to the internal validity of a study exploring causal relationships. The
‘cause’ (the independent variable, that is, the treatment or intervention of
interest) should occur in time before the explored ‘effect’ (the dependent
variable, which is the effect or outcome of interest). Check if it is clear which
variable is manipulated as a potential cause. Check if it is clear which variable
is measured as the effect of the potential cause. Is it clear that the ‘cause’ was
manipulated before the occurrence of the ‘effect’?

2. Were the participants included in any comparisons similar?


The differences between participants included in compared groups constitute a
threat to the internal validity of a study exploring causal relationships. If there
are differences between participants included in compared groups there is a risk
of selection bias. If there are differences between participants included in the
compared groups maybe the ‘effect’ cannot be attributed to the potential ‘cause’,
as maybe it is plausible that the ‘effect’ may be explained by the differences
between participants, that is, by selection bias. Check the characteristics reported
for participants. Are the participants from the compared groups similar with
regards to the characteristics that may explain the effect even in the absence of
the ‘cause’, for example, age, severity of the disease, stage of the disease, co-
existing conditions and so on? [NOTE: In one single group pre-test/post-test
studies where the patients are the same (the same one group) in any pre-post
comparisons, the answer to this question should be ‘yes.’]
3. Were the participants included in any comparisons receiving similar
treatment/care, other than the exposure or intervention of interest?
In order to attribute the ‘effect’ to the ‘cause’ (the exposure or intervention of
interest), assuming that there is no selection bias, there should be no other
difference between the groups in terms of treatments or care received, other than
the manipulated ‘cause’ (the intervention of interest). If there are other exposures
or treatments occurring in the same time with the ‘cause’, other than the
intervention of interest, then potentially the ‘effect’ cannot be attributed to the
intervention of interest, as it is plausible that the ‘effect’ may be explained by
other exposures or treatments, other than the intervention of interest, occurring
in the same time with the intervention of interest. Check the reported exposures
or interventions received by the compared groups. Are there other exposures or
treatments occurring in the same time with the intervention of interest? Is it
plausible that the ‘effect’ may be explained by other exposures or treatments
occurring in the same time with the intervention of interest?

4. Was there a control group?


Control groups offer the conditions to explore what would have happened with
groups exposed to other different treatments, other than to the potential ‘cause’
(the intervention of interest). The comparison of the treated group (the group
exposed to the examined ‘cause’, that is, the group receiving the intervention of
interest) with such other groups strengthens the examination of the causal
plausibility. The validity of causal inferences is strengthened in studies with at
least one independent control group compared to studies without an independent
control group. Check if there are independent, separate groups, used as control
groups in the study. [Note: The control group should be an independent,
separate control group, not the pre-test group in a single group pre-test post-
test design.]

5. Were there multiple measurements of the outcome both pre and post the
intervention/exposure?
In order to show that there is a change in the outcome (the ‘effect’) as a result of
the intervention/treatment (the ‘cause’) it is necessary to compare the results of
measurement before and after the intervention/treatment. If there is no
measurement before the treatment and only measurement after the treatment is
available it is not known if there is a change after the treatment compared to
before the treatment. If multiple measurements are collected before the
intervention/treatment is implemented then it is possible to explore the
plausibility of alternative explanations other than the proposed ‘cause’ (the
intervention of interest) for the observed ‘effect’, such as the naturally occurring
changes in the absence of the ‘cause’, and changes of high (or low) scores
towards less extreme values even in the absence of the ‘cause’ (sometimes called
regression to the mean). If multiple measurements are collected after the
intervention/treatment is implemented it is possible to explore the changes of the
‘effect’ in time in each group and to compare these changes across the groups.
Check if measurements were collected before the intervention of interest was
implemented. Were there multiple pre-test measurements? Check if
measurements were collected after the intervention of interest was implemented.
Were there multiple post-test measurements?

6. Was follow up complete and if not, were differences between groups in


terms of their follow up adequately described and analyzed?
If there are differences with regards to the loss to follow up between the
compared groups these differences represent a threat to the internal validity of a
study exploring causal effects as these differences may provide a plausible
alternative explanation for the observed ‘effect’ even in the absence of the
‘cause’ (the treatment or exposure of interest). Check if there were differences
with regards to the loss to follow up between the compared groups. If follow up
was incomplete (that is, there is incomplete information on all participants),
examine the reported details about the strategies used in order to address
incomplete follow up, such as descriptions of loss to follow up (absolute
numbers; proportions; reasons for loss to follow up; patterns of loss to follow
up) and impact analyses (the analyses of the impact of loss to follow up on
results). Was there a description of the incomplete follow up (number of
participants and the specific reasons for loss to follow up)? If there are
differences between groups with regards to the loss to follow up, was there an
analysis of patterns of loss to follow up? If there are differences between the
groups with regards to the loss to follow up, was there an analysis of the impact
of the loss to follow up on the results?

