research paper appraisal tool

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Critical Appraisal tools

Critical appraisal worksheets to help you appraise the reliability, importance and applicability of clinical evidence.

Critical appraisal is the systematic evaluation of clinical research papers in order to establish:

• Does this study address a  clearly focused question ?
• Did the study use valid methods to address this question?
• Are the valid results of this study important?
• Are these valid, important results applicable to my patient or population?

If the answer to any of these questions is “no”, you can save yourself the trouble of reading the rest of it.

This section contains useful tools and downloads for the critical appraisal of different types of medical evidence. Example appraisal sheets are provided together with several helpful examples.

Critical Appraisal Worksheets

• Systematic Reviews  Critical Appraisal Sheet
• Diagnostics  Critical Appraisal Sheet
• Prognosis  Critical Appraisal Sheet
• Randomised Controlled Trials  (RCT) Critical Appraisal Sheet
• Critical Appraisal of Qualitative Studies  Sheet
• IPD Review  Sheet

Chinese - translated by Chung-Han Yang and Shih-Chieh Shao

• Systematic Reviews  Critical Appraisal Sheet
• Diagnostic Study  Critical Appraisal Sheet
• Prognostic Critical Appraisal Sheet
• RCT  Critical Appraisal Sheet
• IPD reviews Critical Appraisal Sheet
• Qualitative Studies Critical Appraisal Sheet 

German - translated by Johannes Pohl and Martin Sadilek

• Systematic Review  Critical Appraisal Sheet
• Diagnosis Critical Appraisal Sheet
• Prognosis Critical Appraisal Sheet
• Therapy / RCT Critical Appraisal Sheet

Lithuanian - translated by Tumas Beinortas

• Systematic review appraisal Lithuanian (PDF)
• Diagnostic accuracy appraisal Lithuanian  (PDF)
• Prognostic study appraisal Lithuanian  (PDF)
• RCT appraisal sheets Lithuanian  (PDF)

Portugese - translated by Enderson Miranda, Rachel Riera and Luis Eduardo Fontes

• Portuguese – Systematic Review Study Appraisal Worksheet
• Portuguese – Diagnostic Study Appraisal Worksheet
• Portuguese – Prognostic Study Appraisal Worksheet
• Portuguese – RCT Study Appraisal Worksheet
• Portuguese – Systematic Review Evaluation of Individual Participant Data Worksheet
• Portuguese – Qualitative Studies Evaluation Worksheet

Spanish - translated by Ana Cristina Castro

• Systematic Review  (PDF)
• Diagnosis  (PDF)
• Prognosis  Spanish Translation (PDF)
• Therapy / RCT  Spanish Translation (PDF)

Persian - translated by Ahmad Sofi Mahmudi

• Prognosis  (PDF)
• PICO  Critical Appraisal Sheet (PDF)
• PICO Critical Appraisal Sheet (MS-Word)
• Educational Prescription  Critical Appraisal Sheet (PDF)

Explanations & Examples

• Pre-test probability
• SpPin and SnNout
• Likelihood Ratios

• Critical appraisal checklists

There are numerous checklists available to act as memory aids for evaluating studies and they can be very useful.

The SR toolbox is a website providing regularly updated lists of the available guidance and software for each stage of the systematic review process, including screening and quality assessment.

Critical appraisal is much more than a 'tick box' exercise. It is needed to evaluate the weight we can put on the findings, and how far we can generalise the results from trials into routine practice to inform clinical care.

Since these pragmatic issues always need to be borne in mind when critically appraising study data, here we present some examples of checklists for different study types and some information for tricky critical appraisal scenarios.

Appraising two-armed RCTs Appraising multiple-armed RCTs Appraising diagnostic test studies Appraising systematic reviews Assessing multiple systematic reviews on the same question

Content created by BMJ Knowledge Centre

• Statistics calculators
• A glossary of EBM terms
• A glossary of health economics terms
• Bibliography of key resources
• Links to other EBM resources

EBM Toolkit home

Learn, Practise, Discuss, Tools

• Critical Appraisal Tools
• Introduction
• Related Guides
• Getting Help

Critical Appraisal of Studies

Critical appraisal is the process of carefully and systematically examining research to judge its trustworthiness, and its value/relevance in a particular context by providing a framework to evaluate the research. During the critical appraisal process, researchers can:

• Decide whether studies have been undertaken in a way that makes their findings reliable as well as valid and unbiased
• Make sense of the results
• Know what these results mean in the context of the decision they are making
• Determine if the results are relevant to their patients/schoolwork/research

Burls, A. (2009). What is critical appraisal? In What Is This Series: Evidence-based medicine. Available online at  What is Critical Appraisal?

Critical appraisal is included in the process of writing high quality reviews, like systematic and integrative reviews and for evaluating evidence from RCTs and other study designs. For more information on systematic reviews, check out our  Systematic Review  guide.

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• Last Updated: Nov 16, 2023 1:27 PM
• URL: https://guides.library.duq.edu/critappraise

CASP Checklists

• How to use our CASP Checklists
• Referencing and Creative Commons
• Online Training Courses
• CASP Workshops
• What is Critical Appraisal
• Study Designs
• Useful Links
• Bibliography
• View all Tools and Resources
• Testimonials

Critical appraisal tools and resources

CASP has produced simple critical appraisal checklists for the key study designs. These are not meant to replace considered thought and judgement when reading a paper but are for use as a guide and aide memoire. All CASP checklists cover three main areas: validity , results and clinical relevance.

What is Critical Appraisal?

Critical Appraisal is the process of carefully and systematically examining research to judge its trustworthiness, and its value and relevance in a particular context. It is an essential skill for evidence-based medicine because it allows people to find and use research evidence reliably and efficiently.

Learn more about what critical appraisal is, why we need it and more

A complete list (published & unpublished) of articles and research papers about CASP and other critical appraisal tools and approaches, covering from 1993-2012.

• CASP Checklist

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• Published: 31 January 2022

The fundamentals of critically appraising an article

• Sneha Chotaliya 1  

BDJ Student volume  29 ,  pages 12–13 ( 2022 ) Cite this article

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Sneha Chotaliya

We are often surrounded by an abundance of research and articles, but the quality and validity can vary massively. Not everything will be of a good quality - or even valid. An important part of reading a paper is first assessing the paper. This is a key skill for all healthcare professionals as anything we read can impact or influence our practice. It is also important to stay up to date with the latest research and findings.

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Chambers R, 'Clinical Effectiveness Made Easy', Oxford: Radcliffe Medical Press , 1998

Loney P L, Chambers L W, Bennett K J, Roberts J G and Stratford P W. Critical appraisal of the health research literature: prevalence or incidence of a health problem. Chronic Dis Can 1998; 19 : 170-176.

