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• Published: 31 January 2022

The fundamentals of critically appraising an article

• Sneha Chotaliya 1  

BDJ Student volume  29 ,  pages 12–13 ( 2022 ) Cite this article

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Sneha Chotaliya

We are often surrounded by an abundance of research and articles, but the quality and validity can vary massively. Not everything will be of a good quality - or even valid. An important part of reading a paper is first assessing the paper. This is a key skill for all healthcare professionals as anything we read can impact or influence our practice. It is also important to stay up to date with the latest research and findings.

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Chambers R, 'Clinical Effectiveness Made Easy', Oxford: Radcliffe Medical Press , 1998

Loney P L, Chambers L W, Bennett K J, Roberts J G and Stratford P W. Critical appraisal of the health research literature: prevalence or incidence of a health problem. Chronic Dis Can 1998; 19 : 170-176.

Brice R. CASP CHECKLISTS - CASP - Critical Appraisal Skills Programme . 2021. Available at: https://casp-uk.net/casp-tools-checklists/ (Accessed 22 July 2021).

White S, Halter M, Hassenkamp A and Mein G. 2021. Critical Appraisal Techniques for Healthcare Literature . St George's, University of London.

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Chotaliya, S. The fundamentals of critically appraising an article. BDJ Student 29 , 12–13 (2022). https://doi.org/10.1038/s41406-021-0275-6

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Critical Appraisal of Clinical Research

Azzam al-jundi.

1 Professor, Department of Orthodontics, King Saud bin Abdul Aziz University for Health Sciences-College of Dentistry, Riyadh, Kingdom of Saudi Arabia.

Salah Sakka

2 Associate Professor, Department of Oral and Maxillofacial Surgery, Al Farabi Dental College, Riyadh, KSA.

Evidence-based practice is the integration of individual clinical expertise with the best available external clinical evidence from systematic research and patient’s values and expectations into the decision making process for patient care. It is a fundamental skill to be able to identify and appraise the best available evidence in order to integrate it with your own clinical experience and patients values. The aim of this article is to provide a robust and simple process for assessing the credibility of articles and their value to your clinical practice.

Introduction

Decisions related to patient value and care is carefully made following an essential process of integration of the best existing evidence, clinical experience and patient preference. Critical appraisal is the course of action for watchfully and systematically examining research to assess its reliability, value and relevance in order to direct professionals in their vital clinical decision making [ 1 ].

Critical appraisal is essential to:

• Combat information overload;
• Identify papers that are clinically relevant;
• Continuing Professional Development (CPD).

Carrying out Critical Appraisal:

Assessing the research methods used in the study is a prime step in its critical appraisal. This is done using checklists which are specific to the study design.

Standard Common Questions:

• What is the research question?
• What is the study type (design)?
• Selection issues.
• What are the outcome factors and how are they measured?
• What are the study factors and how are they measured?
• What important potential confounders are considered?
• What is the statistical method used in the study?
• Statistical results.
• What conclusions did the authors reach about the research question?
• Are ethical issues considered?

The Critical Appraisal starts by double checking the following main sections:

I. Overview of the paper:

• The publishing journal and the year
• The article title: Does it state key trial objectives?
• The author (s) and their institution (s)

The presence of a peer review process in journal acceptance protocols also adds robustness to the assessment criteria for research papers and hence would indicate a reduced likelihood of publication of poor quality research. Other areas to consider may include authors’ declarations of interest and potential market bias. Attention should be paid to any declared funding or the issue of a research grant, in order to check for a conflict of interest [ 2 ].

II. ABSTRACT: Reading the abstract is a quick way of getting to know the article and its purpose, major procedures and methods, main findings, and conclusions.

• Aim of the study: It should be well and clearly written.
• Materials and Methods: The study design and type of groups, type of randomization process, sample size, gender, age, and procedure rendered to each group and measuring tool(s) should be evidently mentioned.
• Results: The measured variables with their statistical analysis and significance.
• Conclusion: It must clearly answer the question of interest.

III. Introduction/Background section:

An excellent introduction will thoroughly include references to earlier work related to the area under discussion and express the importance and limitations of what is previously acknowledged [ 2 ].

-Why this study is considered necessary? What is the purpose of this study? Was the purpose identified before the study or a chance result revealed as part of ‘data searching?’

-What has been already achieved and how does this study be at variance?

-Does the scientific approach outline the advantages along with possible drawbacks associated with the intervention or observations?

IV. Methods and Materials section : Full details on how the study was actually carried out should be mentioned. Precise information is given on the study design, the population, the sample size and the interventions presented. All measurements approaches should be clearly stated [ 3 ].