7. Were the outcomes of participants included in any comparisons


measured in the same way?
If the outcome (the ‘effect’) is not measured in the same way in the compared
groups there is a threat to the internal validity of a study exploring a causal
relationship as the differences in outcome measurements may be confused with
an effect of the treatment or intervention of interest (the ‘cause’). Check if the
outcomes were measured in the same way. Same instrument or scale used? Same
measurement timing? Same measurement procedures and instructions?

8. Were outcomes measured in a reliable way?


Unreliability of outcome measurements is one threat that weakens the validity
of inferences about the statistical relationship between the ‘cause’ and the
‘effect’ estimated in a study exploring causal effects. Unreliability of outcome
measurements is one of different plausible explanations for errors of statistical
inference with regards to the existence and the magnitude of the effect
determined by the treatment (‘cause’). Check the details about the reliability of
measurement such as the number of raters, training of raters, the intra-rater
reliability, and the inter-raters reliability within the study (not to external
sources). This question is about the reliability of the measurement performed in
the study, it is not about the validity of the measurement instruments/scales used
in the study. [Note: Two other important threats that weaken the validity of
inferences about the statistical relationship between the ‘cause’ and the ‘effect’
are low statistical power and the violation of the assumptions of statistical tests.
These other threats are not explored within Question 8, these are explored within
Question 9.]

9. Was appropriate statistical analysis used?


Inappropriate statistical analysis may cause errors of statistical inference with
regards to the existence and the magnitude of the effect determined by the
treatment (‘cause’). Low statistical power and the violation of the assumptions
of statistical tests are two important threats that weakens the validity of
inferences about the statistical relationship between the ‘cause’ and the ‘effect’.
Check the following aspects: if the assumptions of statistical tests were
respected; if appropriate statistical power analysis was performed; if appropriate
effect sizes were used; if appropriate statistical procedures or methods were used
given the number and type of dependent and independent variables, the number
of study groups, the nature of the relationship between the groups (independent
or dependent groups), and the objectives of statistical analysis (association
between variables; prediction; survival analysis etc.).
ELEMEN DAN PERTANYAAN YA TIDAK
Masalah
 Sebutkan dan jelaskan secara singkat keseluruhan fenomena
yang menarik untuk studi yang diajukan. (mis., Depresi,

Perawatan Kesehatan, dan Lansia, dll.) Ringkas, apa masalah
minat yang terkait dengan fenomena minat Anda. Aspek apa
dari masalah yang diidentifikasi yang Anda rencanakan
untuk diatasi?
Kajian Literatur-Kerja Selesai Masalah
 Apa kata-kata yang Anda gunakan untuk mencari database yang
relevan? √
 Database apa yang Anda telusuri (mis., PubMed, CINAHL, dll)?
 Apa kekurangan dalam pekerjaan yang dilakukan hingga saat √
ini? Kembangkan ringkasan singkat tentang apa yang diketahui
tentang masalah penelitian dan apa kesenjangan pengetahuan
yang ada √
Desain & Metode yang Diusulkan
 Apa desain studi yang diajukan (misalnya, deskriptif,
korelasional, kuasi-eksperimental, eksperimental, metode √
campuran, dll.)?
 Jelaskan pengaturan dan sampel studi yang diusulkan. Jika studi
yang Anda usulkan memiliki intervensi, jelaskan perbandingan
dan kelompok kontrol. √
Tujuan Penelitian, Pertanyaan atau Hipotesis
 Apakah studi yang diusulkan termasuk tujuan, pertanyaan dan √
/ atau hipotesis? Jika demikian: Apa tujuannya?
 Apa pertanyaan penelitiannya? Apa hipotesisnya? √
 Buat daftar masing-masing variabel studi yang Anda √
rencanakan untuk diukur.
 Buat daftar definisi (gambar kata atau gambar mental) untuk √
setiap konsep studi yang diusulkan.*

 Berikan definisi operasional (yaitu, definisikan setiap konsep √


dalam hal pengamatan dan / atau kegiatan yang
mengukurnya) untuk setiap variabel yang akan diukur.*

 Apa pendekatan pengukuran yang diusulkan untuk setiap


variabel (fisiologis, kuesioner, skala, dll)? Apakah variabel √
perlu diukur terus menerus atau pada titik waktu tertentu?

