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Critical appraisal for speech and language therapists: observational studies

Critical appraisal for speech and language therapists: observational studies

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A 10 question appraisal framework for considering articles based on observational studies. (See separate framework for questionnaire studies.)
A 10 question appraisal framework for considering articles based on observational studies. (See separate framework for questionnaire studies.)

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Published by: Speech & Language Therapy in Practice on Aug 05, 2013
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04/14/2014

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Adapted from Public Health Resource Unit, England (2006) Critical Appraisal Skills Programme by Jennifer Reid, Speech and Language Therapy Service, NHS Fife. Cartoons by Fran commissioned by Speech and Language Therapy in Practice. Accompanies Reid, J. (2011)‘Journal Club 5: observational studies’,
Speech & Language Therapy in Practice
Autumn, pp.18-21.Please attribute these sources if you use, distribute or adapt any of this material.
Critical appraisal for speech and language therapists:observational study
Cohort study:
People with something in common are recruited and followed up over time (remember those
 
Roman soldiers marching off into the future…) in order to observe outcomes of interest. NB Recruitment happensbefore the appearance of the outcome. This is the strongest observational method (next best to experimental) forproviding evidence for questions about
causal relationships
,
such as, “Do children with language impairmentdevelop poorer social networks than their peers?” or, “ Are people who have received (a new medical or surgicalintervention) less likely to need speech and language therapy follow-up than those receiving conventionaltreatment?” However, check how well the findings support inference of causality.
Case-controlled study:
People with a particular outcome (‘cases’) are identified and matched with ‘controls’ in
 
order to answer questions such as, “Are young people not in employment, education or training more likely to havea history of primary language impairment?” Case-controlled studies are good for investigating rare or negativeoutcomes, but they are more susceptible to bias so provide less robust evidence than cohort studies, and theirpower is limited to evidence of 
strength of association
. The inference of causality from findings of an individualstudy is dodgy – it should be done only in the context of a broader evidence base.
Cross-sectional survey:
A representative
 
sample of patients, practitioners, carers etc. are interviewed, examined
 
or otherwise studied to gain information on a clinical question, such as, “Are speech and language therapy servicesaccessible to children in local authority care?” or, “What influences speech and language therapy intervention forpatients with [condition]?”. The data for cross-sectional studies are collected at a single time point but may refer toretrospective information, such as what intervention people with aphasia received during the first year following astroke. It is even dodgier to infer causality from the results of a survey! NB There is a separate tool for surveys thatuse questionnaires.Use the following questions to appraise a report of a case-controlled study or cross-sectional survey with respect tothe study results, their validity and whether they will help with clinical practice or decision-making. There is spacefor you to add your own notes. The prompts are there to highlight why an issue is important but they shouldn’t limityour thinking. There is quite a lot of overlap between questions.
Study reference:
 Aims
Did the study address a clearly focused issue?
 
Which population was studied?
 
Which risk factors or outcomes were investigated?
 
Did they try to detect a beneficial or harmful effect?
 
Is the underlying issue one of causation?
 
Can you formulate aims into a clinical question? Is it important for your practice?
 
 Adapted from Public Health Resource Unit, England (2006) Critical Appraisal Skills Programme by Jennifer Reid, Speech and Language Therapy Service, NHS Fife. Cartoons by Fran commissioned by Speech and Language Therapy in Practice. Accompanies Reid, J. (2011)‘Journal Club 5: observational studies’,
Speech & Language Therapy in Practice
Autumn, pp.18-21.Please attribute these sources if you use, distribute or adapt any of this material.
2
 Method
Choice of method appropriate to answer the study question?
 
Did method address the study question?
 
Is an observational design an appropriate way of addressing the question under thecircumstances?
 
Is this a cohort, case-controlled or cross-sectional study?
 
If a cohort study, did recruitment precede occurrence of outcome?
 
If a case-controlled study, is the outcome rare or harmful?
 
 Authors cautious about inferring causality?
 
 Adapted from Public Health Resource Unit, England (2006) Critical Appraisal Skills Programme by Jennifer Reid, Speech and Language Therapy Service, NHS Fife. Cartoons by Fran commissioned by Speech and Language Therapy in Practice. Accompanies Reid, J. (2011)‘Journal Club 5: observational studies’,
Speech & Language Therapy in Practice
Autumn, pp.18-21.Please attribute these sources if you use, distribute or adapt any of this material.
3
 Sampling andrecruitment
Were the cases recruited in an acceptable way?
Look for selection bias which might compromise thevalidity of the findings.
 
Participants/cases representative of defined population (geographically and/or temporally)?
 
Time frame of prospective study relevant to the development of the outcome?
 
How has attrition (loss to follow-up) been dealt with?
 
‘Caseness’ defined precisely? (One or more wrongly allocated individuals may seriously influencethe results of case-controlled study.)
 
 Are cases incident or prevalent, and is this appropriate for addressing question?
 
 Anything special about the cases (that would hinder generalisation of findings)?
 
Sufficient number of participants selected? Power calculation used?
Were the controls selected in an acceptable way?
Look for selection bias which might compromise theextent to which the findings can be generalised.
 
 Anything special about the controls?
 
Non-response high? Could non-respondents be different in any way?
 
Established reliable system for selecting all the cases?
 
 Are they matched, population-based or randomly selected? Rationale okay? Systematic methodsused for matching?
 
Sufficient number of controls selected?

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