Critical

Appraisal
Guide
As you use the MedBridge curriculum, instructors will be
referencing current literature to validate and support their
didactic content. You may want to go to these articles directly
to study the evidence further for application to practice and
clinical decision making. Standard guidelines to assist you in
analyzing the quality of your literature review may be helpful.

Research Methodology
There is a continuum of research
methodology across descriptive
(describing populations), exploratory
(finding relationships) and experimental
(identifying cause and effect
relationships) design categories. The
first 2 categories are observational
or nonexperimental, while the third
is investigational where one or more
variables are manipulates or controlled1.
The gold standard for experimental
design is the randomized controlled
trial (RCT), however many other models
of research design are apparent in the
literature1 , especially since we often
deal with human subjects rather than
laboratory (bench research) experiments.
Due to the difficulty of administering
RCTs with patients, compared
effectiveness trials have become more
common in physical therapy research.

1. Portney LG and Watkins MP. Foundations of Clinical Research: Applications to Practice, 3rd ed. Upper Saddle River, NJ:
Pearson Prentice Hall, 2009.
 Critical Appraisal Guide

Guyatt et al. recommend your appraisal of physical therapy literature

should include consideration of the following2

ARE THE RESULTS VALID? WHAT ARE THE RESULTS?

a. Did intervention and control groups a. How large was the treatment effect?
start with the same prognosis? b. How precise was the estimate of the
b. Were patients randomized? treatment effect?
c. Were patients in the study group
similar with respect to know
prognostic factors?
d. To what extent was the study HOW CAN I APPLY THE
blinded? RESULTS TO PATIENT CARE?
e. Was follow-up complete? a. Were the study patients similar to my
f. Were patient analyzed in the groups patient?
to which they were randomized? b. Were all clinically important outcomes
g. Was the trial stopped early? considered? Are the likely treatment
h. How do results compare to gold benefits worth the potential harm and
standard studies or outcome costs?
measures?

Systematic Reviews: A Synthesis of

Literature
Synthesis of literature can be particularly useful to the practicing clinician. Systematic
reviews present an inclusive analysis of a topic from the current literature, often applying
a meta-analysis combining the findings from several studies to acquire a summary.
This reflects the scope of research following a rigorous process to search, appraise and
summarize current and comprehensive information to aide in clinical decision making.1

1. Portney LG and Watkins MP. Foundations of Clinical Research: Applications to Practice, 3rd ed. Upper Saddle River, NJ:
Pearson Prentice Hall, 2009.
2. Guyatt G, Rennie D, Meade M, Cook D. JAMAevidence User’s Guides to the Medical Literature: Essentials of Evidence-
Based Practice; 2nd edition. McGrawHill, Chicago, IL; 2008.
 Critical Appraisal Guide

Levels of Evidence: A Hierarchy

A hierarchy for “levels of evidence” is used to describe studies based on the strength of
the design used. This includes RCTs, cohort studies and clinical prediction rules at the
highest end of the spectrum, in contrast to a case series (often extrapolations from level
2 or 3 studies) or expert opinion as the lowest level of evidence.1

Clinical
Case Expert Cohort
Prediction RCTs
Studies Opinion Studies
Rules

Factors such as subject recruitment, selection criteria, research design, quality of

methodology, measurable outcomes, search strategy and bias are all components which
can strengthen or weaken the validity and clinical applicability of a study. Evidence-
based practice should be based on these critical elements: application of available and
relevant research, clinician experience, and patient preference.

As users of evidence based literature, we must be informed consumers before applying

research results to our practice as the instructors in this curriculum have done. Use of
these resources for further understanding of clinical research may be helpful in your
study and professional development.

Written by
Kathryn Brewer, PT, DPT, MEd, GCS, CEEAA

1. Portney LG and Watkins MP. Foundations of Clinical Research: Applications to Practice, 3rd ed. Upper Saddle River, NJ:
Pearson Prentice Hall, 2009.