Brice R. CASP CHECKLISTS - CASP - Critical Appraisal Skills Programme . 2021. Available at: https://casp-uk.net/casp-tools-checklists/ (Accessed 22 July 2021).

White S, Halter M, Hassenkamp A and Mein G. 2021. Critical Appraisal Techniques for Healthcare Literature . St George's, University of London.

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• Published: 16 September 2004

A systematic review of the content of critical appraisal tools

• Persis Katrak 1 ,
• Andrea E Bialocerkowski 2 ,
• Nicola Massy-Westropp 1 ,
• VS Saravana Kumar 1 &
• Karen A Grimmer 1  

BMC Medical Research Methodology volume  4 , Article number:  22 ( 2004 ) Cite this article

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Consumers of research (researchers, administrators, educators and clinicians) frequently use standard critical appraisal tools to evaluate the quality of published research reports. However, there is no consensus regarding the most appropriate critical appraisal tool for allied health research. We summarized the content, intent, construction and psychometric properties of published, currently available critical appraisal tools to identify common elements and their relevance to allied health research.

A systematic review was undertaken of 121 published critical appraisal tools sourced from 108 papers located on electronic databases and the Internet. The tools were classified according to the study design for which they were intended. Their items were then classified into one of 12 criteria based on their intent. Commonly occurring items were identified. The empirical basis for construction of the tool, the method by which overall quality of the study was established, the psychometric properties of the critical appraisal tools and whether guidelines were provided for their use were also recorded.

Eighty-seven percent of critical appraisal tools were specific to a research design, with most tools having been developed for experimental studies. There was considerable variability in items contained in the critical appraisal tools. Twelve percent of available tools were developed using specified empirical research. Forty-nine percent of the critical appraisal tools summarized the quality appraisal into a numeric summary score. Few critical appraisal tools had documented evidence of validity of their items, or reliability of use. Guidelines regarding administration of the tools were provided in 43% of cases.

Conclusions

There was considerable variability in intent, components, construction and psychometric properties of published critical appraisal tools for research reports. There is no "gold standard' critical appraisal tool for any study design, nor is there any widely accepted generic tool that can be applied equally well across study types. No tool was specific to allied health research requirements. Thus interpretation of critical appraisal of research reports currently needs to be considered in light of the properties and intent of the critical appraisal tool chosen for the task.

Peer Review reports

Consumers of research (clinicians, researchers, educators, administrators) frequently use standard critical appraisal tools to evaluate the quality and utility of published research reports [ 1 ]. Critical appraisal tools provide analytical evaluations of the quality of the study, in particular the methods applied to minimise biases in a research project [ 2 ]. As these factors potentially influence study results, and the way that the study findings are interpreted, this information is vital for consumers of research to ascertain whether the results of the study can be believed, and transferred appropriately into other environments, such as policy, further research studies, education or clinical practice. Hence, choosing an appropriate critical appraisal tool is an important component of evidence-based practice.

Although the importance of critical appraisal tools has been acknowledged [ 1 , 3 – 5 ] there appears to be no consensus regarding the 'gold standard' tool for any medical evidence. In addition, it seems that consumers of research are faced with a large number of critical appraisal tools from which to choose. This is evidenced by the recent report by the Agency for Health Research Quality in which 93 critical appraisal tools for quantitative studies were identified [ 6 ]. Such choice may pose problems for research consumers, as dissimilar findings may well be the result when different critical appraisal tools are used to evaluate the same research report [ 6 ].

Critical appraisal tools can be broadly classified into those that are research design-specific and those that are generic. Design-specific tools contain items that address methodological issues that are unique to the research design [ 5 , 7 ]. This precludes comparison however of the quality of different study designs [ 8 ]. To attempt to overcome this limitation, generic critical appraisal tools have been developed, in an attempt to enhance the ability of research consumers to synthesise evidence from a range of quantitative and or qualitative study designs (for instance [ 9 ]). There is no evidence that generic critical appraisal tools and design-specific tools provide a comparative evaluation of research designs.

Moreover, there appears to be little consensus regarding the most appropriate items that should be contained within any critical appraisal tool. This paper is concerned primarily with critical appraisal tools that address the unique properties of allied health care and research [ 10 ]. This approach was taken because of the unique nature of allied health contacts with patients, and because evidence-based practice is an emerging area in allied health [ 10 ]. The availability of so many critical appraisal tools (for instance [ 6 ]) may well prove daunting for allied health practitioners who are learning to critically appraise research in their area of interest. For the purposes of this evaluation, allied health is defined as encompassing "...all occasions of service to non admitted patients where services are provided at units/clinics providing treatment/counseling to patients. These include units primarily concerned with physiotherapy, speech therapy, family panning, dietary advice, optometry occupational therapy..." [ 11 ].

The unique nature of allied health practice needs to be considered in allied health research. Allied health research thus differs from most medical research, with respect to:

• the paradigm underpinning comprehensive and clinically-reasoned descriptions of diagnosis (including validity and reliability). An example of this is in research into low back pain, where instead of diagnosis being made on location and chronicity of pain (as is common) [ 12 ], it would be made on the spinal structure and the nature of the dysfunction underpinning the symptoms, which is arrived at by a staged and replicable clinical reasoning process [ 10 , 13 ].

• the frequent use of multiple interventions within the one contact with the patient (an occasion of service), each of which requires appropriate description in terms of relationship to the diagnosis, nature, intensity, frequency, type of instruction provided to the patient, and the order in which the interventions were applied [ 13 ]

• the timeframe and frequency of contact with the patient (as many allied health disciplines treat patients in episodes of care that contain multiple occasions of service, and which can span many weeks, or even years in the case of chronic problems [ 14 ])

• measures of outcome, including appropriate methods and timeframes of measuring change in impairment, function, disability and handicap that address the needs of different stakeholders (patients, therapists, funders etc) [ 10 , 12 , 13 ].

Search strategy

In supplementary data [see additional file 1 ].

Data organization and extraction

Two independent researchers (PK, NMW) participated in all aspects of this review, and they compared and discussed their findings with respect to inclusion of critical appraisal tools, their intent, components, data extraction and item classification, construction and psychometric properties. Disagreements were resolved by discussion with a third member of the team (KG).

