CRITICAL APPRAISAL

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 Critical Appraisal

Methods for evaluating carefully and

systematically – scientific paper

!  Reliability
!  Validity
!  Applicable

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The ability to conduct critical appraisal should be
one of the basic competencies of a physician to
accurately recognize and use data on the results of
examinations or research efficiency.

Evidence-based Medicine
(EBM)

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 Steps of Evidence-based Medicine

Clinical Asking Making

Search Appraise Evaluate
problems questions decision

Finding Critical
PICO
evidence appraisals
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 Components of Critical Appraisal

Components
(VIA)

Validity Importance Applicability

Patient’s condition,
Clinical service capacity,
Internal validity: External validity:
importance of the economy, socio-
Bias Generalization
study results culture

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Components of a Research Article
OUTLINE: Abstract

INTRODUCTION:
Level of clinical/health problems, research question,
research urgency, and hypothesis

METHODS:
Population, sample, sample size, sampling
techniques, measurement, analysis plan

RESULTS:
Research flow chart, participant’s characteristics,
baseline data, outcome

DISCUSSION:
Internal validity external validity, importancy,
applicability
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 List of Questions for the Introduction
Components
1. What is the data that has been
presented to show the magnitude of
problems
2. What data that has been known
before (elaborated)?
3. Is there any gap?
4. What are the major aims (primary
endpoints)?
5. What are the minor aims (secondary
endpoints)?
6. What is the study hypothesis
Explanation Check
Prevalence, incidence, impact
Substantial and methodological
elaboration
Substantial and methodological gap, and
confirmation of previous study results
The most important objective of the
study
It may be elaborative and provides
baseline data for further studies
It consists of non-inferiority and
inferiority trials
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 List of Questions for the Methods
Components Explanation Check
1. Population and Who are the target and accessible population?
subjects What are the inclusion and exclusion criteria?

2. Study design What are the methods used?

What tools that has been used?
Who perform the randomization?
Is there any blinding?

3. Sample size What is the formula of sample size that used?

What are the rationales for determining the sample size?

4. Analysis plan What kind of statistical tests that have been used? Are they
consistent with the hypothesis and the aim of the study?
What are the methods used for analysis?
What computer program used for statistical analysis?
Is there any interim analysis that has been planned the
study?
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Study Design and Its Strength of
Evidence
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 List of Questions for the Results
Components Explanation Check

1. Flow and How many subjects are randomized for each

baseline data group?
How many and what is the percentage of subjects
that completed the study?
What are the reasons for subjects being excluded
from the study?
Are the baseline data comparable?
What had been done by the researcher when the
baseline data are not comparable?
2. Primary Primary outcomes:
outcome Are the statistically or clinically significant?
3. Secondary Secondary outcomes: significant?
outcome
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 List of Questions for the Discussions
Components Check
1. What are the power and limitation of the study
according to the researcher’s point of view?

2. How is the comparison between the study results and

other studies?

3. How is the biological plausibility of the study results?

4. Can the results of the study be generalized?
5. How is the clinical significance of the study results?
6. How is the applicability of study results according to
the researcher?
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 References

!  Belsey J. What is evidence-based medicine?

London: Hayward Medical Communications;
2009.
!  Oxford Centre for Evidence-Based Medicine.
Levels of evidence. http://www. cebm.net.
!  Moore A, McQuay H. Clinical trials. Bandolier’s
little book of making sense of the medical
evidence. Oxford: Oxford University Press,
2006.

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 Terima Kasih

ありがとうございました

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