Dr. Lai, CASP-Worksheets

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Critical Appraisal Worksheets 1

Critical Appraisal Worksheets




壹 ..Primary Studies

CRI TI CAL REVI EWFORMFOR THERAPY

I . Are the Resul ts Val i d?

1. Was the assi gnment of pati ents to treatments randomi zed?

2. Were al l pati ents who entered the tri al properl y accounted for

and attri buted at i ts concl usi on?

a. Was fol l ow-up compl ete?

b. Were pati ents anal yzed i n the groups to whi ch they were

randomi zed?

3. Were pati ents, cl i ni ci ans, and study personnel "bl i nd" to

treatment?4. Were the groups si mi l ar at the start of the tri al ?

5. Asi de f romthe experi mental i nterventi on, were the groups

treated equal l y?

I I . What Are the Resul ts?

1. How l arge was the treatment effect?

2. How preci se i s the esti mate of the treatment effect?

I I I . Wi l l the Resul ts Hel p Me i n My Pati ent Care?

1. Can the resul ts be appl i ed to my pati ents?2. Were al l cl i ni cal l y i mportant outcomes consi dered?

3. Are the benef i ts worth the harms and costs?

References: J AMA 1993; 270: 2598-2601, J AMA 1994; 271: 59-63




CRI TI CAL REVI EWFORMFOR A D AGNOSTIC TEST


1. Was there an i ndependent, bl i nd compari son wi th a reference

standard?

2. Di d the pati ent sampl e i ncl ude an appropri ate spectrumof

pati ents to whomthe test wi l l be appl i ed?

3. Di d the resul ts of the test bei ng eval uated i nf l uence the

deci si on to performthe reference standard?

4. Were the test methods descri bed cl earl y enough to permi t

repl i cati on?


1. What are the l i kel i hood rati os for the test resul ts?I I I . Wi l l the Resul ts Hel p Me I n My Pati ent Care?

1. Wi l l the test be reproduci bl e and wel l i nterpreted i n my

practi ce sett i ng?

2. Are the resul ts appl i cabl e to my pati ents?

3. Wi l l the resul ts change my management?

4. Wi l l my pati ents be better of f because of the test?

References: J AMA 1994; 271: 389-391, J AMA 1994; 271: 703-707




CRI TI CAL REVI EWFORMFOR HARM


1. Except for the exposure under study, were the compared groups

si mi l ar to each other?

2. Were the outcomes and exposures measured i n the same ways i n

both groups?

3. Was the fol l ow-up of pati ents suf f i ci entl y l ong and compl ete?

4. I s the temporal rel ati onshi p correct?

5. I s there a dose-response gradi ent?


1. Howst rong i s the associ ati on between exposure and outcome?

2. How preci se i s the esti mate of ri sk?I I I . Wi l l the Resul ts Hel p Me I n My Pati ent Care?

1. Are the resul ts appl i cabl e to my pati ents?

2. What i s the magni tude of the ri sk?

3. Shoul d I attempt to stop the exposure?

Reference: J AMA 1994; 271: 1616-1619




CRI TI CAL REVI EWFORMFOR PROGNOSI S


1. Was there a def i ned representati ve sampl e of pati ents

assembl ed at a si mi l ar poi nt i n the course of the di sease?

2. Was fol l ow-up suf f i ci entl y l ong and compl ete?

3. Were obj ecti ve and unbi ased outcome cri teri a used?

4. Was there adj ustments for i mportant prognost i c factors?


1. How l i kel y are the outcomes over t i me?

2. How preci se are the esti mates of prognosi s?

I I I . Wi l l the Resul ts Hel p Me I n My Pati ent Care?

1. Were the study pati ents si mi l ar to my own?2. Wi l l the resul ts l ead di rectl y to sel ecti ng or avoi di ng

therapy?

3. Are the resul ts useful f or counsel i ng pati ents?

Reference: J AMA 1994; 272: 234-237




CRITICAL REVIEW FORM ON APPLICABILITY

I . BI OLOGI C:

1. Ar e t her e pat hophysi ol ogi c di f f er ences i n t he

i l l ness under st udy that may l ead t o a di mi ni shed

t r eat ment r esponse?

