STEP 3 - QUANTITATIVE CRITICAL APPRAISAL TOOLS



STEP 3 - QUANTITATIVE CRITICAL APPRAISAL TOOLS

A PROCESS INSTRUCTION CHART FOR SPECIALISTS AND MANAGERS

Introduction

This process chart for Quantitative Critical Appraisal Tools has been designed to assist Specialists and Managers/Supervisors within Peel Public Health in choosing the appropriate critical appraisal tool to assess research literature.

This document describes the hierarchy of evidence, provides recommended critical appraisal tools and describes the process for starting your critical appraisal of the evidence. This document does not describe how to critically appraise grey literature. Critical appraisal of qualitative literature is described under the “Qualitative Critical Appraisal Tools – A Process Instruction Chart for Specialists and Managers”.

There are many levels of evidence as shown in Figure 1 entitled the “Hierarchy of Evidence”. Ideally, it is best to obtain evidence from summaries, synopses of syntheses, and syntheses. Sometimes, however, there is only evidence available from either single studies or from synopses of single studies. Searching through the literature for this type of evidence can be time consuming. The stop sign shown in this hierarchy of evidence means that staff should consult with their Manager/Supervisor and the Librarian to discuss whether it is appropriate to conduct a search and evaluate the research evidence at this level.

It should be noted that research may be published in peer reviewed journals or it may be found on websites. Some research will have very strong methodological requirements for document review and some will not.

What is the process for Critical Appraisal?

• Using the literature search you conducted in Step 2 – Searching the Evidence, obtain the full text articles from your search.

• Discuss the result of the literature search with your Manager/Supervisor to determine whether you have the right number of studies.

• Critically appraise the research studies starting with the most recent article by following the instructions in this document – Step 3. Please note, after you critically appraise your studies, you will be required to provide the completed critical appraisal documents to your Manager/Supervisor along with the other documents described in Steps 4 to 6.

• Create a data extraction table as outlined in Step 4 – Data Extraction for Systematic Reviews using the sample table as a guide. Use RefWorks or other software if possible. This table is required for the final 1:2:20 Report – Step 6 – Literature Review Report Template.

Note to Managers/Supervisors: Critical appraisal requires reading the article at least twice. Please ensure enough time is allowed for this process.

HIERARCHY OF EVIDENCE

SYSTEM

A system provides public health professionals with information to guide an intervention or action. It can also be defined as a decision support service that matches information from individual patients with the best evidence from research that applies (Haynes, 2007).

Examples of systems includes practice guidelines, decision pathways, or evidence based summaries of a public health practice (NCCMT – compendium document)

Example of source: Computerized decision support systems (CDSS)

What do I Use to Critically Appraise?

The critical appraisal of systems is not required for Public Health since no such system currently exists for the public health setting.

SUMMARY

A summary includes clinical pathways or textbook summaries that integrate evidence-based information about specific clinical problems and provide regular updating.

Examples of sources include: Clinical Practice Guidelines and Evidence-Based Textbooks

Tools for Critical Appraisal

AGREE:

SIGN:

SYNOPSIS OF SYNTHESIS

A synopsis of syntheses is also referred to as a summary of systematic reviews. This type of systematic review summarizes the systematic review with key methodologic details and results required to apply the evidence (Haynes, 2001)

Examples of sources include: Healthevidence.ca, Evidence-based abstract journals, CDC ranked sites

Tools for Critical Appraisal

CASP:

SYNTHESIS OR SYSTEMATIC REVIEW

A synthesis, also referred to as a systematic review is a systematic consolidation of the research evidence on a specific topic. It provides public health professionals with all the evidence that addresses a focused public health question (NCCMT – compendium document)

Examples of sources of systematic reviews include: Cochrane Library Reviews, Campbell Collaboration Reviews

Critical Appraisal Tools

CASP:

AMSTAR:

(tool can be downloaded from this article)

Health-Evidence.ca: and Dictionary to go with the tool:

SYNOPSES (SUMMARIES) OF SINGLE STUDIES

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NOTE! The critical appraisal of single studies should only be conducted under the following circumstances:

• When a new single study has come out and is adding important information to an existing review that has not been updated with the new study or evidence.

• When there is not enough or no evidence available from a higher level of the hierarchy of evidence (i.e., no available or no relevant summaries, synopses of synthesis or synthesis on your PICO and you have deemed it appropriate to search for single studies).

A synopses or a summary of a single study provides a brief summary of individual studies with key methodologic details and results required to apply the evidence (Haynes, 2001 and NCCMT compendium document).

Examples of sources include: Evidence-based abstract journals

Tools for Critical Appraisal

Randomized Control Trials

CASP:

Cohort Studies

CASP:

Case Control Studies

CASP:

SINGLE STUDIES

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NOTE! The critical appraisal of single studies should only be conducted under the following circumstances:

• When a new single study has come out and is adding important information to an existing review that has not been updated with the new study or evidence.

• When there is not enough or no evidence available from a higher level of the hierarchy of evidence (i.e., no available or no relevant summaries, synopses of synthesis or synthesis on your PICO and you have deemed it appropriate to search for single studies).

A single study article describes the methods, analysis and results for one individual study. Single studies contribute to clinical decisions if no higher level of preprocessed evidence is available.

Examples of sources for single studies include: PubMed clinical queries, CINAHL clinical queries

Critical Appraisal Tools

Randomized Control Trials

CASP:

Cohort Studies

CASP:

Case Control Studies

CASP:

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