PHT 517

CRITICAL APPRAISAL TOOL

PEDro Scale
AFEEFA RAIHANA BINTI MOHD NOOR AZMI 2018288798
NURUL SALWA BINTI MUSTAFA KAMAL 2018292368
ZATIL ZAHIDAH HAJIDAH BINTI MOHD YUSOFF 2018292246
MARDIAH BINTI ALAN HAFIFI 2018825022 HS244/6C
NORFAZ NADZIRAH BINTI AHMAD FAZLI 2018288792

LECTURER’S NAME :
DR. FATIM TAHIRAH MIRZA
BACKGROUND
Name of Tools
 Physiotherapy Evidence Database (PEDro) Scale

Developed/Introduced by Type Of Study

 Developed by Verhagen et al at the Department of  Randomized controlled trials
Epidemiology, University of Maastricht (RCT)
 Based on the 9-item Delphi List (a criteria list for (Kamper et al., 2015;Gazzi et al., 2010)

quality assessment of randomized clinical trials for Commonly/Rarely Used

conducting systematic reviews developed by  Commonly and widely used to
Delphi concensus) assess RCT
 2 additional items related to statistical reporting
that are not on the Delphi list. (Elkins, Herbert, Moseley, Sherrington, & Maher,
2010)

Year
 1998
(Pedro, Ap, & Delphi, 1999; Cashin & Mcauley, 2019)
HOW TO USE PEDro SCALE?

NOTE:
Points are only awarded when a
criterion is clearly satisfied.

SCORE RATE
9-10 EXCELLENT

6-8 GOOD

4-5 FAIR
<4 POOR

(Cashin & McAuley, 2020)

 EXPLANATION OF EACH DOMAIN
CRITERION DOMAIN DESCRIPTION

CRITERION 1 Eligibility criteria were specified • The report describes the source of subjects and a list of criteria used to determine who
was eligible to participate in the study

CRITERION 2 Subjects were randomly allocated to group • The report must state that allocation was random.
• The method of randomization should meet the satisfaction of criterion (e.g. coin-tossing
and dice-rolling).

CRITERION 3 Allocation was concealed • The person who determined if a subject was eligible for inclusion in the trial was
unaware of which group the subject would be allocated to.
CRITERION 4 The group were similar at baseline • The report must describe at least one measure of the severity of the condition being
regarding the most important prognostic treated and at least one (different) key outcome measure at baseline.
indicator • The groups’ outcome should not have significant differences
• This criterion is satisfied even if only baseline data of study completers are presented

CRITERION 5 Blinding of all subjects • Subject, therapist or assessor did not know which group the subject had been allocated
to.
CRITERION 6 Blinding of all therapist who administered • In trials in which key outcomes are self-reported (eg, visual analogue scale, pain diary),
the therapy the assessor is considered to blind if the subject was blind.

CRITERION 7 Blinding of all assessor who measured at

least one key outcome
 EXPLANATION OF EACH DOMAIN
CRITERION DOMAIN
CRITERION 8 Measure of at least one key outcome
were obtained from more than 85% of the
subjects initially allocated to groups
CRITERION 9 All subjects for whom outcome measures
were available received the treatment or
control condition as allocated or, where
this was not the case, data for at least
one key outcome was analysed by
“intention to treat”
CRITERION 10 The results of between-group statistical
comparisons are reported for at least one
key outcome
CRITERION 11 The study provides both point measures
and measures of variability for at least
one key outcome
DESCRIPTION
• The report should explicitly state both the number of subjects initially allocated to
groups and the number of subjects from whom key outcome measures were
obtained.
• Subjects who did not receive treatment (control group) should also be given
treatment.
• This criterion is satisfied, even if there is no mention of analysis by intention to treat,
if the report explicitly states that all subjects received treatment or control conditions
as allocated.
• The result must involve statistical comparison of one group with another.
• The analysis may be a simple comparison of outcomes measured after the
treatment was administered, or a comparison of the change in one group with the
change in another.
• Point measure is a measure of the size of the treatment effect. The treatment effect
may be described as a difference in group outcomes, or as the outcome in (each of)
all groups
• Measures of variability include standard deviations, standard errors, confidence
intervals, interquartile ranges (or other quantile ranges), and ranges
STRENGTH AND LIMITATIONS OF PEDRO SCALE
Strength:
• Its scoring system is straightforward, simple and easy to
interpret compared to JADAD scale.
• The summary scores of PEDro scale can helps the reader
to rapidly identify the strength of a paper.
• It appears to be more useful to assess the methodological
quality of physical therapy trials compared to JADAD scale
as PEDro assess based on other important criteria such
as concealed allocation, intention-to-treat analysis and
adequacy of follow up.
• The inclusion and exclusion criteria mentioned in Criteria
1 is critical in determining a hypothesis of a study, thus
making the study more realistic and this item is not been
mentioned in JADAD scale.
• Blinding assessed by PEDro includes the blinding of
subjects, therapist and assessors which can reduce the risk
of bias and higher score can be achieved compared to
JADAD scale, since only 1 point are given if double-blind is
mentioned and only 0.5 for single-blind.
(Olivo et al., 2008)
Limitation:
• The score cannot be used as a
measure of the “validity” of a study’s
conclusion (Olivo et al., 2008; Sherrington,
Herbert, Maher & Moseley, 2000)
• It does not include a precise
performance of the intervention, the
validity, reliability and the
responsiveness of the tests and
measurement in assessing the quality
of the RCT compared to Maastricht and
Bizzini scales as both of the scales
consider parameters of treatment such
as frequency, intensity, duration and
adherence (Olivo et al., 2008).
• It cannot be used to compare the
“quality” of trial performed in different
areas of therapy because it is
impossible to satisfy all the scale items
in some area of physiotherapy (Moseley,
Elkins, Janer-Duncan & Hush, 2014).
CRITICALLY APPRAISE PAPER
 PEDro SCALE 10/10