 Apakah Anda mempertimbangkan langkah-langkah berulang √


dalam desain Anda?
 Akankah karakteristik tertentu dari populasi yang diteliti √
membatasi pada pendekatan pengukuran yang dapat
digunakan ? Jika ya, cantumkan karakteristik dan batas yang
terkait. (Contoh karakteristik tertentu adalah: usia, etnis,
diagnosis, bahasa, dll.)

 Apakah lebih dari satu pendekatan pengukuran (yaitu, √


fisiologis, kuesioner, dll) tersedia untuk mengukur setiap
variabel? Jika demikian daftar mereka.*

 Identifikasi pendekatan pengukuran dan metode untuk setiap √


variabel yang paling akurat dan tepat untuk populasi yang
Anda pelajari. Apakah mungkin untuk studi yang diusulkan
untuk dirancang untuk memasukkan lebih dari satu metode
pengukuran untuk masing-masing variabel sedang dipelajari?
Applicability
 Peneliti membahas kontribusi studi yang dibuat untuk
pengetahuan atau pemahaman misalnya: √
Pertimbangan temuan dalam kaitannya dengan arus latihan
atau kebijakan atau penelitian yang relevan
 Mengidentifikasi area penelitian baru dimana diperlukan √
 Peneliti telah membahas apakah penelitiannya bisa di transfer
ke populasi lain atau dianggap apakah penelitiannya dapat √
digunakan?

Sumber :
CASP, Critical Appraisal Skills Programme. 2018. Qualitative Ceklist 2018.
Diakes dari www.casp-uk.net
Kathleen, et all (2016) critical appraisal and selection of data collection
instruments : a step-by-step guide. Journal of Nursing Education and
Practice 2017, vol.7 No.3. DOI: 10.5430/jnep.v7n3p77
TELAAH JURNAL

A. Judul Jurnal
Efektivitas pelvic rocking exercises terhadap lama waktu persalinan pada
ibu primipara di Puskesmas wilayah Kabupaten Banjarnegara.

B. Telaah Step 1 (Fokus Penelitian Jelas)


1. Problem (Masalah)
Persalinan merupakan rangkaian proses yang berakhir dengan
pengeluaran hasil konsepsi oleh ibu (Varney,2007). Proses dinamika dari
persalinan meliputi empat faktor power, passage, passanger, psikis dan juga
tidak kalah pentingnya factor Penolong persalinan. Jika terdapat masalah
pada salah satu factor tersebut maka dapat menyebabkan kesulitan selama
persalinan (Walsh,2007; Purwaningsih, 2010). Persalinan lama menjadi
salah satu penyebab meningkatnya mortalitas dan morbiditas pada ibu
dan janin. Pada ibu dengan persalinan lama lebih berisiko terjadi
perdarahan karena atonia uteri, laserasi jalan lahir, infeksi.
Sedangkan pada janin dapat meningkatkan risiko asfiksia berat,
trauma cerebral, infeksi dan cedera akibat tindakan (Oxon &Forte, 2010;
Henderson, 2005). Dalam dua tahun terakhir kasus persalinan lama
mengalami peningkatan dikabupaten Banjarnegara. Pada tahun 2013
terdapat 168 kasus persalinan lama dari 1721 persalinan Tahun 2014
meningkat menjadi173 kasus persalinan lama dari 1692 persalinan
(10,1%). Dari data persalinan lama ˃40 % bersalin dengan seksio sesaria
(RM RSUD Banjarnegara, 2015). Intervensi yang sering dilakukan
diantaranya adalah induksi oksitosin, vakum ekstraksi dan secsio sesaria
dan dapat dipastikan intervensi ini meningkatkan morbiditas ibu dan bayi.
Hasil penelitian Xaiver Chang dkk (2007) menunjukan ibu primipara yang
mengalami persalinan kala II lama 57% persalinan dilakukan dengan SC
dan 85% penyebab persalinan kala II lama disebabkan oleh malposisi kepala
janin.
Penelitian lain yang dilakukan oleh Janni dkk (2002) mendapatkan
efek persalinan lama terjadi perdarahan lebih banyakyaitu 1,84 g/dl
dibandingkan dengan yang lama persalinan normal hanya 0,79 g/dl. Ibu
yang mengalami kala II lama lebih besar berisiko menjalani tindakan
persalinan dengan vacuum danforcep, cedera sefingter anal, demam
postpartum dan menyebabkan fetalasidosis (pH kurangdari 7,2) sehingga
bayi membutuhkan bantuan oksigen lebih banyak.
2. Intervensi: Pada Penelitian yang dilakukan yaitu pelvic rocking
3. Intervensi Pembanding: Tidak dilakukan pelvic rocking
4. Outcome (Hasil Penelitian): PRE atau Pelvic Rocking Exercise sangat
efektif dalam memperpendek lama kala I fase aktif dengan p-value 0,000
< α 0.05 dan efek size sebesar 0.6. PRE juga efektif dalam memperpendek
lama kala II dengan p-value 0.007 < α 0.05 dengan efek size sebesar 0.43.
Dari hasil penelitian disimpulkan bahwa PRE efektif memperpendek lama
kala I dan kala II persalinan pada primigravida.

