Appraise the evidence
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The Appraisal[edit | edit source]
After we have searched for the evidence, we need to decide if it is both valid and important before deciding if we can apply the evidence to our individual patients. The order in which we consider validity and importance depends on individual preference.
The third step of evidence based practice, critical appraisal is the systematic evaluation of clinical research papers in order to establish:
- Does this study address a clearly focused question?
- Did the study use valid methods to address this question?
- Are the valid results of this study important?
- Are these valid, important results applicable to my patient or population?
If the answer to any of these questions is “no”, you can save yourself the trouble of reading the rest of it.
The following questions are appropriate to appraise the literature:
Are the results of the study valid?
Primary Guides:
- Was the assignment of patients to treatments randomized?
- Were all patients who entered the trial properly accounted for and attributed at its conclusion?
- Was follow up complete?
- Were patients analyzed in the groups to which they were randomized?
Secondary Guides:
- Were patients, health workers, and study personnel "blind" to treatment?
- Were the groups similar at the start of the trial?
- Aside from the experimental intervention, were the groups treated equally?
What were the results?
- How large was the treatment effect?
- How precise was the estimate of the treatment effect?
Will the results help me in caring for my patients?
- Can the results be applied to my patient care?
- Were all clinically important outcomes considered?
- Are the likely treatment benefits worth the potential harms and costs?
Critical Appraisal Worksheets[edit | edit source]
These critical appraisal worksheets from the centre for evidence based medicine are very useful:
- Systematic Review Critical Appraisal Sheet
- Diagnosis Critical Appraisal Sheet
- Prognosis Critical Appraisal Sheet
- Therapy / RCT Critical Appraisal Sheet
Resources
[edit | edit source]
The Pedro Tutorial is designed to help readers of clinical trials differentiate those trials which are likely to be valid from those that might not be. It also looks briefly at how therapists might use the findings of properly performed studies to make clinical decisions. The PEDro scale is a valid measure of the methodological quality of clinical trials. DeMorton (2009) suggests it is valid to sum PEDro scale item scores to obtain a total score that can be treated as interval level measurement and subjected to parametric statistical analysis[1].
Understand Levels and Grades of evidence with our related page
Understand simple statistics with our Test Diagnostics page
Recent Related Research (from Pubmed)[edit | edit source]
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References[edit | edit source]
References will automatically be added here, see adding references tutorial.
- ↑ de Morton NA (2009). The PEDro scale is a valid measure of the methodological quality of clinical trials: a demographic study, Australian Journal Physiotherapy, 55(2), 129-133
