How to Critically Appraise a Paper

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How to critically appraise a paper

How to review a paper1
Checklist for a qualitative research paper3
Checklist for material provided by a pharmaceutical company representative4 Checklist for a paper that claims to validate a diagnostic or screening test4 Checklist for a set of clinical guidelines4

Checklist for a systematic review or meta-analysis4
Checklist for an economic analysis5
Checklist for health care organisations working towards an evidence based culture for clinical and purchasing decisions5 Checklist for searching Medline or the Cochrane library6

How to review a paper

Determine what a paper is about

• Why was the study done (what clinical question did it examine)? • Is there a clear description of the problem
• Is the study useful and relevant to General Practice • If the study is conducted in a hospital environment, can the results be interpreted in a general practice situation • Was the study design appropriate to the broad field of research examined (therapy, diagnosis, screening, prognosis, causation)? • What type of study was done?

- Primary research (experiment, randomised controlled trial, other controlled clinical trial, cohort study, case-control study, cross sectional survey, longitudinal survey, case report, or case series)? - Secondary research (simple overview, systematic review, meta-analysis, decision analysis, guideline development, economic analysis)? • Was the study ethical?

- Are there are any ethical objections to the design or reporting of the study • Is there a review of the literature
• Is the writing style easily understood
• Is the paper was well laid out and easy to follow

Paper methodology

• The design of the study is consistent with the aims
- Observational studies - qualitative, by interviewing - Observational studies - quantitative, obtain baseline values - Retrospective studies - information from past events - Prospective studies - following events as they happen - Experimental Studies – e.g. randomized control trial • Was the design of the study sensible?

• Was the study original?
• Who is the study about?
• The sample of the study is representative of the population as a whole • How were subjects recruited?
• Are controls needed in the study
- If a cohort, case-control, or other non-randomised comparative study were the controls appropriate? • Who was included in and who was excluded from the study? • The methods of selecting cases and controls is defined well • Were the subjects studied in “real life” circumstances? • What intervention or other manoeuvre was being considered? • Details of the study such as numbers, time intervals, statistical test used are clear and appropriate • The questionnaire and proformas are appropriate and relevant to the study • Was the study adequately controlled?

• If a “randomised trial” was randomisation truly random? • Were the groups comparable in all important aspects except for the variable being studied? • What outcome(s) were measured and how?

• Was assessment of outcome (or, in a case-control study, allocation of caseness) “blind”? • Are there sources of bias in the setting of the subjects • Have confounding influences and multiple influences been removed • Was the study large enough and continued for long enough, and was follow up complete enough, to make the results credible?

Statistical aspects of a paper

• Have the authors set the scene correctly?
❖ Have they determined whether their groups are comparable and, if necessary, adjusted for baseline differences? ❖ What sort of data have they got and have they used appropriate statistical tests? ❖ If the statistical tests in the paper are obscure why have the authors chosen to use them? ❖ Have the data been...
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