CRITICAL APPRAISAL

Oleh :
Apt. Baiq Lenysia Puspita Anjani, M.Farm
MENDAPATKAN ARTIKEL DARI JURNAL
CRITICAL APPRAISAL – MENGAPA?

Penelitian yang telah dipublikasikan tidak

selalu reliable, walaupun artikel tersebut
dipublikasikan dijurnal terkemuka.
Kita memerlukan suatu metode kerja yang
sistematis untuk membaca dan
menginterpretasikan artikel penelitian.
 CRITICAL APPRAISAL

Sacket & Haynes (EBM 1995; 1:4-5)

To weigh up the evidence critically by assessing its
validity (closeness to the truth) and usefulness
(clinical applicability).

Atau Suatu proses yang sistematis untuk menilai

validitas, hasil & relevansi suatu penelitian
sebelum digunakan sebagai dasar pengambilan
keputusan.
 CRITICAL APPRAISAL

Merupakan salah satu tahapan dalam EBM.

Tujuan: membantu kita untuk memahami metode
dan hasil suatu penelitian → menilai kualitas suatu
penelitian.
 KEUNTUNGAN CRITICAL APPRAISAL

Cara sistematis → menilai validitas,hasil &

kegunaan suatu artikel penelitian.
Penilaian objektif tentang kegunaan suatu
informasi dari suatu penelitian.
Mudah dipelajari oleh siapa saja.
 KERUGIAN CRITICAL APPRAISAL

‘Time-consuming’ – hanya pada awal.

Tidak selalu memberikan jawaban dengan
‘mudah’ atau yang diharapkan.
 CRITICAL APPRAISAL

Penelitian acak terkontrol/ Randomised

Controlled Trials.
Tinjauan Sistematis/ Systematic Review.
 CRITICAL APPRAISAL

Validity ?

Critical Appraisal
Importance ?

Applicability ?
 CRITICAL APPRAISAL - TRIAL

Screening Questions (SQ)?

– SQ 1: Did the study ask a clearly focused
question?
– SQ 2: Did the authors use the right type of
study?
 CRITICAL APPRAISAL - TRIAL

Is the trial valid?

– Q 3 : Was the assignment of patients to
treatments randomised?
– Q 4 : Were all of the patients who entered the trial
properly accounted for at its conclusion?
– Q 5 : Were patients, health workers and study
personnel ‘blind’ to treatment?
– Q 6 : Were the groups similar at the start of the
study?
– Q 7 : Aside from the experimental intervention,
were the groups treated equally?
 CRITICAL APPRAISAL - TRIAL

What are the results?

– Q 8: How are the results presented and what
are the main results?
– Q 9: How precise are these results?
 CRITICAL APPRAISAL - TRIAL

Will the results help me in caring for my patients?

– Q 10: Can the results be applied to my patient
care?
– Q 11: Were all clinically important outcomes
considered?
– Q 12: Are the benefits worth the harms and costs?
 SCREENING QUESTION 1
(PERTANYAAN PENDAHULUAN 1)

Did the study ask a clearly focused question?

(Apakah penelitian tsb memiliki pertanyaan yang
jelas?)
Pertanyaan harus jelas dalam hal :
The population studied (Populasi penelitian)
The intervention given (Intervensi yang
diberikan)
The outcomes considered (Hasil penelitian yang
diamati)
 CONTOH

To evaluate the benefits and harms (the outcomes) of ACEi and AIIRA (the
interventions) in patients with DKD (the population), with major focus on renal
and cardiovascular outcomes.
 SCREENING QUESTION 2
(PERTANYAAN PENDAHULUAN 2)

Did the authors use the right type of study?

(Apakah peneliti menggunakan jenis
penelitian yang tepat?)
Jenis penelitian yang tepat?
Untuk menjawab pertanyaan penelitian
Menggunakan disain penelitian yang tepat
 PERTANYAAN PENDAHULUAN
(SCREENING QUESTIONS)

Merupakan pertanyaan penyaring

2 pertanyaan pendahuluan – jawaban pada
halaman 1 (abstrak)
 CRITICAL APPRAISAL - TRIAL

Guyatt, Sackett & Cook (JAMA 1993 & 1994)

3 pertanyaan untuk mengkritisi suatu RCT :
Is the trial valid? (Apakah penelitian tsb
valid?)
What are the results? (Apakah hasilnya?)
Will the results help me in caring for my
patients?(Apakah hasil penelitian tsb
berguna dlm memberikan layanan pada
pasien saya?)
 IS THE TRIAL VALID? – 5 PERTANYAAN
(APAKAH PENELITIAN TERSEBUT VALID?)

1) Was the assignment of patients to treatments

randomised? (Apakah pengelompokan pasien
dilakukan secara acak?)
2) Were all of the patients who entered the trial
properly accounted for at its conclusion?
(Apakah semua pasien dalam penelitian ikut
diperhitungkan sampai pada kesimpulan?)
 IS THE TRIAL VALID? – 5 PERTANYAAN
(APAKAH PENELITIAN TERSEBUT VALID?)

3) Were patients, health workers and study personnel ‘blind’

to treatment? (Apakah pasien, tenaga kesehatan dan staf
penelitian tidak mengetahui jenis intervensi yang diterima
oleh pasien penelitian?)
4) Were the groups similar at the start of the study? (Apakah
karakteristik kelompok yang menerima intervensi/obat dan
plasebo hampir sama pada saat awal penelitian?)
 IS THE TRIAL VALID? – 5 PERTANYAAN
(APAKAH PENELITIAN TERSEBUT VALID?)

5) Aside from the experimental intervention, were the

groups treated equally? (Selain intervensi
eksperimental,apakah kedua kelompok tersebut
menerima perlakuan yang sama?)
 Q3. WAS THE ASSIGNMENT OF PATIENTS TO
TREATMENTS RANDOMISED?

Tujuan randomisation :
Menghindari bias → memastikan semua
faktor (diketahui & tidak) yang dapat
mempengaruhi hasil penelitian, terbagi rata
ke kelompok eksperimental & plasebo
Kelompok eksperimental & plasebo
mempunyai karakteristik yang hampir sama

Perbedaan yang muncul benar2 hanya

disebabkan oleh perbedaan intervensi
yang diterima oleh ke-2 kelompok
 Q3. WAS THE ASSIGNMENT OF PATIENTS TO
TREATMENTS RANDOMISED?

Apakah proses pengelompokan benar

- benar acak?
Apakah ada suatu metode digunakan untuk
menyeimbangkan pengelompokan pasien selama
proses acak/randomisation, contoh : stratifikasi?
Q3. WAS THE ASSIGNMENT OF PATIENTS TO TREATMENTS
RANDOMISED?

Bagaimana proses acak dilakukan?

Jika pengelompokan pasien tidak seimbang.
Apakah perbedaan antarkelompok saat awal
mengikuti penelitian dilaporkan?
 Q3. WAS THE ASSIGNMENT OF PATIENTS TO
TREATMENTS RANDOMISED?

Apakah perbedaan yang dilaporkan

Dapat mempengaruhi hasil penelitian
(Confounding factor)?
Q3. WAS THE ASSIGNMENT OF PATIENTS TO
TREATMENTS RANDOMISED?
Q3. WAS THE ASSIGNMENT OF PATIENTS TO
TREATMENTS RANDOMISED?
SELAMAT MELAKUKAN CRITICAL APPRAISAL

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