Data extraction consisted of a four-staged process. First, identical replica critical appraisal tools were identified and removed prior to analysis. The remaining critical appraisal tools were then classified according to the study design for which they were intended to be used [ 1 , 2 ]. The scientific manner in which the tools had been constructed was classified as whether an empirical research approach has been used, and if so, which type of research had been undertaken. Finally, the items contained in each critical appraisal tool were extracted and classified into one of eleven groups, which were based on the criteria described by Clarke and Oxman [ 4 ] as:

• Study aims and justification

• Methodology used , which encompassed method of identification of relevant studies and adherence to study protocol;

• Sample selection , which ranged from inclusion and exclusion criteria, to homogeneity of groups;

• Method of randomization and allocation blinding;

• Attrition : response and drop out rates;

• Blinding of the clinician, assessor, patient and statistician as well as the method of blinding;

• Outcome measure characteristics;

• Intervention or exposure details;

• Method of data analyses ;

• Potential sources of bias ; and

• Issues of external validity , which ranged from application of evidence to other settings to the relationship between benefits, cost and harm.

An additional group, " miscellaneous ", was used to describe items that could not be classified into any of the groups listed above.

Data synthesis

Data was synthesized using MS Excel spread sheets as well as narrative format by describing the number of critical appraisal tools per study design and the type of items they contained. Descriptions were made of the method by which the overall quality of the study was determined, evidence regarding the psychometric properties of the tools (validity and reliability) and whether guidelines were provided for use of the critical appraisal tool.

One hundred and ninety-three research reports that potentially provided a description of a critical appraisal tool (or process) were identified from the search strategy. Fifty-six of these papers were unavailable for review due to outdated Internet links, or inability to source the relevant journal through Australian university and Government library databases. Of the 127 papers retrieved, 19 were excluded from this review, as they did not provide a description of the critical appraisal tool used, or were published in languages other than English. As a result, 108 papers were reviewed, which yielded 121 different critical appraisal tools [ 1 – 5 , 7 , 9 , 15 – 102 , 116 ].

Empirical basis for tool construction

We identified 14 instruments (12% all tools) which were reported as having been constructed using a specified empirical approach [ 20 , 29 , 30 , 32 , 35 , 40 , 49 , 51 , 70 – 72 , 79 , 103 , 116 ]. The empirical research reflected descriptive and/or qualitative approaches, these being critical review of existing tools [ 40 , 72 ], Delphi techniques to identify then refine data items [ 32 , 51 , 71 ], questionnaires and other forms of written surveys to identify and refine data items [ 70 , 79 , 103 ], facilitated structured consensus meetings [ 20 , 29 , 30 , 35 , 40 , 49 , 70 , 72 , 79 , 116 ], and pilot validation testing [ 20 , 40 , 72 , 103 , 116 ]. In all the studies which reported developing critical appraisal tools using a consensus approach, a range of stakeholder input was sought, reflecting researchers and clinicians in a range of health disciplines, students, educators and consumers. There were a further 31 papers which cited other studies as the source of the tool used in the review, but which provided no information on why individual items had been chosen, or whether (or how) they had been modified. Moreover, for 21 of these tools, the cited sources of the critical appraisal tool did not report the empirical basis on which the tool had been constructed.

Critical appraisal tools per study design

Seventy-eight percent (N = 94) of the critical appraisal tools were developed for use on primary research [ 1 – 5 , 7 , 9 , 18 , 19 , 25 – 27 , 34 , 37 – 41 ], while the remainder (N = 26) were for secondary research (systematic reviews and meta-analyses) [ 2 – 5 , 15 – 36 , 116 ]. Eighty-seven percent (N = 104) of all critical appraisal tools were design-specific [ 2 – 5 , 7 , 9 , 15 – 90 ], with over one third (N = 45) developed for experimental studies (randomized controlled trials, clinical trials) [ 2 – 4 , 25 – 27 , 34 , 37 – 73 ]. Sixteen critical appraisal tools were generic. Of these, six were developed for use on both experimental and observational studies [ 9 , 91 – 95 ], whereas 11 were purported to be useful for any qualitative and quantitative research design [ 1 , 18 , 41 , 96 – 102 , 116 ] (see Figure 1 , Table 1 ).

Number of critical appraisal tools per study design [1,2]

Critical appraisal items

One thousand, four hundred and seventy five items were extracted from these critical appraisal tools. After grouping like items together, 173 different item types were identified, with the most frequently reported items being focused towards assessing the external validity of the study (N = 35) and method of data analyses (N = 28) (Table 2 ). The most frequently reported items across all critical appraisal tools were:

Eligibility criteria (inclusion/exclusion criteria) (N = 63)

Appropriate statistical analyses (N = 47)

Random allocation of subjects (N = 43)

Consideration of outcome measures used (N = 43)

Sample size justification/power calculations (N = 39)

Study design reported (N = 36)

Assessor blinding (N = 36)

Design-specific critical appraisal tools

Systematic reviews.

Eighty-seven different items were extracted from the 26 critical appraisal tools, which were designed to evaluate the quality of systematic reviews. These critical appraisal tools frequently contained items regarding data analyses and issues of external validity (Tables 2 and 3 ).

Items assessing data analyses were focused to the methods used to summarize the results, assessment of sensitivity of results and whether heterogeneity was considered, whereas the nature of reporting of the main results, interpretation of them and their generalizability were frequently used to assess the external validity of the study findings. Moreover, systematic review critical appraisal tools tended to contain items such as identification of relevant studies, search strategy used, number of studies included and protocol adherence, that would not be relevant for other study designs. Blinding and randomisation procedures were rarely included in these critical appraisal tools.

Experimental studies

One hundred and twenty thirteen different items were extracted from the 45 experimental critical appraisal tools. These items most frequently assessed aspects of data analyses and blinding (Tables 1 and 2 ). Data analyses items were focused on whether appropriate statistical analysis was performed, whether a sample size justification or power calculation was provided and whether side effects of the intervention were recorded and analysed. Blinding was focused on whether the participant, clinician and assessor were blinded to the intervention.

Diagnostic studies

Forty-seven different items were extracted from the seven diagnostic critical appraisal tools. These items frequently addressed issues involving data analyses, external validity of results and sample selection that were specific to diagnostic studies (whether the diagnostic criteria were defined, definition of the "gold" standard, the calculation of sensitivity and specificity) (Tables 1 and 2 ).

Observational studies

Seventy-four different items were extracted from the 19 critical appraisal tools for observational studies. These items primarily focused on aspects of data analyses (see Tables 1 and 2 , such as whether confounders were considered in the analysis, whether a sample size justification or power calculation was provided and whether appropriate statistical analyses were preformed.

Qualitative studies

Thirty-six different items were extracted from the seven qualitative study critical appraisal tools. The majority of these items assessed issues regarding external validity, methods of data analyses and the aims and justification of the study (Tables 1 and 2 ). Specifically, items were focused to whether the study question was clearly stated, whether data analyses were clearly described and appropriate, and application of the study findings to the clinical setting. Qualitative critical appraisal tools did not contain items regarding sample selection, randomization, blinding, intervention or bias, perhaps because these issues are not relevant to the qualitative paradigm.