2. Ar e t her e pat i ent di f f er ences t hat may di mi ni sh t he

t r eat ment r esponse?

I I . SOCI AL AND ECONOMI C:

1. Ar e t her e i mpor t ant di f f er ences i n pat i ent

compl i ance t hat may di mi ni sh t he t r eat ment

r esponse?2. Ar e t her e i mpor t ant di f f er ences i n pr ovi der

compl i ance t hat may di mi ni sh t he t r eat ment

r esponse?

I I I . EPI DEMI OLOGI C:

1. Do my pat i ent s have comorbi d condi t i ons t hat

si gni f i cant l y al t er t he pot ent i al benef i t s and

r i sks of t r eat ment ?2. Ar e t her e i mpor t ant di f f er ences i n unt r eat ed

pat i ent s at r i sk of adver se out comes t hat mi ght

al t er t he ef f i ci ency of t r eat ment ?

Ref erences: J AMA 1994; 271: 389- 391, J AMA 1994; 271: 703- 707




貳 ..Integrative Studies

CRI TI CAL REVI EWFORMFOR SYSTEMATI C REVI EW


1. Di d thi s revi ew address a focused cl i ni cal questi on?

2. Were the cri teri a f or arti cl e i ncl usi on appropri ate?

3. I s i t unl i kel y that rel evant studi es were mi ssed?

4. Was the val i di ty of the i ncl uded studi es apprai sed?

5. Was the assessments of studi es reproduci bl e?

6. Were the resul ts si mi l ar f romstudy to study?

I I . What Are the Resul ts?1. What are the overal l resul ts of the revi ew?

2. How preci se are the resul ts?


1. Can the resul ts be appl i ed to my pati ents?

2. Were al l cl i ni cal l y i mportant outcomes consi dered?

3. Are the benef i ts worth the harms and costs?

References: J AMA 1994; 272: 1367-1371




CRITICAL REVIEW FORM FOR A PRACTICE GUIDELINE

I . Ar e t he Resul t s Val i d?

1. Wer e al l i mpor t ant opt i ons and out comes cl ear l y

speci f i ed?

2. Was an expl i ci t and sensi bl e pr ocess used t o

i dent i f y, sel ect , and combi ne t he evi dence?


consi der t he rel at i ve val ue to di f f er ent out comes?

4. I s t he gui del i ne l i kel y t o account f or i mpor t ant

r ecent devel opment s?

5. Has t he gui del i nes been subj ect t o peer r evi ew andt est i ng?

I I . What are t he r ecommendat i ons?

1. Ar e cl ear , pr act i cal , and i mpor t ant

r ecommendat i ons made?

2. How st r ong are t he r ecommendat i ons?

3. Coul d t he uncer t ai nt y i n t he evi dence or val ues

change t he gui del i ne i s r ecommendat i ons?

I I I . Wi l l t he r esul t s hel p me i n car i ng f or my pat i ent s?

1. I s t he obj ect i ve of t he gui del i ne consi st ent wi t h

mi ne?

2. Ar e t he r ecommendat i ons appl i cabl e t o my pat i ent s?

Ref erences: J AMA 1995; 274: 570- 574, J AMA 1995; 274: 1630- 1632




CRI TI CAL REVI EWFOR UTI LI ZATI ON REVI EW

I . Are the Cri teri a Val i d?

1. Was an expl i ci t and sensi bl e process used to i denti f y, sel ect,

and combi ne evi dence for the cri teri a?

2. What i s the qual i ty of the evi dence used i n f rami ng the

cri teri a?

3. I f necessary, was an expl i ci t, systemati c, and rel i abl e

process used to tap expert opi ni on?

4. Was an expl i ci t and sensi bl e process used to consi der the

rel ati ve val ues of di f ferent outcomes?

5. I f the qual i ty of the evi dence used i n ori gi nal l y f rami ng the

cri teri a was weak, have the cri teri a themsel ves beencorrel ated wi th pati ent outcomes?