V. Results section : This section should clearly reveal what actually occur to the subjects. The results might contain raw data and explain the statistical analysis. These can be shown in related tables, diagrams and graphs.

VI. Discussion section : This section should include an absolute comparison of what is already identified in the topic of interest and the clinical relevance of what has been newly established. A discussion on a possible related limitations and necessitation for further studies should also be indicated.

Does it summarize the main findings of the study and relate them to any deficiencies in the study design or problems in the conduct of the study? (This is called intention to treat analysis).

• Does it address any source of potential bias?
• Are interpretations consistent with the results?
• How are null findings interpreted?
• Does it mention how do the findings of this study relate to previous work in the area?
• Can they be generalized (external validity)?
• Does it mention their clinical implications/applicability?
• What are the results/outcomes/findings applicable to and will they affect a clinical practice?
• Does the conclusion answer the study question?
• -Is the conclusion convincing?
• -Does the paper indicate ethics approval?
• -Can you identify potential ethical issues?
• -Do the results apply to the population in which you are interested?
• -Will you use the results of the study?

Once you have answered the preliminary and key questions and identified the research method used, you can incorporate specific questions related to each method into your appraisal process or checklist.

1-What is the research question?

For a study to gain value, it should address a significant problem within the healthcare and provide new or meaningful results. Useful structure for assessing the problem addressed in the article is the Problem Intervention Comparison Outcome (PICO) method [ 3 ].

P = Patient or problem: Patient/Problem/Population:

It involves identifying if the research has a focused question. What is the chief complaint?

E.g.,: Disease status, previous ailments, current medications etc.,

I = Intervention: Appropriately and clearly stated management strategy e.g.,: new diagnostic test, treatment, adjunctive therapy etc.,

C= Comparison: A suitable control or alternative

E.g.,: specific and limited to one alternative choice.

O= Outcomes: The desired results or patient related consequences have to be identified. e.g.,: eliminating symptoms, improving function, esthetics etc.,

The clinical question determines which study designs are appropriate. There are five broad categories of clinical questions, as shown in [ Table/Fig-1 ].

[Table/Fig-1]:

Categories of clinical questions and the related study designs.

2- What is the study type (design)?

The study design of the research is fundamental to the usefulness of the study.

In a clinical paper the methodology employed to generate the results is fully explained. In general, all questions about the related clinical query, the study design, the subjects and the correlated measures to reduce bias and confounding should be adequately and thoroughly explored and answered.

Participants/Sample Population:

Researchers identify the target population they are interested in. A sample population is therefore taken and results from this sample are then generalized to the target population.

The sample should be representative of the target population from which it came. Knowing the baseline characteristics of the sample population is important because this allows researchers to see how closely the subjects match their own patients [ 4 ].

Sample size calculation (Power calculation): A trial should be large enough to have a high chance of detecting a worthwhile effect if it exists. Statisticians can work out before the trial begins how large the sample size should be in order to have a good chance of detecting a true difference between the intervention and control groups [ 5 ].

• Is the sample defined? Human, Animals (type); what population does it represent?
• Does it mention eligibility criteria with reasons?
• Does it mention where and how the sample were recruited, selected and assessed?
• Does it mention where was the study carried out?
• Is the sample size justified? Rightly calculated? Is it adequate to detect statistical and clinical significant results?
• Does it mention a suitable study design/type?
• Is the study type appropriate to the research question?
• Is the study adequately controlled? Does it mention type of randomization process? Does it mention the presence of control group or explain lack of it?
• Are the samples similar at baseline? Is sample attrition mentioned?
• All studies report the number of participants/specimens at the start of a study, together with details of how many of them completed the study and reasons for incomplete follow up if there is any.
• Does it mention who was blinded? Are the assessors and participants blind to the interventions received?
• Is it mentioned how was the data analysed?
• Are any measurements taken likely to be valid?

Researchers use measuring techniques and instruments that have been shown to be valid and reliable.

Validity refers to the extent to which a test measures what it is supposed to measure.

(the extent to which the value obtained represents the object of interest.)

• -Soundness, effectiveness of the measuring instrument;
• -What does the test measure?
• -Does it measure, what it is supposed to be measured?
• -How well, how accurately does it measure?

Reliability: In research, the term reliability means “repeatability” or “consistency”

Reliability refers to how consistent a test is on repeated measurements. It is important especially if assessments are made on different occasions and or by different examiners. Studies should state the method for assessing the reliability of any measurements taken and what the intra –examiner reliability was [ 6 ].