Generic critical appraisal tools

Experimental and observational studies.

Forty-two different items were extracted from the six critical appraisal tools that could be used to evaluate experimental and observational studies. These tools most frequently contained items that addressed aspects of sample selection (such as inclusion/exclusion criteria of participants, homogeneity of participants at baseline) and data analyses (such as whether appropriate statistical analyses were performed, whether a justification of the sample size or power calculation were provided).

All study designs

Seventy-eight different items were contained in the ten critical appraisal tools that could be used for all study designs (quantitative and qualitative). The majority of these items focused on whether appropriate data analyses were undertaken (such as whether confounders were considered in the analysis, whether a sample size justification or power calculation was provided and whether appropriate statistical analyses were preformed) and external validity issues (generalization of results to the population, value of the research findings) (see Tables 1 and 2 ).

Allied health critical appraisal tools

We found no critical appraisal instrument specific to allied health research, despite finding at least seven critical appraisal instruments associated with allied health topics (mostly physiotherapy management of orthopedic conditions) [ 37 , 39 , 52 , 58 , 59 , 65 ]. One critical appraisal development group proposed two instruments [ 9 ], specific to quantitative and qualitative research respectively. The core elements of allied health research quality (specific diagnosis criteria, intervention descriptions, nature of patient contact and appropriate outcome measures) were not addressed in any one tool sourced for this evaluation. We identified 152 different ways of considering quality reporting of outcome measures in the 121 critical appraisal tools, and 81 ways of considering description of interventions. Very few tools which were not specifically targeted to diagnostic studies (less than 10% of the remaining tools) addressed diagnostic criteria. The critical appraisal instrument that seemed most related to allied health research quality [ 39 ] sought comprehensive evaluation of elements of intervention and outcome, however this instrument was relevant only to physiotherapeutic orthopedic experimental research.

Overall study quality

Forty-nine percent (N = 58) of critical appraisal tools summarised the results of the quality appraisal into a single numeric summary score [ 5 , 7 , 15 – 25 , 37 – 59 , 74 – 77 , 80 – 83 , 87 , 91 – 93 , 96 , 97 ] (Figure 2 ). This was achieved by one of two methods:

Number of critical appraisal tools with, and without, summary quality scores

An equal weighting system, where one point was allocated to each item fulfilled; or

A weighted system, where fulfilled items were allocated various points depending on their perceived importance.

However, there was no justification provided for any of the scoring systems used. In the remaining critical appraisal tools (N = 62), a single numerical summary score was not provided [ 1 – 4 , 9 , 25 – 36 , 60 – 73 , 78 , 79 , 84 – 90 , 94 , 95 , 98 – 102 ]. This left the research consumer to summarize the results of the appraisal in a narrative manner, without the assistance of a standard approach.

Psychometric properties of critical appraisal tools

Few critical appraisal tools had documented evidence of their validity and reliability. Face validity was established in nine critical appraisal tools, seven of which were developed for use on experimental studies [ 38 , 40 , 45 , 49 , 51 , 63 , 70 ] and two for systematic reviews [ 32 , 103 ]. Intra-rater reliability was established for only one critical appraisal tool as part of its empirical development process [ 40 ], whereas inter-rater reliability was reported for two systematic review tools [ 20 , 36 ] (for one of these as part of the developmental process [ 20 ]) and seven experimental critical appraisal tools [ 38 , 40 , 45 , 51 , 55 , 56 , 63 ] (for two of these as part of the developmental process [ 40 , 51 ]).

Critical appraisal tool guidelines

Forty-three percent (N = 52) of critical appraisal tools had guidelines that informed the user of the interpretation of each item contained within them (Table 2 ). These guidelines were most frequently in the form of a handbook or published paper (N = 31) [ 2 , 4 , 9 , 15 , 20 , 25 , 28 , 29 , 31 , 36 , 37 , 41 , 50 , 64 – 67 , 69 , 80 , 84 – 87 , 89 , 90 , 95 , 100 , 116 ], whereas in 14 critical appraisal tools explanations accompanied each item [ 16 , 26 , 27 , 40 , 49 , 51 , 57 , 59 , 79 , 83 , 91 , 102 ].

Our search strategy identified a large number of published critical appraisal tools that are currently available to critically appraise research reports. There was a distinct lack of information on tool development processes in most cases. Many of the tools were reported to be modifications of other published tools, or reflected specialty concerns in specific clinical or research areas, without attempts to justify inclusion criteria. Less than 10 of these tools were relevant to evaluation of the quality of allied health research, and none of these were based on an empirical research approach. We are concerned that although our search was systematic and extensive [ 104 , 105 ], our broad key words and our lack of ready access to 29% of potentially useful papers (N = 56) potentially constrained us from identifying all published critical appraisal tools. However, consumers of research seeking critical appraisal instruments are not likely to seek instruments from outdated Internet links and unobtainable journals, thus we believe that we identified the most readily available instruments. Thus, despite the limitations on sourcing all possible tools, we believe that this paper presents a useful synthesis of the readily available critical appraisal tools.

The majority of the critical appraisal tools were developed for a specific research design (87%), with most designed for use on experimental studies (38% of all critical appraisal tools sourced). This finding is not surprising as, according to the medical model, experimental studies sit at or near the top of the hierarchy of evidence [ 2 , 8 ]. In recent years, allied health researchers have strived to apply the medical model of research to their own discipline by conducting experimental research, often by using the randomized controlled trial design [ 106 ]. This trend may be the reason for the development of experimental critical appraisal tools reported in allied health-specific research topics [ 37 , 39 , 52 , 58 , 59 , 65 ].

We also found a considerable number of critical appraisal tools for systematic reviews (N = 26), which reflects the trend to synthesize research evidence to make it relevant for clinicians [ 105 , 107 ]. Systematic review critical appraisal tools contained unique items (such as identification of relevant studies, search strategy used, number of studies included, protocol adherence) compared with tools used for primary studies, a reflection of the secondary nature of data synthesis and analysis.

In contrast, we identified very few qualitative study critical appraisal tools, despite the presence of many journal-specific guidelines that outline important methodological aspects required in a manuscript submitted for publication [ 108 – 110 ]. This finding may reflect the more traditional, quantitative focus of allied health research [ 111 ]. Alternatively, qualitative researchers may view the robustness of their research findings in different terms compared with quantitative researchers [ 112 , 113 ]. Hence the use of critical appraisal tools may be less appropriate for the qualitative paradigm. This requires further consideration.