ITEM 8

ITEM 1 (not included)

ITEM 2 ITEM 5
ITEM 9

ITEM 6
ITEM 3

ITEM 10
ITEM 4 ITEM 7
ITEM 11
 REFERENCES
Cashin, A. G., & McAuley, J. H. (2020). Clinimetrics: Physiotherapy Evidence Database (PEDro) Scale. Journal of Physiotherapy, 66(1), 59.
https://doi.org/10.1016/j.jphys.2019.08.005
Cashin, A. G., & Mcauley, J. H. (2019). Clinimetrics : Physiotherapy Evidence Database ( PEDro ) Scale. Journal of Physiotherapy, 9553. https://
doi.org/10.1016/j.jphys.2019.08.005
 
Elkins, M. R., Herbert, R. D., Moseley, A. M., Sherrington, C., & Maher, C. (2010). Rating the Quality of Trials in Systematic Reviews of Physical Therapy
Interventions. Cardiopulmonary Physical Therapy Journal, 21(3).
Gazzi, L., Elkins, M. R., Maher, C. G., Moseley, A. M., Herbert, R. D., & Sherrington, C. (2010). There was evidence of convergent and construct validity of
Physiotherapy Evidence Database quality scale for physiotherapy trials. Journal of Clinical Epidemiology, 63(8), 920–925.
https://doi.org/10.1016/j.jclinepi.2009.10.005
Kamper, S. J., Moseley, A. M., Herbert, R. D., Maher, C. G., Elkins, M. R., & Sherrington, C. (2015). 15 years of tracking physiotherapy evidence on PEDro ,
where are we now ? 49(14), 907–909. https://doi.org/10.1136/bjsports-2014-094468
Kaysin, M. Y., Akpinar, P., Aktas, I., Ozkan, F. U., Karamanlioglu, D. S., Hartevioglu, H. C., & Vural, N. (2018). Effectiveness of Shortwave Diathermy for
Subacromial Impingement Syndrome and Value of Night Pain for Patient Selection. American Journal of Physical Medicine & Rehabilitation, 97(3), 178–
186. doi:10.1097/phm.0000000000000819
Moseley, A. M., Elkins, M. R., Janer-Duncan, L., & Hush, J. M. (2014). The quality of reports of randomized controlled trials varies between Subdisciplines of
physiotherapy. Physiotherapy Canada, 66(1), 36-43. https://doi.org/10.3138/ptc.2012-68
Olivo, S. A., Macedo, L. G., Gadotti, I. C., Fuentes, J., Stanton, T., & Magee, D. J. (2008). Scales to assess the quality of randomized controlled trials: A
systematic review. Physical Therapy, 88(2), 156-175. https://doi.org/10.2522/ptj.20070147
Pedro, T., Ap, V., & Delphi, T. (1999). PEDro scale.
Sherrington, C., Herbert, R., Maher, C., & Moseley, A. (2000). PEDro. A database of randomized trials and systematic reviews in physiotherapy.  Manual
Therapy, 5(4), 223-226. https://doi.org/10.1054/math.2000.0372