3-Selection issues:

The following questions should be raised:

• - How were subjects chosen or recruited? If not random, are they representative of the population?
• - Types of Blinding (Masking) Single, Double, Triple?
• - Is there a control group? How was it chosen?
• - How are patients followed up? Who are the dropouts? Why and how many are there?
• - Are the independent (predictor) and dependent (outcome) variables in the study clearly identified, defined, and measured?
• - Is there a statement about sample size issues or statistical power (especially important in negative studies)?
• - If a multicenter study, what quality assurance measures were employed to obtain consistency across sites?
• - Are there selection biases?
• • In a case-control study, if exercise habits to be compared:
• - Are the controls appropriate?
• - Were records of cases and controls reviewed blindly?
• - How were possible selection biases controlled (Prevalence bias, Admission Rate bias, Volunteer bias, Recall bias, Lead Time bias, Detection bias, etc.,)?
• • Cross Sectional Studies:
• - Was the sample selected in an appropriate manner (random, convenience, etc.,)?
• - Were efforts made to ensure a good response rate or to minimize the occurrence of missing data?
• - Were reliability (reproducibility) and validity reported?
• • In an intervention study, how were subjects recruited and assigned to groups?
• • In a cohort study, how many reached final follow-up?
• - Are the subject’s representatives of the population to which the findings are applied?
• - Is there evidence of volunteer bias? Was there adequate follow-up time?
• - What was the drop-out rate?
• - Any shortcoming in the methodology can lead to results that do not reflect the truth. If clinical practice is changed on the basis of these results, patients could be harmed.

Researchers employ a variety of techniques to make the methodology more robust, such as matching, restriction, randomization, and blinding [ 7 ].

Bias is the term used to describe an error at any stage of the study that was not due to chance. Bias leads to results in which there are a systematic deviation from the truth. As bias cannot be measured, researchers need to rely on good research design to minimize bias [ 8 ]. To minimize any bias within a study the sample population should be representative of the population. It is also imperative to consider the sample size in the study and identify if the study is adequately powered to produce statistically significant results, i.e., p-values quoted are <0.05 [ 9 ].

4-What are the outcome factors and how are they measured?

• -Are all relevant outcomes assessed?
• -Is measurement error an important source of bias?

5-What are the study factors and how are they measured?

• -Are all the relevant study factors included in the study?
• -Have the factors been measured using appropriate tools?

Data Analysis and Results:

- Were the tests appropriate for the data?

- Are confidence intervals or p-values given?

• How strong is the association between intervention and outcome?
• How precise is the estimate of the risk?
• Does it clearly mention the main finding(s) and does the data support them?
• Does it mention the clinical significance of the result?
• Is adverse event or lack of it mentioned?
• Are all relevant outcomes assessed?
• Was the sample size adequate to detect a clinically/socially significant result?
• Are the results presented in a way to help in health policy decisions?
• Is there measurement error?
• Is measurement error an important source of bias?

Confounding Factors:

A confounder has a triangular relationship with both the exposure and the outcome. However, it is not on the causal pathway. It makes it appear as if there is a direct relationship between the exposure and the outcome or it might even mask an association that would otherwise have been present [ 9 ].

6- What important potential confounders are considered?

• -Are potential confounders examined and controlled for?
• -Is confounding an important source of bias?

7- What is the statistical method in the study?

• -Are the statistical methods described appropriate to compare participants for primary and secondary outcomes?
• -Are statistical methods specified insufficient detail (If I had access to the raw data, could I reproduce the analysis)?
• -Were the tests appropriate for the data?
• -Are confidence intervals or p-values given?
• -Are results presented as absolute risk reduction as well as relative risk reduction?

Interpretation of p-value:

The p-value refers to the probability that any particular outcome would have arisen by chance. A p-value of less than 1 in 20 (p<0.05) is statistically significant.

• When p-value is less than significance level, which is usually 0.05, we often reject the null hypothesis and the result is considered to be statistically significant. Conversely, when p-value is greater than 0.05, we conclude that the result is not statistically significant and the null hypothesis is accepted.

Confidence interval:

Multiple repetition of the same trial would not yield the exact same results every time. However, on average the results would be within a certain range. A 95% confidence interval means that there is a 95% chance that the true size of effect will lie within this range.

8- Statistical results:

• -Do statistical tests answer the research question?

Are statistical tests performed and comparisons made (data searching)?

Correct statistical analysis of results is crucial to the reliability of the conclusions drawn from the research paper. Depending on the study design and sample selection method employed, observational or inferential statistical analysis may be carried out on the results of the study.

It is important to identify if this is appropriate for the study [ 9 ].