Of the small number of generic critical appraisal tools, we found few that could be usefully applied (to any health research, and specifically to the allied health literature), because of the generalist nature of their items, variable interpretation (and applicability) of items across research designs, and/or lack of summary scores. Whilst these types of tools potentially facilitate the synthesis of evidence across allied health research designs for clinicians, their lack of specificity in asking the 'hard' questions about research quality related to research design also potentially precludes their adoption for allied health evidence-based practice. At present, the gold standard study design when synthesizing evidence is the randomized controlled trial [ 4 ], which underpins our finding that experimental critical appraisal tools predominated in the allied health literature [ 37 , 39 , 52 , 58 , 59 , 65 ]. However, as more systematic literature reviews are undertaken on allied health topics, it may become more accepted that evidence in the form of other research design types requires acknowledgement, evaluation and synthesis. This may result in the development of more appropriate and clinically useful allied health critical appraisal tools.

A major finding of our study was the volume and variation in available critical appraisal tools. We found no gold standard critical appraisal tool for any type of study design. Therefore, consumers of research are faced with frustrating decisions when attempting to select the most appropriate tool for their needs. Variable quality evaluations may be produced when different critical appraisal tools are used on the same literature [ 6 ]. Thus, interpretation of critical analysis must be carefully considered in light of the critical appraisal tool used.

The variability in the content of critical appraisal tools could be accounted for by the lack of any empirical basis of tool construction, established validity of item construction, and the lack of a gold standard against which to compare new critical tools. As such, consumers of research cannot be certain that the content of published critical appraisal tools reflect the most important aspects of the quality of studies that they assess [ 114 ]. Moreover, there was little evidence of intra- or inter-rater reliability of the critical appraisal tools. Coupled with the lack of protocols for use, this may mean that critical appraisers could interpret instrument items in different ways over repeated occasions of use. This may produce variable results [123].

Based on the findings of this evaluation, we recommend that consumers of research should carefully select critical appraisal tools for their needs. The selected tools should have published evidence of the empirical basis for their construction, validity of items and reliability of interpretation, as well as guidelines for use, so that the tools can be applied and interpreted in a standardized manner. Our findings highlight the need for consensus to be reached regarding the important and core items for critical appraisal tools that will produce a more standardized environment for critical appraisal of research evidence. As a consequence, allied health research will specifically benefit from having critical appraisal tools that reflect best practice research approaches which embed specific research requirements of allied health disciplines.

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Persis Katrak, Nicola Massy-Westropp, VS Saravana Kumar & Karen A Grimmer

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PK Sourced critical appraisal tools

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Katrak, P., Bialocerkowski, A.E., Massy-Westropp, N. et al. A systematic review of the content of critical appraisal tools. BMC Med Res Methodol 4 , 22 (2004). https://doi.org/10.1186/1471-2288-4-22

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Critical Appraisal Tools and Reporting Guidelines for Evidence-Based Practice

Affiliations.

• 1 Professor, School of Nursing & Health Professions, University of San Francisco, San Francisco, CA, USA.
• 2 Reference Librarian and Primary Liaison, School of Nursing & Health Professions, Gleeson Library, Geschke Center, University of San Francisco, San Francisco, CA 94117, USA.
• PMID: 28898556
• DOI: 10.1111/wvn.12258

Background: Nurses engaged in evidence-based practice (EBP) have two important sets of tools: Critical appraisal tools and reporting guidelines. Critical appraisal tools facilitate the appraisal process and guide a consumer of evidence through an objective, analytical, evaluation process. Reporting guidelines, checklists of items that should be included in a publication or report, ensure that the project or guidelines are reported on with clarity, completeness, and transparency.

Purpose: The primary purpose of this paper is to help nurses understand the difference between critical appraisal tools and reporting guidelines. A secondary purpose is to help nurses locate the appropriate tool for the appraisal or reporting of evidence.

Methods: A systematic search was conducted to find commonly used critical appraisal tools and reporting guidelines for EBP in nursing.

Rationale: This article serves as a resource to help nurse navigate the often-overwhelming terrain of critical appraisal tools and reporting guidelines, and will help both novice and experienced consumers of evidence more easily select the appropriate tool(s) to use for critical appraisal and reporting of evidence. Having the skills to select the appropriate tool or guideline is an essential part of meeting EBP competencies for both practicing registered nurses and advanced practice nurses (Melnyk & Gallagher-Ford, 2015; Melnyk, Gallagher-Ford, & Fineout-Overholt, 2017).

Results: Nine commonly used critical appraisal tools and eight reporting guidelines were found and are described in this manuscript. Specific steps for selecting an appropriate tool as well as examples of each tool's use in a publication are provided.

Linking evidence to action: Practicing registered nurses and advance practice nurses must be able to critically appraise and disseminate evidence in order to meet EBP competencies. This article is a resource for understanding the difference between critical appraisal tools and reporting guidelines, and identifying and accessing appropriate tools or guidelines.

Keywords: critical appraisal tools; evidence-based nursing; evidence-based practice; reporting guidelines.

© 2017 Sigma Theta Tau International.

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• Data Collection / methods
• Evidence-Based Practice / methods
• Evidence-Based Practice / standards*
• Nurses / trends*
• Practice Guidelines as Topic / standards*
• Quality of Health Care / standards
• Risk Management / methods
• Risk Management / standards*

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Abstract: The integration and deployment of large language model (LLM)-based intelligent agents have been fraught with challenges that compromise their efficiency and efficacy. Among these issues are sub-optimal scheduling and resource allocation of agent requests over the LLM, the difficulties in maintaining context during interactions between agent and LLM, and the complexities inherent in integrating heterogeneous agents with different capabilities and specializations. The rapid increase of agent quantity and complexity further exacerbates these issues, often leading to bottlenecks and sub-optimal utilization of resources. Inspired by these challenges, this paper presents AIOS, an LLM agent operating system, which embeds large language model into operating systems (OS) as the brain of the OS, enabling an operating system "with soul" -- an important step towards AGI. Specifically, AIOS is designed to optimize resource allocation, facilitate context switch across agents, enable concurrent execution of agents, provide tool service for agents, and maintain access control for agents. We present the architecture of such an operating system, outline the core challenges it aims to resolve, and provide the basic design and implementation of the AIOS. Our experiments on concurrent execution of multiple agents demonstrate the reliability and efficiency of our AIOS modules. Through this, we aim to not only improve the performance and efficiency of LLM agents but also to pioneer for better development and deployment of the AIOS ecosystem in the future. The project is open-source at this https URL .

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Using quality assessment tools to critically appraise ageing research: a guide for clinicians

Jennifer kirsty harrison.