C. Telaah Step 2 (Validitas)


1. Rekruitmen
a. Desain: Penelitian ini adalah quasi experiment dengan desain posttest
only control group.
b. Teknik sampling: teknik sampling dalam penelitian ini non probability
sampling secara purposive sampling.
c. Besar sample: Populasi 43 Responden.
d. Kriteria inklusi dan eksklusi: kriteria inkluasi yaitu
 Ibu primipara yang bersedia menjadi responden yang
melakukan ANC dan merencanakan persalinan di Puskesmas
Mandiraja I, Wanadadi I dan Kelampok I,
 usia ibu 20-35 tahun,
 tidak memiliki komplikasi kehamilan (non-risiko),
 Kehamilan tunggal dengan presentasi kepala,
 TFU tidak>dari 40 cm,
 LILA tidak>dari 23,5 cm dan
 Tinggi badan> 150 cm.
2. Maintenance (Bagaimana Intervensi diberikan)
Perlakuan Pelvic Rocking Execises dilaksanakan sesuai Standar Operating
Prosedur (SOP). PRE dilaksanakan dilaksanakan 2 kali dalam seminggu,
lama latihan 30 menit dengan total 8 pertemuan. Setiap pertemuan
sebelum dan selesai pelvic Rocking exercises dilakukan pencatatan
dampen dokument asian terhadap frekuensi denyut jantung dan tekanan
darah ibu hamil. Pengukuran efek pelvic Rocking exercises dengan
mengobservasi dan mencatat lama waktu persalinan kala I dan kala II yang
dibutuhkan oleh responden baik kelompok perlakuan maupun kelompok
kontrol. Pengukuran lama waktu persalinan Kala I diamati pada fase aktif
yaitu pembukaan 4-10 cm sedangkan lama waktu kala II diamati dari
pembukaan lengkap sampai bayi lahir. Pengukuran lama waktu
menggunakan stopwatch dan dicatat pada lembar observasi dan
partograf.
3. Measuremen (instrument dan cara pengukuran variable penelitian)
Instrumen yang digunakan adalah alat yang digunakan dalam
pengumpulan data dengan skala numeric dimana peneliti mendapat
keterangan atau pendirian secara lisan dari seseorang sasaran penelitian
(responden), atau bertemu langsung (face to face).
Pengukuran nyeri dilakukan dengan numeric rating scale. Analisis data
dilakukan dengan analisis univariat dan analisis bivariate. Analisis
bivariat dilakukan dengan menggunakan uji parametrik (paired t test). Uji
tersebut tidak disebutkan secara eksplisit di bagian metode penelitian, dan
hanya muncul pada bagian hasil penelitian.

D. Telaah Step 3 (Aplikabilitas)


Dalam memberikan asuhan kebidanan pada ibu hamil, tenaga kesehatan
dapat menerapkan pelvic rocking exercises sebagai salah satu latihan ibu hamil
dalam upaya mempersiapkan diri menghadap persalinan sehingga lama waktu
persalinan dapat lebih pendek.
Khususnya Puskesmas di Wilayah Kabupaten Banjarnegara dapat
menjadikan senam pelvic rocking exercise sebagai salah satu program yang
ada pada kelas ibu hamil dalam upaya memperpendek lama waktu
persalinan kala I dan lama waktu persalinan kala II.