• -Was the sample size adequate to detect a clinically/socially significant result?
• -Are the results presented in a way to help in health policy decisions?

Clinical significance:

Statistical significance as shown by p-value is not the same as clinical significance. Statistical significance judges whether treatment effects are explicable as chance findings, whereas clinical significance assesses whether treatment effects are worthwhile in real life. Small improvements that are statistically significant might not result in any meaningful improvement clinically. The following questions should always be on mind:

• -If the results are statistically significant, do they also have clinical significance?
• -If the results are not statistically significant, was the sample size sufficiently large to detect a meaningful difference or effect?

9- What conclusions did the authors reach about the study question?

Conclusions should ensure that recommendations stated are suitable for the results attained within the capacity of the study. The authors should also concentrate on the limitations in the study and their effects on the outcomes and the proposed suggestions for future studies [ 10 ].

• -Are the questions posed in the study adequately addressed?
• -Are the conclusions justified by the data?
• -Do the authors extrapolate beyond the data?
• -Are shortcomings of the study addressed and constructive suggestions given for future research?
• -Bibliography/References:

Do the citations follow one of the Council of Biological Editors’ (CBE) standard formats?

10- Are ethical issues considered?

If a study involves human subjects, human tissues, or animals, was approval from appropriate institutional or governmental entities obtained? [ 10 , 11 ].

Critical appraisal of RCTs: Factors to look for:

• Allocation (randomization, stratification, confounders).
• Follow up of participants (intention to treat).
• Data collection (bias).
• Sample size (power calculation).
• Presentation of results (clear, precise).
• Applicability to local population.

[ Table/Fig-2 ] summarizes the guidelines for Consolidated Standards of Reporting Trials CONSORT [ 12 ].

[Table/Fig-2]:

Summary of the CONSORT guidelines.

Critical appraisal of systematic reviews: provide an overview of all primary studies on a topic and try to obtain an overall picture of the results.

In a systematic review, all the primary studies identified are critically appraised and only the best ones are selected. A meta-analysis (i.e., a statistical analysis) of the results from selected studies may be included. Factors to look for:

• Literature search (did it include published and unpublished materials as well as non-English language studies? Was personal contact with experts sought?).
• Quality-control of studies included (type of study; scoring system used to rate studies; analysis performed by at least two experts).
• Homogeneity of studies.

[ Table/Fig-3 ] summarizes the guidelines for Preferred Reporting Items for Systematic reviews and Meta-Analyses PRISMA [ 13 ].

[Table/Fig-3]:

Summary of PRISMA guidelines.

Critical appraisal is a fundamental skill in modern practice for assessing the value of clinical researches and providing an indication of their relevance to the profession. It is a skills-set developed throughout a professional career that facilitates this and, through integration with clinical experience and patient preference, permits the practice of evidence based medicine and dentistry. By following a systematic approach, such evidence can be considered and applied to clinical practice.

Financial or other Competing Interests

Introduction to Critical Appraisal : Quantitative Research

Dec 26, 2011

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Introduction to Critical Appraisal : Quantitative Research. South East London Outreach Librarians January 2008. Learning objectives. Understand the principles of critical appraisal and its role in evidence based practice Be able to appraise quantitative research and judge its validity

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• cohort studies
• health professionals
• retrospective
• different types
• odds ratios
• case control

Presentation Transcript

Introduction to Critical Appraisal : Quantitative Research South East London Outreach Librarians January 2008

Learning objectives • Understand the principles of critical appraisal and its role in evidence based practice • Be able to appraise quantitative research and judge its validity • Be able to assess the relevance of published research to your own work

Daily Mail exercise • Would you treat a patient based on this article? Why? • Validity • Reliability • Transferable to practice

What is evidence based practice? Evidence-based practice is the integration of • individual clinical expertise with the • best available external clinical evidence from systematic research and • patient’s values and expectations

The evidence-based practice process. • Decision or question arising from a patient’s care. • Formulate a focused question. • Search for the best evidence. • Appraise the evidence. • Apply the evidence.

Why does evidence from research fail to get into practice? • 75% cannot understand the statistics • 70% cannot critically appraise a research paper • Using research for Practice: a UK experience of the barriers scale. Dunn, V. et al.

What is critical appraisal? • Weighing up evidence to see how useful it is in decision making • Balanced assessment of benefits and strengths of research against its flaws and weaknesses • Assess research process and results • Skill that needs to be practiced by all health professionals as part of their work

What critical appraisal is NOT • Negative dismissal of any piece of research • Assessment of results alone • Based entirely on statistical analysis • Only to be undertaken by researchers/ statisticians

Why do we need to critically appraise? • “It usually comes as a surprise to students to learn that some (the purists would say 99% of) published articles belong in the bin and should not be used to inform practice” (Greenhalgh 2001) • Find that 1% - save time and avoid information overload

How do I appraise? • Mostly common sense. • You don’t have to be a statistical expert! • Checklists help you focus on the most important aspects of the article. • Different checklists for different types of research. • Will help you decide if research is valid and relevant.