1 University of Edinburgh,Centre for Cognitive Ageing and Cognitive Epidemiology & The Alzheimer Scotland Dementia Research Centre , Edinburgh, United Kingdom

2 Queen Elizabeth University Hospital, Medicine for the Elderly , Glasgow, United Kingdom

Terry J Quinn

3 University of Glasgow, Institute of Cardiovascular and Medical Sciences , Glasgow, United Kingdom

Susan Deborah Shenkin

4 University of Edinburgh, Geriatric Medicine, Department of Clinical and Surgical Sciences , Edinburgh, United Kingdom

5 University of Edinburgh, Centre for Cognitive Ageing and Cognitive Epidemiology , Edinburgh, United Kingdom

Associated Data

Evidence based medicine tells us that we should not accept published research at face value. Even research from established teams published in the highest impact journals can have methodological flaws, biases and limited generalisability. The critical appraisal of research studies can seem daunting, but tools are available to make the process easier for the non-specialist. Understanding the language and process of quality assessment is essential when considering or conducting research, and is also valuable for all clinicians who use published research to inform their clinical practice.

We present a review written specifically for the practising geriatrician. This considers how quality is defined in relation to the methodological conduct and reporting of research. Having established why quality assessment is important, we present and critique tools which are available to standardise quality assessment. We consider five study designs: RCTs, non-randomised studies, observational studies, systematic reviews and diagnostic test accuracy studies. Quality assessment for each of these study designs is illustrated with an example of published cognitive research. The practical applications of the tools are highlighted, with guidance on their strengths and limitations. We signpost educational resources and offer specific advice for use of these tools.

We hope that all geriatricians become comfortable with critical appraisal of published research and that use of the tools described in this review – along with awareness of their strengths and limitations – become a part of teaching, journal clubs and practice.

Risk of bias, allocation and randomisation describe fundamental aspects of clinical research, but they are only useful if you know what they mean and how to apply them. Understanding how to assess published research quality is an essential skill for any clinician. For geriatricians, an ability to evaluate the available evidence and apply the findings to our population is essential. In this review we describe the importance of quality assessment; outline some assessment tools and reporting guidelines, and illustrate, with examples from published cognitive research studies, how the use of these tools can improve the quality of research and maximise its relevance to practice. We also highlight specific aspects of study design and conduct which can help support the inclusion of older people in research and maximise its value.

What is ‘quality’ in relation to research?

Quality in research includes two complementary aspects: methodological and reporting quality. We consider both of these aspects in turn. Here ’quality’ does not relate to the importance of the topic or the enjoyability of the prose. The term is not universally popular, as some erroneously interpret ‘quality’ as relating to the value of the research. For brevity, and in keeping with current literature, we will use the term in this paper. Although relevant to all branches of medicine we highlight quality considerations for research relevant to geriatricians (see Supplementary data, Table S1 Appendix 2, available at Age and Ageing online ).

Methodological quality

Methodological quality relates to the design and conduct of research, and is fundamental to understanding the results and the level of confidence in the findings. We consider the important aspects of quality of conduct for each type of study.

Randomised controlled trials

A well-conducted randomised controlled trial (RCT) is considered the highest form of evidence for assessing the effect of interventions, e.g. drug treatments [ 1 ]. In a RCT, one group is allocated to receive an intervention and the other receive a control. An example RCT compared the cognitive and functional outcomes between groups given Donepezil or placebo [ 2 ].

Assessing bias in trials

Establishing the methodological quality of individual RCTs is largely based around assessment of the risk of bias. Bias can be defined as: ‘a systematic error, or deviation from the truth, in results or inferences’ [ 3 ]. Recognising the importance of a standardised approach to describing potential bias, Cochrane developed a tool to assess risk of bias in RCTs [ 4 ]. This considers bias in terms of selection , performance , detection , attrition , reporting and other biases and the user rates studies as high, low or unclear risk of bias for each domain [ 4 ]: these are described in detail, using the example of a RCT of donepezil and placebo in Table ​ Table1 1 .

Cochrane Risk of Bias assessment – with examples based around a randomised trial of Donepezil [ 2 ].

Considering ‘ performance bias’ , ideally participants should not be aware which arm of a study (intervention or control) they are part of. This can be problematic for complex interventions such as falls prevention, as it can be difficult to blind patients who are receiving specialist care. This often necessitates an assessment score of ‘high risk of bias’ when applying the tool. However, the creating a complex ‘sham intervention’ for the control group can have its own limitations. Logan et al . describe the unintended effect of providing an activity diary to their control arm of an occupational therapy intervention study for stroke survivors as minimising the true difference between the groups, as it stimulated activity among controls [ 5 ].

The category of ‘ other bias ’ is relevant in determining whether an RCT is valuable to practice by assessing whether the included participants are representative of your population. There is a recognition that many clinical trials have excluded older people, despite the intervention being studied being relevant to their needs [ 6 ]. Study design and conduct can take account of the needs of this population to increase their participation and thus the value of such trials. Risk of bias across a group of RCTs can be summarised graphically, generated by using the freely available ‘Review Manager’ software (see Supplementary data, Appendix 2, available at Age and Ageing online ) [ 7 ].

Alternative approaches include scales – such as the Jadad scale [ 8 ] – which are designed to give a summary ‘quality’ score. These can lead to an over-simplification of quality assessment and are at greater risk of problems with inter-rater reliability, i.e. how different assessors respond to the same questions and how consistently they score the responses [ 9 ]. These scales have been criticised as, they can result in a RCT with a single significant flaw being considered as high quality, while a RCT with a number of minor biases would be classed as low quality. The use of quality scores in meta-analyses of clinical trials should therefore be avoided [ 10 ].

Non-randomised and observational studies

Non-randomised and observational studies are not interchangeable terms. A non-randomised interventional study may compare the effects of an intervention (allocated in a non-random way) with a control [ 11 ]. Observational studies include cohort and case–control designs, and can all be described as non-randomised. There are a variety of quality tools for these studies, each with different indications and applications, and with no consensus agreement on a preferred tool [ 12 , 13 ]. Three tools are compared in see Supplementary data, Appendix 2, Table S3, available at Age and Ageing online .

Non-randomised studies where an intervention is being evaluated are primarily conducted where randomisation is not considered to be pragmatic or possible. One example is the Hospital Elder Life Programme, developed in the USA as a multicomponent programme to prevent delirium [ 14 ]. Here the authors wished to study their multicomponent intervention in one unit, compared with two control units, but they felt that they could not feasibly randomise participants to these units due to the large numbers requiring care in hospital [ 14 ].