I I . Were the Cri teri a Appl i ed Appropri atel y?

1. Was the process of appl yi ng the cri teri a rel i abl e, unbi ased,

and l i kel y to yi el d robust concl usi ons?

2. What i s the i mpact of uncertai nty associ ated wi th evi dence

and val ues on the cri teri a-based rati ngs of process of care?

I I I . Can You Use the Cri teri a i n Your Practi ce Setti ng?

1. Are the cri teri a rel evant to your practi ce sett i ng?

2. Have the cri teri a been f i el d- tested for f easi bi l i ty of use

i n di verse sett i ngs, i ncl udi ng your own?

References: J AMA 1996; 275: 1435-1439




CRITICAL REVIEW FOR HEALTH SERVICES RESEARCH

I . Thr ee I ni t i al Questi ons

1. Wer e t he outcome measur es accur at e and

comprehensi ve?

2. Wer e t her e cl ear l y i dent i f i ed, sensi bl e compar i son

groups?

3. How wel l di d t he compar ed groups mat ch up on

i mpor t ant f act or s t hat can af f ect t he out comes of

a heal t h ser vi ce:

4. Who pr ovi ded t he ser vi ce?

5. What ser vi ce was pr ovi ded?

6. When was t he ser vi ce pr ovi ded?7. Where was t he servi ce pr ovi ded?

8. How was t he servi ce pr ovi ded?

I I . Fur t her Quest i ons

1. Wer e al l i mpor t ant pr ognost i c f act or s measur e?

2. Wer e measur es of pat i ent s¡ ¦ pr ognost i c f act or s

r epr oduci bl e and accur at e?

3. Wer e pat i ent s si mi l ar wi t h r espect t o t hese

f actor s?4. How much di f f erence i n out come(s) r emai ns af t er

adj ust ment f or t he pr ognost i c f act or s?

Ref erences: J AMA 1996; 275: 554- 558




CRITICAL REVIEW FORM FOR DECISION ANALYSIS

I . Ar e t he Resul t s Val i d?

1. Were al l i mport ant st r ategi es and out comes

i ncl uded?


assembl e t he evi dence i nt o pr obabi l i t i es?

3. Wer e t he ut i l i t i es obt ai ned i n an expl i ci t and

sensi bl e way f r om credi bl e sour ces?

4. Was t he i mpact of uncert ai nt y i n evi dence expl or ed?

I I . What Ar e t he Resul t s?

1. Does one st r at egy yi el d a cl i ni cal l y i mpor t ant gai n

f or pat i ent s? I f not , i s t he r esul t a "t oss- up"?2. How st r ong i s t he evi dence used i n t he anal ysi s?

3. Coul d uncer t ai nt y i n t he evi dence change t he

r esul t s?

I I I . Wi l l t he Resul t s Hel p Me I n My Pat i ent Car e?

1. Do t he pr obabi l i t i es f i t my pat i ent s¡¦ c l i ni cal

f eat ur es?

2. Do t he ut i l i t i es r ef l ect my pat i ent s¡ ¦ val ues?

Ref erences: J AMA 1995; 273: 1292- 1295,

J AMA 1995; 273: 1610- 1613




CRI TI CAL REVI EWFOR ECONOMC ANALYSI S


1. Di d the anal ysi s provi de a ful l economi c compari son of

heal thcare strategi es?

2. Were the costs and outcomes properl y measured and val ued?

3. Was appropri ate al l owance made for uncertai nti es i n the

anal ysi s?

4. Are est i mates of costs and outcomes rel ated to the basel i ne

ri sk i n the treatment popul ati on?

I I . What Were the Resul ts?

1. What were the i ncremental costs and outcomes of eachstrategy?

2. Do i ncremental costs and outcomes di f fer between subgroups?

3. Howmuch does al l owance for uncertai nty change the resul ts?


1. Are treatment benef i ts worth the harms and costs?

2. Coul d my pati ents expect si mi l ar heal th outcomes?

3. Coul d I expect si mi l ar costs?

References: J AMA 1997; 277: 1552-1557

Dr. Lai, CASP-Worksheets

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