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Iain K. Crombie. The Pocket Guide to Critical Appraisal
Table of Contents
List of Tables
Guide
Pages
The Pocket Guide to Critical Appraisal
Acknowledgements
Preface to the First Edition
Preface to the Second Edition
CHAPTER 1 Introduction to Critical Appraisal
The aims of critical appraisal
Three stages of critical appraisal
Identify the research design
Select the appropriate appraisal tool
Apply the tool to assess the bias and the value of the research
CHAPTER 2 Do Not Read the Paper
The initial interrogation
What does the title reveal about the study?
Does the abstract help in constructing the mental map?
Does the introduction confirm the aims?
Does the methods section explain how the study aims will be achieved?
The in‐depth interrogation
CHAPTER 3 Identifying the Research Design
Surveys
Essential features
Complications
Terms of identification
Cohort studies
Essential features
Complications
Terms of identification
Case–control studies
Essential features
Complications
Terms of identification
RCTs
Essential features
Complications
Terms of identification
Cohort studies that evaluate the effectiveness of interventions
Essential features
Complications
Terms of identification
Systematic reviews
Essential features
Complications
Terms of identification
CHAPTER 4 Interpreting the Results
The effect size
The relative risk
Other ratio measures of risk
The absolute risk reduction
Effect size for surveys
Taking the play of chance into account
Probability
Statistical tests and p‐values
Confidence intervals
Factors that distort the effect size. Bias
Confounding
Questionable research practices
Hypothesising after the analysis
Data manipulation
Rounding p‐values down
Conclusion
Note
CHAPTER 5 The In‐Depth Interrogation
Bias
Critical questions for bias
Important questions for bias
Is the recruitment strategy clearly described?
Are the measurements likely to be valid and reliable?
Could missing data be a problem?
Are the statistical methods appropriate?
Was the adjustment for confounding adequate?
Are all the main findings discussed?
Was there data dredging?
Could selective reporting of outcomes have occurred?
Has spin been used to mislead?
Could conflict of interest have influenced the findings?
Was there industry involvement in the study?
Indicative questions for bias
Are the study aims focused?
Was the sample size justified and achieved?
Was a pilot study conducted?
How are null findings interpreted?
Is the discussion of study limitations helpful?
Questions about value
Were the participant characteristics and the research setting adequately described?
Was the outcome measure important to patients?
Was the effect size large enough to be important?
Was precision assessed?
How plausible are the main findings?
How do the results compare with previous reports?
Conclusion
CHAPTER 6 Appraising Surveys
The critical bias questions for bias
Will the sampling strategy produce a representative sample?
Is the response rate acceptable?
Are the measurements likely to be valid and reliable?
The complete list for appraising surveys*
The critical questions for bias
The important questions for bias
The indicative questions for bias
Questions of value
CHAPTER 7 Appraising Cohort Studies
The critical questions for bias
Was an appropriate control group used?
Could there be errors in assessing exposure status?
Were the outcomes measured in the same way for the exposed and the control groups?
Could loss to follow‐up be a problem?
Was the adjustment for confounding adequate?
The important questions for bias. Was the length of follow‐up adequate?
Did the analysis allow for the passage of time?
The indicative questions for risk of bias. Was the study prospective or retrospective in design?
The complete list for the appraisal of cohort studies*
Critical questions for bias
Important questions for bias
Indicative questions of risk of bias
Questions of value
CHAPTER 8 Appraising Case–Control Studies
The critical questions for bias
Was the identification and recruitment of cases clearly described and systematic?
Is the control group appropriate?
Were data on potential risk factors collected in the same way for cases and controls?
Was the adjustment for confounding adequate?
The important questions for bias. Were incident cases used?
Could ascertainment bias be a problem?
Were the response rates different for cases and controls?
Could misclassification bias have occurred?
Could recall bias be a problem?
Is there a plausible interval between exposure and diagnosis of disease?