Risk of bias is a key quality concern in non-randomised studies: systematic biases may influence the outcome in non-randomised studies, and this can be inflated in studies with large sample sizes, whereas in RCTs randomisation should minimise differences between the groups, and this is more effective the larger the study. For example, characteristics which might affect the incidence of delirium, such as presence of dementia, illness severity, etc. may not be equally distributed between the groups, potentially increasing the rates of delirium in one group compared to the other unrelated to the intervention. The Risk of Bias Assessment tool for Non-Randomised Studies (RoBANS) is a six-domain tool designed to look at risk of bias alone ( Table 3 ) [ 15 ]. RoBANS is consistent with the Cochrane Risk of Bias tool [ 4 ] and thus simple diagrams can be created to transparently report the assessment of each study. It has been validated by its original authors, but has not yet had an external validation [ 15 ].

Observational studies (cohort and case–control designs) are used where randomised trials are not feasible or ethical or to provide initial evidence for interventions which can later be tested in randomised trials. Cohort studies prospectively follow groups who differ in their exposure to see how this exposure relates to the development of an outcome [ 16 ]. Case–control studies retrospectively compare individuals with a disease (‘cases’) with matched ‘controls’ without that disease, to understand which factors are associated with the development of the disease [ 16 ]. An example is whether delirium is associated with development of dementia [ 17 ]. It would be unethical, and perhaps impossible, to randomise individuals to experience delirium, therefore a cohort study follows individuals with and without delirium to determine who later develops dementia. The parameters under investigation are not controlled by the study design, and quality assessment, particularly the role of bias, is crucial.

Observational studies can provide evidence of associations between factors, but they cannot prove that an observed relationship is causative. The summary statistics of the strength of association can be adjusted for ‘potential confounders’ if data have been collected, such as age, sex, disease severity [ 17 ] to check that the association which has been observed persists after these have been accounted for. For example, if an increased likelihood of developing dementia after delirium is due to age differences between the groups. However, there is always the risk of ‘residual confounding’ – that results are due to variables that were not included in the analyses – and future RCTs may contradict the findings from observational studies.

The Newcastle-Ottawa Quality Assessment Scale (NOS) is a freely available eight-item scale with a version for cohort and case–control studies ( Table 3 ) [ 18 ]. It has not yet been published in any peer-reviewed publication. The scale evaluates the domains of selection, comparability and outcome or exposure. One star is allocated when a feature of quality is present, to a maximum of nine (the comparability domain can score up to two stars) [ 18 ]. No specific value is assigned to high or low quality, although higher scores indicate greater use of favourable methodological aspects. The inter-rater reliability of the NOS has been questioned [ 19 ] as has its usefulness in distinguishing between studies of high and low quality [ 19 , 20 ] and its lack of external validation makes it difficult to assess this.

Diagnostic test accuracy studies

Diagnostic test accuracy studies evaluate the usefulness of a screening or diagnostic test(s) by comparing the performance of the test(s) against an established reference standard diagnostic approach [ 21 ]. The dementia diagnostic pathway requires diagnostic test accuracy research as a range of imaging tests, biomarkers, cognitive tests and informant instruments have been advocated [ 22 ]. A recent example featured evaluation of an informant instrument, the AD-8: the Washington University Dementia Screening Test, to diagnose cognitive impairment [ 23 ].

Quality assessment in test accuracy

The Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool is organised into four domains ( patient selection, index test, reference standard and flow and timing ) and, within these there are assessments of the risk of bias and, the applicability of findings [ 24 ]. Assessments are made for each domain, determining yes/no/unclear for each.

In dementia test accuracy:

• Patient selection considers the type of people included (e.g. cognitively intact, cognitively impaired), setting of recruitment, exclusion criteria (particularly exclusion of significant co-morbidities).
• Assessing applicability depends on judging how similar they are to the population seen in practice.
• The index test questions ask you to judge if the test was conducted as you would expect in practice, if it was independent of the reference standard and if any cut-off value was pre-specified or if these were decided based on the results.
• The reference standard questions establish if the assessment was independent from the index test result and if the standard used is likely to correctly identify the condition, e.g. recognised diagnostic standard such as the International Classification of Disease (ICD) criteria.
• Flow and timing relates to the timing of administration of the test within the diagnostic encounter and whether all those participating in the study are clearly accounted for, to ensure there have been no exclusions which might mean the tool was less useful in practice (e.g. exclusion of those who have no carer/informant).

QUADAS-2 includes ‘signalling questions’ to help direct the interpretation of the tool questions [ 24 ]. Some test accuracy studies are at risk of incorporation bias as often, particularly for cognitive and informant tests, these inform the clinical expert diagnosis, thus studies can be penalised if these results have formed part of the reference standard. Graphical summary tables can be produced [ 24 ]. These quality assessment concepts are exemplified in a series of Cochrane reviews, including use of the Informant Questionnaire for Cognitive Decline in the Elderly (IQCODE) in secondary care [ 25 ].

Systematic reviews and meta-analyses

Systematic reviews are the results of an organised synthesis of the evidence on a particular topic. Meta-analyses are a subgroup of systematic review where the same outcome measure is reported in multiple studies and the results can be combined statistically to calculate the estimated overall effect size from all the trials together. A recent Cochrane review sought to establish the evidence for the effectiveness of case management approaches to home support for people with dementia [ 26 ]. The outcomes which the authors wanted to describe included institutionalisation, hospital admission, mortality, quality of life, carer burden and service use [ 26 ]. Meta-analysis was possible for the outcome of institutional care, as these results were reported in eight studies at four different time points [ 26 ].

Well-conducted systematic reviews are valuable resources for researchers and clinicians, identifying where sufficient evidence exists for or against an intervention and where evidence is lacking. They not only summarise the available literature, but critically appraise it and summarise the confidence with which the conclusions are justified. If you are planning to undertake a systematic review it is advisable to consult your local librarian or information specialist who can provide support and expertise to help maximise the value of your work.

Assessing the quality of a systematic review

The Assessing the Methodological Quality of Systematic Reviews (AMSTAR) tool [ 27 ] scores out of a total of 11 points. Key aspects include an a priori design, search method, quality assessment and how quality informs the review conclusions. There is no score which separates a high from a low quality review. AMSTAR has been validated by its original authors and has good inter-rater reliability and other favourable assessment score qualities [ 28 , 29 ]. Similar reliability has been obtained in external validation [ 30 ].

Assessing study quality when conducting a systematic review

It is necessary to assess the quality of the included studies in the review, using tools specific to the study design. If a systematic review is well conducted and robust, it may be possible to make recommendations about the quality of the identified evidence. This enables quantitative findings to be qualified with assessment of the quality. For example, if there are several studies of lower quality which are combined with one high quality RCT, the numerical results alone could lead to erroneous conclusions to be drawn if quality is not considered.