Quantitative Uses numbers to describe and analyse Useful for finding precise answers to defined questions Qualitative Uses words to describe and analyse Useful for finding detailed information about people’s perceptions and attitudes Research methods

Levels of quantitative evidence. (In order of decreasing scientific validity.) • Systematic reviews. • Randomized controlled trials. • Prospective studies (cohort studies). • Retrospective studies (case control). • Case series and reports • Opinions of respected authorities.

Systematic Reviews. • Thorough search of literature carried out. • All RCTs (or other studies) on a similar subject synthesised and summarised. • Meta-analysis to combine statistical findings of similar studies.

Randomised Controlled Trials (RCTs) • Normal treatment/placebo versus new treatment. • Participants are randomised. • If possible should be double-blinded. • Intention to treat analysis

Cohort studies • prospective • groups (cohorts) • exposure to a risk factor • followed over a period of time • compare rates of development of an outcome of interest • Confounding factors and bias

Case control studies • Retrospective • Subjects confirmed with a disease (cases) are compared with non-diseased subjects (controls) in relation to possible past exposure to a risk factor. • Confounding factors and bias

Appraising original research Are the results valid? • Is the research question focused? • Was the method appropriate? • How was it conducted, e.g. randomisation, blinding, recruitment and follow up? What are the results? • How was data collected and analysed? • Are they significant? Will the results help my work with patients?

Appraising systematic reviews. In addition to the above: • Was a thorough literature search carried out ? • Publication bias - papers with more ‘interesting’ results are more likely to be: • Submitted for publication • Accepted for publication • Published in a major journal • Published in the English language

Reviews in general medical journals • 50 reviews in 4 major journals 1985-6 • No statement of methods • Summary inappropriate • “Current systematic reviews do not routinely use scientific methods to identify, assess and synthesise information” (Mulrow, 1987)

Is the research question focused? • Patient (e.g. child) • Intervention (e.g. MMR vaccine) • Comparison (e.g. single vaccines) • Outcome (e.g. autism)

Are results significant? • How was data collected? • Which statistical analyses were used? • How precise are the results? • How are the results presented?

Intention to treat analyses • Analysing people, at the end of the trial, in the groups to which they were randomised, even if they did not receive the intended intervention

Statistical analyses Odds ratios, absolute and relative risks/benefits • The likelihood of something happening vs the likelihood of something not happening Numbers needed to treat (NNT) • The number of people you would need to treat to see one additional occurrence of a specific beneficial outcome

Odds Ratio Diagrams. (Blobbograms or Forest Plots.)

Odds Ratio Diagrams • Line of no effect – no difference between treatment and control group • Result (blob) to the Left of the line of no effect = Less of the outcome in the treatment group. • Result to the Right of the line = More of the outcome. • BUT - Is the outcome good or bad?

Cardiac deaths – Less = good

Smoking cessation – More = good

Confidence Intervals. • Longer confidence interval = less confident of results – wider range. • Shorter confidence interval = more confident – narrower range. • Crosses line of no effect/no significance =Inconclusive results.

Confidence intervals

P Values. • P stands for probability - how likely is the result to have occurred by chance? • P value of less than 0.05 means likelihood of results being due to chance is less than 1 in 20 = “statistically significant”. • P values and confidence intervals should be consistent

Number Needed to Treat • The number of people you would need to treat to see one additional occurrence of a specific beneficial outcome. • The number of patients that need to be treated to prevent one bad outcome. • The NNT can be calculated by finding the Absolute Risk Reduction (ARR)

Events or outcomes are used for reporting results. The event rate is the proportion of patients in a group in whom the event is observed

CER and EER • Control Event Rate (CER) is the proportion of patients in the control group in whom an event is observed. CER = c/(c+d) • Experimental Event Rate (EER) is the proportion of patients in the experimental in whom an event is observed. EER = a/(a+b)

AAR & NNT • Absolute Risk Reduction is the difference between the Control Event Rate (CER) and the Experimental Event Rate (EER). ARR = CER – EER • Number needed to treat (NNT) NNT = 1/ARR

Outcome event Total Yes No Experimental group 3 7 10 Control group 5 5 10 Total 8 12 20

Answers • What is the event ? • Lack of concentration and sleeping • What is the control event rate (CER)? • 5/10 = 0.50 • What is the experimental event rate (EER)? • 3/10 = 0.30 • Calculate the absolute risk reduction (ARR) • 0.50 – 0.30 = 0.20 • What is the number needed to treat (NNT)? • 1.00/0.20 = 5

Are results relevant? • Can I apply these results to my own practice? • Is my local setting significantly different? • Are these findings applicable to my patients? • Are findings specific/detailed enough to be applied? • Were all outcomes considered?