The complete list for the appraisal of case–control studies*
The critical questions for bias
The important questions for bias
The indicative questions for bias
The questions of value
CHAPTER 9 Appraising Randomised Controlled Trials
The critical questions for bias
Were patients randomly allocated to treatments?
Was the allocation to treatments concealed?
Could lack of blinding bias the assessment of the outcome?
Could loss to follow‐up be a source of bias?
Have the outcomes been selectively reported?
The important questions for bias. Was the trial registered or was a protocol published?
Were the treatment groups comparable at baseline?
Did the treatment and control groups receive similar care?
Was the length of follow‐up adequate?
Were the outcomes clearly defined, and measured in the same way for intervention and control groups?
Were the results analysed by intention to treat?
Could small sample size be a problem?
The questions of value
Have data on harms been presented and discussed?
The complete list for the appraisal of clinical trials*
The critical questions for bias
The important questions for bias
The indicative questions for bias
Questions of value
CHAPTER 10 Cohort Studies That Evaluate the Effectiveness of Interventions
Overview of advantages of cohort treatment studies and challenges for critical appraisal. Advantages
Challenges for critical appraisal
The critical questions for bias
Were efforts made to improve data quality and were these methods transparent and reproducible?
Could the process of selecting treatments for patients bias the estimates of effect size?
Was the control treatment chosen to minimise confounding by indication?
Were efforts made to reduce or adjust for confounding?
The important questions for bias. Was the study hypothesis testing or exploratory?
Were the same inclusion and exclusion criteria used for the intervention and control groups?
Could immortal time bias be a problem?
The questions of value
Was the outcome measure important to patients?
Conclusion
The complete list for the appraisal of cohort studies that evaluate interventions
Critical questions for bias
Important questions for bias
Indicative questions of risk of bias
Questions of value
CHAPTER 11 Appraising Systematic Reviews
The critical questions for risk of bias
Was the search strategy adequate?
Was publication bias assessed?
Was the risk of bias of the primary studies taken into account?
Was heterogeneity of effect fully investigated?
Was an appropriate method used to combine estimated effect sizes?
The important questions for risk of bias. Were the papers carefully screened for inclusion?
Were the data extracted by more than one reviewer?
Was missing information sought?
How were multiple outcome measures dealt with?
Could conflict of interest have influenced the findings?
The questions of value
Has diversity in patients and research settings across the primary studies been assessed?
Have data on harms been presented and discussed?
The complete list for the appraisal of systematic reviews*
The critical questions for risk of bias
The important questions for risk of bias
The indicative questions for risk of bias
Questions of value
CHAPTER 12 Summarising Risk of Bias
Identify the risk of bias of the research designs
Review the biases in study design, conduct, and interpretation
Derive an overall rating
Summary
CHAPTER 13 Certainty of Evidence
The nature of certainty of evidence
Downgrading the certainty of evidence
Risk of bias
Imprecision
Inconsistency
Indirectness
Publication bias
Factors that increase certainty
Large effect size
Dose–response gradient
Effect of unmeasured or residual confounding factors
Overall assessment of certainty
Conclusion
CHAPTER 14 Assessing Value
Measuring potential benefit
The burden of the disease
Duration of benefit
Timely delivery
Harm and the balance between benefit and harm. Measuring harms
The balance between benefit and harm
Costs and cost effectiveness
Opportunity cost
Feasibility of implementation of a treatment. Suitability for a health care system
Acceptability to patients and carers
Health equity
Accessibility
The worse‐off principle
Summary
Appendix: Further Reading
Chapter 1: Introduction
Chapter 3: Identifying the research design
Chapter 4: Interpreting the results
Chapter 5: The in‐depth interrogation
Chapter 6: Appraising surveys
Chapter 7: Appraising cohort studies
Chapter 8: Appraising case–control studies
Chapter 9: Appraising randomised controlled trials
Chapter 10: Cohort studies that evaluate the effectiveness of interventions
Chapter 11: Appraising systematic reviews
Chapter 12: Summarising risk of bias
Chapter 13: Certainty of evidence
Chapter 14: Assessing value
Index. A
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