What process provides a careful appraisal of a research studys strengths as well as weaknesses?

A valid piece of research truly measures what it sets out to measure.

To give valid results, a piece of research needs to:

•     have clear objectives
•     include methodology to minimise bias
•     draw the appropriate conclusions from the data.

How do we critically appraise the literature?

The following questions may be asked to appraise the validity of research:

1. What is the research question? Are the objectives of the study clearly stated? Why was this research necessary?

2. Is the research original or important? Does the study have new findings? Is a treatment outcome clinically relevant?

3. Does the research question consider the following:

•     the group or population of patients
•     the intervention or therapy
•     the outcome.

4. Did the authors use the relevant type of study for the research question?

5. Did the study design minimise the risk of bias in its methodology, reporting and patient selection? Did the study use best practice design such as a randomised controlled trial or a systematic review? Blinding of patients and outcome assessors, randomization, concealment, intention-to-treat analysis, similarity of patients for known prognostic factors, and completeness of follow-up are indicators of validity.

6. Was the study designed in line with the original protocol? Is the focus of the report in keeping with the study objectives? Were changes made to the inclusion or exclusion criteria?

7. Has the study's hypothesis been tested?

8. Is the analysis of the data accurate? What level of uncertainty surrounds any results?

9. Are the conclusions based on the data and analysis? Do the authors draw conclusions that are supported by the data? Have the authors discussed other work that both supports and contradicts their findings? Have the authors identified any limitations to their study?

10. Does the study contribute to the understanding of the problem being investigated? What are the strengths and limitations of the study? Are the findings of the study useful for clinical practice? Do the risks of a treatment or diagnostic procedure outweigh the potential benefits?

Remember that while general principles apply, critical appraisal may be a little different for each type of study.

Summary and Introduction

Summary

Critical appraisal is a systematic process used to identify the strengths and weaknesses of a research article in order to assess the usefulness and validity of research findings. The most important components of a critical appraisal are an evaluation of the appropriateness of the study design for the research question and a careful assessment of the key methodological features of this design. Other factors that also should be considered include the suitability of the statistical methods used and their subsequent interpretation, potential conflicts of interest and the relevance of the research to one's own practice. This Review presents a 10-step guide to critical appraisal that aims to assist clinicians to identify the most relevant high-quality studies available to guide their clinical practice.

Introduction

To practice evidence-based medicine, clinicians need to apply the findings of scientific research to the circumstances of individual patients as part of their clinical decision-making process. Clinicians, therefore, must be able to select and appraise scientific literature that is relevant to their field, understand the implications of research findings for individual patients, elicit patients' own preferences and develop an appropriate management plan based on the combination of this information. Each of these tasks presents its own challenges, but the sheer volume of medical literature means that the first step (that of selecting and appraising scientific evidence) can be daunting. The number of new medical research articles published each year continually increases, and more than 12,000 new articles, including papers on in excess of 300 randomized controlled trials (RCTs), are added to the MEDLINE database each week.[1,2] One practical way that clinicians can manage this 'information overload'[2] is to develop efficient skills in critical appraisal, which enable them focus on only the highest-quality studies that will guide their clinical practice and to extrapolate information when necessary from studies of less rigorous design if high-quality trials are unavailable.

Critical appraisal has been defined as the "...application of rules of evidence to a study to assess the validity of the data, completeness of reporting, methods and procedures, conclusions, compliance with ethical standards, etc. The rules of evidence vary with circumstances."[3] Although the methodological criteria by which the validity of a study is assessed will vary according to its design, some general principles underpin the evaluation of any research study. Various guidelines and assessment tools have been developed to provide a structured approach to the process of critical appraisal for clinicians.[4,5,6,7,8,9,10,11,12,13,14]

Despite the plethora of documents available to guide the process, no 'gold-standard' instrument for critical appraisal exists. The criteria used to assess the validity and relevance of scientific literature are not static; they must evolve with improvements in understanding of the important sources of bias inherent in different study designs, and increased awareness of the potential influence of other nonmethodological factors, such as conflicts of interest.[15] A structured approach to critical appraisal could potentially improve the quality of this process, and simple checklists can be useful to screen out research that is of low quality or of little relevance.[16] This Review presents a guide to the critical-appraisal process.

What process provides a careful appraisal of a research study's strengths as well as weaknesses?

Which steps of the critique process focus on the identification of the strengths and weaknesses of a study?

What is a critical appraisal process?

When performing a critical appraisal of a research study which aspects of the research study is the nurse judging?