The good news! • Some resources have already been critically appraised for you. • An increasing number of guidelines and summaries of appraised evidence are available on the internet.

Summary. • Search for resources that have already been appraised first, e.g. Guidelines, Cochrane systematic reviews. • Search down through levels of evidence, e.g. systematic reviews, RCTs. • Use checklists to appraise research. • How can these results be put into practice?

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Critical Appraisal for Health Students

• Critical Appraisal of a qualitative paper
• Critical Appraisal: Help
• Critical Appraisal of a quantitative paper
• Useful resources

Appraisal of a Qualitative paper : Top tips

• Introduction

Critical appraisal of a qualitative paper

This guide aimed at health students, provides basic level support for appraising qualitative research papers. It's designed for students who have already attended lectures on critical appraisal. One framework  for appraising qualitative research (based on 4 aspects of trustworthiness) is  provided and there is an opportunity to practise the technique on a sample article.

Support Materials

• Framework for reading qualitative papers
• Critical appraisal of a qualitative paper PowerPoint

To practise following this framework for critically appraising a qualitative article, please look at the following article:

Schellekens, M.P.J.  et al  (2016) 'A qualitative study on mindfulness-based stress reduction for breast cancer patients: how women experience participating with fellow patients',  Support Care Cancer , 24(4), pp. 1813-1820.

Critical appraisal of a qualitative paper: practical example.

• Credibility
• Transferability
• Dependability
• Confirmability

How to use this practical example 

Using the framework, you can have a go at appraising a qualitative paper - we are going to look at the following article: 

Step 1.  take a quick look at the article, step 2.  click on the credibility tab above - there are questions to help you appraise the trustworthiness of the article, read the questions and look for the answers in the article. , step 3.   click on each question and our answers will appear., step 4.    repeat with the other aspects of trustworthiness: transferability, dependability and confirmability ., questioning the credibility:, who is the researcher what has been their experience how well do they know this research area, was the best method chosen what method did they use was there any justification was the method scrutinised by peers is it a recognisable method was there triangulation ( more than one method used), how was the data collected was data collected from the participants at more than one time point how long were the interviews were questions asked to the participants in different ways, is the research reporting what the participants actually said were the participants shown transcripts / notes of the interviews / observations to ‘check’ for accuracy are direct quotes used from a variety of participants, how would you rate the overall credibility, questioning the transferability, was a meaningful sample obtained how many people were included is the sample diverse how were they selected, are the demographics given, does the research cover diverse viewpoints do the results include negative cases was data saturation reached, what is the overall transferability can the research be transferred to other settings , questioning the dependability :, how transparent is the audit trail can you follow the research steps are the decisions made transparent is the whole process explained in enough detail did the researcher keep a field diary is there a clear limitations section, was there peer scrutiny of the researchwas the research plan shown to peers / colleagues for approval and/or feedback did two or more researchers independently judge data, how would you rate the overall dependability would the results be similar if the study was repeated how consistent are the data and findings, questioning the confirmability :, is the process of analysis described in detail is a method of analysis named or described is there sufficient detail, have any checks taken place was there cross-checking of themes was there a team of researchers, has the researcher reflected on possible bias is there a reflexive diary, giving a detailed log of thoughts, ideas and assumptions, how do you rate the overall confirmability has the researcher attempted to limit bias, questioning the overall trustworthiness :, overall how trustworthy is the research, further information.

See Useful resources  for links, books and LibGuides to help with Critical appraisal.

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• Last Updated: Aug 25, 2023 2:48 PM
• URL: https://libguides.tees.ac.uk/critical_appraisal

Medicine: A Brief Guide to Critical Appraisal

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• A Brief Guide to Critical Appraisal
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Have you ever seen a news piece about a scientific breakthrough and wondered how accurate the reporting is? Or wondered about the research behind the headlines? This is the beginning of critical appraisal: thinking critically about what you see and hear, and asking questions to determine how much of a 'breakthrough' something really is.

The article " Is this study legit? 5 questions to ask when reading news stories of medical research " is a succinct introduction to the sorts of questions you should ask in these situations, but there's more than that when it comes to critical appraisal. Read on to learn more about this practical and crucial aspect of evidence-based practice.

