Critical Appraisal

7 Step of Evidence-based Practice

• Step 0 : Cultivate a spirit of inquiry
• Step 1 : Formulate the clinical PICOT/PICO question
• Step 2 : Search for the best evidence
• Step 3 : Critical appraisal of Evidence
• Step 4 : Integrate the evidence with clinical expertise and
patients prefrence to make the best clinical decision
• Step 5 : Evaluate the out comes based on Evidence
• Step 6 : Disseminate the outcome
 Appraising an evidence
Purpose:
NOT to find RIGHT or WRONG but to find out
the truth and the practical of the knowledge
The knowledge is valid, reliable, practical in clinical setting
Randomized Control Trial: RCT
Randomized control trial
is the STRONGEST study design to answer questios of
efficacy & effectiveness of intervention
 Approaches to conducting RCT
• Efficacy study  how well intervention actually
work?  everything is controlled tightly,
homogeneus participants

• Effectiveness study  pragmatic value of an

intervention in clinical practice
Rapid critical appraisal questions for RCT

Validity

Result

Applicability
Bagaimana Melakukan
Critical Appraisal?
Are the result of the study valid?

• Apakah menggunakan metode penelitian yang tepat?

• Subject randomly assigned ?
• Subject & providers kept blind to study group?
• Bagaimana prosedur pemberian intervensinya?
• Apakah hasil penelitian nya ?
• Apakah Intervensi layak untuk diterapkan di klinik
What are the results?

• Apakah intervensi berhasil?

• Seberapa besar efek diperoleh?
• Apakah tenaga kesehatan diperkirakan akan mendapatkan hasil
yang sama jika mereka menerapkan intervensi dilapangan?
• How precise is the intervention or treatment?
 Will the results help me in caring
for my patients? (Applicability)

• Apakah subyek dalam penelitian mirip dengan pasien yang

ditangani
• Memiliki manfaatnya lebih besar dan resiko minimal
(Risk & benefit of the treatment)
• Intervensi layak untuk diterapkan di klinik (Feasibility)
• Pasien setuju dan menginginkan intervensi tersebut
(Patient’s/family’s values & expectations)
Analysis using JBI and CASP
 SINTESIS HASIL ANALISA JURNAL

 Apakah intervensi memiliki manfaat yang tinggi

 Apakah intervensi memiliki procedure yang jelas

 Apakah alat-alat yang di gunakan mudah di dapatkan

 Apakah SDM (sumber daya manusia) ada / apakah memerlukan keahlian

khusus
 Apakah harga nya terjangkau

 Apakah sesuai kebutuhan pasien

 References
Bhandari, M & Giannoudis, P.V.(2006). evidence-based medicine: what it is and
what it is not. Journal Injury. DOI:10.1016/j.injury.2006.01.034
Sutherland, S.E.(2001). evidence-based dentistry: part iv. research design and
level of evidence.
JBI.(2014). Supporting document for the joanna briggs institute kevel of evidence
and grades of recommendation. The university of Adelaide
JBI.(2014). Level of evidence. The university of Adelaide
CEMB.(2013). Level of evidence. Oxford University . www.cebm.net