What is Critical Appraisal?
Critical appraisal - the process of assessing and interpreting evidence by systematically considering its validity, results and relevance
Critical appraisal involves using a set of systematic techniques that enable you to evaluate the quality of published research including the research methodology, potential bias, strengths and weaknesses and, ultimately, its trustworthiness. It is often the case that even peer-reviewed research can have methodological flaws, incorrectly interpret data, draw incorrect conclusions or exaggerate findings. Authors' affiliations, funding sources, study design flaws, sample size and potential bias are only some of the factors that can lead you to include poor quality research in your own work if not addressed through critical appraisal. It is important to apply your own critical appraisal skills when you evaluate research studies to decide if they merit being considered or used as reliable sources of information.
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How to Read a Paper
EBM Pyramid
The use of the hierarchy of evidence pyramid is not enough to determine the quality of research because study types can vary in quality whether it is a systematic review or a case study therefore critical appraisal skills are required to evaluate all types of evidence regardless of their level.
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Critical Appraisal Checklists
Choosing an appraisal tool can be overwhelming, particularly if your review will include multiple study designs. In these cases, you can use a different existing tool for each methodology, or create your own tool that will sufficiently assess multiple methodologies. The most important aspect of this step is to ensure some kind of evaluation of the trustworthiness of the evidence is conducted.
- NLM list of tools to evaluate health info
- CASP - checklists for RCTs, systematic reviews and a variety of studies
- JBI - checklists for RCTs, systematic reviews and a variety of studies
- AMSTAR 2 - systematic reviews
- GRADE - a methodology and web-based platform for conducting quality evaluations
- CRAAP - Elmira College
- CUT - University of Denver
- Checklists - from a variety of sources
It is important therefore that you possess a good knowledge of research methods in your field of study and a good basic understanding of statistics where statistical analysis is involved.
Hierarchy of Evidence
The hierarchy of evidence pyramid provides a means to visualize the levels of evidence as well as the amount of evidence available. Systematic reviews and meta-analyses are the highest level of evidence therefore they are at the top of the pyramid but they are also the least common because they are based on the studies below them. Moving down the pyramid, the amount of studies increases but the level of evidence decreases.