What is Critical Appraisal?

Critical appraisal forms part of the process of evidence-based practice. “ Evidence-based practice across the health professions ” outlines the fives steps of this process. Critical appraisal is step three:

• Ask a question
• Access the information
• Appraise the articles found
• Apply the information

Critical appraisal is the examination of evidence to determine applicability to clinical practice. It considers (1) :

• Are the results of the study believable?
• Was the study methodologically sound?  
• What is the clinical importance of the study’s results?
• Are the findings sufficiently important? That is, are they practice-changing?  
• Are the results of the study applicable to your patient?
• Is your patient comparable to the population in the study?

Why Critically Appraise?

If practitioners hope to ‘stand on the shoulders of giants’, practicing in a manner that is responsive to the discoveries of the research community, then it makes sense for the responsible, critically thinking practitioner to consider the reliability, influence, and relevance of the evidence presented to them.

While critical thinking is valuable, it is also important to avoid treading too much into cynicism; in the words of Hoffman et al. (1):

… keep in mind that no research is perfect and that it is important not to be overly critical of research articles. An article just needs to be good enough to assist you to make a clinical decision.

How do I Critically Appraise?

Evidence-based practice is intended to be practical . To enable this, critical appraisal checklists have been developed to guide practitioners through the process in an efficient yet comprehensive manner.

Critical appraisal checklists guide the reader through the appraisal process by prompting the reader to ask certain questions of the paper they are appraising. There are many different critical appraisal checklists but the best apply certain questions based on what type of study the paper is describing. This allows for a more nuanced and appropriate appraisal. Wherever possible, choose the appraisal tool that best fits the study you are appraising.

Like many things in life, repetition builds confidence and the more you apply critical appraisal tools (like checklists) to the literature the more the process will become second nature for you and the more effective you will be.

How do I Identify Study Types?

Identifying the study type described in the paper is sometimes a harder job than it should be. Helpful papers spell out the study type in the title or abstract, but not all papers are helpful in this way. As such, the critical appraiser may need to do a little work to identify what type of study they are about to critique. Again, experience builds confidence but having an understanding of the typical features of common study types certainly helps.

To assist with this, the Library has produced a guide to study designs in health research .

The following selected references will help also with understanding study types but there are also other resources in the Library’s collection and freely available online:

• The “ How to read a paper ” article series from The BMJ is a well-known source for establishing an understanding of the features of different study types; this series was subsequently adapted into a book (“ How to read a paper: the basics of evidence-based medicine ”) which offers more depth and currency than that found in the articles. (2)  
• Chapter two of “ Evidence-based practice across the health professions ” briefly outlines some study types and their application; subsequent chapters go into more detail about different study types depending on what type of question they are exploring (intervention, diagnosis, prognosis, qualitative) along with systematic reviews.  
• “ Clinical evidence made easy ” contains several chapters on different study designs and also includes critical appraisal tools. (3)  
• “ Translational research and clinical practice: basic tools for medical decision making and self-learning ” unpacks the components of a paper, explaining their purpose along with key features of different study designs. (4)  
• The BMJ website contains the contents of the fourth edition of the book “ Epidemiology for the uninitiated ”. This eBook contains chapters exploring ecological studies, longitudinal studies, case-control and cross-sectional studies, and experimental studies.

Reporting Guidelines

In order to encourage consistency and quality, authors of reports on research should follow reporting guidelines when writing their papers. The EQUATOR Network is a good source of reporting guidelines for the main study types.

While these guidelines aren't critical appraisal tools as such, they can assist by prompting you to consider whether the reporting of the research is missing important elements.

Once you've identified the study type at hand, visit EQUATOR to find the associated reporting guidelines and ask yourself: does this paper meet the guideline for its study type?

Which Checklist Should I Use?

Determining which checklist to use ultimately comes down to finding an appraisal tool that:

• Fits best with the study you are appraising
• Is reliable, well-known or otherwise validated
• You understand and are comfortable using

Below are some sources of critical appraisal tools. These have been selected as they are known to be widely accepted, easily applicable, and relevant to appraisal of a typical journal article. You may find another tool that you prefer, which is acceptable as long as it is defensible:

• CASP (Critical Appraisal Skills Programme)
• JBI (Joanna Briggs Institute)
• CEBM (Centre for Evidence-Based Medicine)
• SIGN (Scottish Intercollegiate Guidelines Network)
• STROBE (Strengthing the Reporting of Observational Studies in Epidemiology)
• BMJ Best Practice

The information on this page has been compiled by the Medical Librarian. Please contact the Library's Health Team ( [email protected] ) for further assistance.

Reference list

1. Hoffmann T, Bennett S, Del Mar C. Evidence-based practice across the health professions. 2nd ed. Chatswood, N.S.W., Australia: Elsevier Churchill Livingston; 2013.

2. Greenhalgh T. How to read a paper : the basics of evidence-based medicine. 5th ed. Chichester, West Sussex: Wiley; 2014.

3. Harris M, Jackson D, Taylor G. Clinical evidence made easy. Oxfordshire, England: Scion Publishing; 2014.

4. Aronoff SC. Translational research and clinical practice: basic tools for medical decision making and self-learning. New York: Oxford University Press; 2011.

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CRITICAL APPRAISAL OF SCIENTIFIC LITERATURE

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Presentation on theme: "CRITICAL APPRAISAL OF SCIENTIFIC LITERATURE"— Presentation transcript:

Critical Reading Strategies: Overview of Research Process

Dr Ronni Michelle Greenwood Autumn  Introduction  Method  Results  Discussion.

Anatomy Laboratory Write up Emulate standard Scientific Paper (few exceptions)

Writing for Publication

8. Evidence-based management Step 3: Critical appraisal of studies

Introduction to Research Methodology

Reading the Dental Literature

The material was supported by an educational grant from Ferring How to Write a Scientific Article Nikolaos P. Polyzos M.D. PhD.

Dissemination and Critical Evaluation of Published Research Peg Bottjen, MPA, MT(ASCP)SC.

Research Proposal Development of research question

Topics - Reading a Research Article Brief Overview: Purpose and Process of Empirical Research Standard Format of Research Articles Evaluating/Critiquing.

Module 5 Writing the Results and Discussion (Chapter 3 and 4)

Critique of Research Outlines: 1. Research Problem. 2. Literature Review. 3. Theoretical Framework. 4. Variables. 5. Hypotheses. 6. Design. 7. Sample.

SCIENTIFIC ARTICLE WRITING Professor Charles O. Uwadia At the Conference.

All about Empirical Research Articles What’s in them and how to read them… Developed by Debbie Lahav and Elana Spector-Cohen.

Critical Appraisal of an Article by Dr. I. Selvaraj B. SC. ,M. B. B. S

Dr. Alireza Isfandyari-Moghaddam Department of Library and Information Studies, Islamic Azad University, Hamedan Branch

How to Critically Review an Article

DR. AHMAD SHAHRUL NIZAM ISHA

About project

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Best Practice for Literature Searching

• Literature Search Best Practice
• What is literature searching?
• What are literature reviews?
• Hierarchies of evidence
• 1. Managing references
• 2. Defining your research question
• 3. Where to search
• 4. Search strategy
• 5. Screening results
• 6. Paper acquisition
• 7. Critical appraisal
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What is critical appraisal?

We critically appraise information constantly, formally or informally, to determine if something is going to be valuable for our purpose and whether we trust the content it provides.

In the context of a literature search, critical appraisal is the process of systematically evaluating and assessing the research you have found in order to determine its quality and validity. It is essential to evidence-based practice.

More formally, critical appraisal is a systematic evaluation of research papers in order to answer the following questions:

• Does this study address a clearly focused question?
• Did the study use valid methods to address this question?
• Are there factors, based on the study type, that might have confounded its results?
• Are the valid results of this study important?
• What are the confines of what can be concluded from the study?
• Are these valid, important, though possibly limited, results applicable to my own research?

What is quality and how do you assess it?

In research we commissioned in 2018, researchers told us that they define ‘high quality evidence’ by factors such as:

• Publication in a journal they consider reputable or with a high Impact Factor.
• The peer review process, coordinated by publishers and carried out by other researchers.
• Research institutions and authors who undertake quality research, and with whom they are familiar.

In other words, researchers use their own experience and expertise to assess quality.

However, students and early career researchers are unlikely to have built up that level of experience, and no matter how experienced a researcher is, there are certain times (for instance, when conducting a systematic review) when they will need to take a very close look at the validity of research articles.

There are checklists available to help with critical appraisal.  The checklists outline the key questions to ask for a specific study design.  Examples can be found in the  Critical Appraisal  section of this guide, and the Further Resources section.  

You may also find it beneficial to discuss issues such as quality and reputation with:

• Your principal investigator (PI)
• Your supervisor or other senior colleagues
• Journal clubs. These are sometimes held by faculty or within organisations to encourage researchers to work together to discover and critically appraise information.
• Topic-specific working groups

The more you practice critical appraisal, the quicker and more confident you will become at it.

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