The Grading of Recommendations Assessment Development and Evaluation (GRADE) system was developed to improve the evaluation of evidence for clinical guidelines [ 31 ], and has been widely adopted by Cochrane, the World Health Organization and other healthcare organisations and journals [ 32 ]. It includes a risk of bias assessment, but also requires the assessment of consistency, indirectness, imprecision and publication bias [ 31 ].

• Consistency indicates whether the findings are consistent with those in the other included studies
• Indirectness indicates whether the evidence is applicable to the entire population or whether it is indirect and only applicable to a sub-set, e.g. exclusion of those with other significant co-morbidities such as depression would lead you to conclude a dementia research study was at risk of indirectness.
• Imprecision indicates the confidence interval associated with a finding, this will largely be reduced by studies with larger sample sizes, although not if the studies produce conflicting results.
• Publication bias can occur if not all studies conducted in the field are published and available for inclusion. Typically this occurs when studies with a negative result are not published, leading to a summary estimate of positive results which may be biased in this direction. This is more common in studies of interventions and can only be formally assessed where data are available for direct comparisons between studies.

It is possible to assess the quality of each finding from a systematic review by applying GRADE, allowing you to present the statistical findings from each result alongside an assessment of the quality of the evidence from which the result is derived, transparently accounting for why evidence has been downgraded. Its use is not limited to RCTs, but many of the parameters can only be assessed using quantitative data and downgrading is required for study designs other than RCTs. As a system GRADE lends itself well to identifying areas for which further research evidence is required to improve the quality of the evidence. The GRADEpro software to create accompanying tables of results is also freely available (Figure ​ (Figure1) 1 ) [ 33 ].

Useful links to resources for quality assessment and reporting of studies.

Reporting quality

Reporting quality describes how well a piece of scientific work is written- as an article published by a scientific journal. A key criterion is whether the study as reported would allow a reader to replicate the work. Poor quality of reporting is common [ 34 , 35 ], which can make it difficult to assess the methodology [ 35 ]. Various approaches to improving the quality of scientific reporting have been proposed. Successful examples include the guidance offered by Cochrane for systematic review [ 36 ] and the Enhancing the QUAlity and Transparency Of health Research (EQUATOR) Network. The EQUATOR Network provides resources for authors, editors and educationalists to promote all aspects of improving reporting quality in health research (Figure ​ (Figure1) 1 ) [ 37 , 38 ].

Reporting guidance is presented in the form of a checklist of recommendations specific for the study design. The EQUATOR website includes a tool to assist in the selection of the correct guideline [ 39 ], as it can sometimes be difficult for researchers to be confident which is the most appropriate. The first of these guidelines was the Consolidated Standards of Reporting Trials (CONSORT) Statement for RCTs [ 40 ]. CONSORT now comprises a 22-item checklist assessing each section of the research paper [ 41 ]. CONSORT recommends the use of a structured flow diagram: describing numbers of participants at enrolment, allocation, follow-up and analysis [ 42 ]. Similar guidelines exist for the reporting of other study designs [ 39 ] and we encourage all authors to use these.

In reporting guidelines individual items are not weighted to indicate the quality the study report (and the completion of most or all items on the checklist is not necessarily an indicator of quality). For example, in Strengthening the Reporting of Observational Studies in Epidemiology (STROBE), one item is ‘indicate the study's design with a commonly used term in the title or abstract’ and another is ‘describe any efforts to assess potential sources of bias’ [ 43 ]. Clearly, a lack of consideration of bias will have a major impact on the results, whereas the title of the paper will not. Note that these are assessments of reporting quality, not an assessment of the methodology of the study itself.

Are quality tools valuable?

Quality tools are widely available, but not universally accepted. Their use has improved the quality of reporting of studies [ 44 , 45 ] with greater improvements in journals which promote or require their use [ 46 , 47 ] and they can be useful for peer reviewers. Possible arguments against their use include the over-standardisation of published material. It can also challenge researchers if they do not have all the required information

Another limitation for some tools is their lack of external validation. Tool authors must seek external usage and testing of their tool to fully understand how it is applied by non-specialists. In particular identifying questions which may be open to interpretation can allow guidance notes to be provided.

How and when to use the tools

Critical appraisal for journal clubs, peer review or clinical use.

For those delivering teaching about the principles of methodological quality assessment or running local journal clubs, there are plenty of resources available. ‘How to Read a Paper’ [ 48 ] is a short and accessible read and the Critical Appraisal Skills Programme Checklists [ 49 ] can be helpful for facilitating group sessions. Their 10–12 question checklists cover each of the key study designs. These are typically divided into three sections with prompts beside each question to help understanding [ 49 ]. They are largely designed to familiarise users with study designs and help them evaluate the relevance of the paper to their practice as they contain several subjective elements which may not lend themselves to incorporation in a formal quality assessment. Alternatively, the components of other methodological quality assessment tools can be used to facilitate discussion.

Research study design

If you are at the beginning of a project, the tools can help identify factors to include in your design (e.g. who will assess your outcome and how can they be blinded to which participants have received the intervention). Similarly, if you are planning a systematic review, the reporting tools prompt you to find a second reviewer to improve the quality of your data. You also need to decide which tool to use to assess the methodological quality of the studies included in your review – be aware of their strengths and limitations.

Research study reporting

Reporting quality checklists can help you structure the write up of your study, ensuring you present all recommended information. It is also important to be aware that many journals require that a completed checklist is submitted with your manuscript, indicating where you have addressed each point.

Conclusions

Understanding and evaluating the evidence behind clinical practice is a valuable skill for any geriatrician. The formal tools which have been developed for assessment of methodological and reporting quality can be helpful when evaluating evidence or planning writing. Quality assessment is difficult and the most honest way to appraise studies is to look at the individual components of quality, rather than attempting a binary categorisation into high or low quality. These can then be presented in a transparent and understandable way, allowing you to determine whether the research is applicable to your clinical practice.

• Evaluating how well a study has been conducted is essential to determine if the findings are relevant to clinical practice.
• Making this assessment can be difficult depending on how well a study is reported.
• Guidelines are available to help assess the quality of a study's methods and to guide study reporting.
• These guidelines are useful for all clinicians wishing to critically appraise research findings for application in practice.

Supplementary Material

Supplementary data, supplementary data.

Supplementary data mentioned in the text are available to subscribers in Age and Ageing online .

Conflict of interest

The authors report that they have no conflicts of interest to declare.

J.K.H. is supported by a clinical research fellowship from Alzheimer Scotland and The University of Edinburgh Centre for Cognitive Ageing and Cognitive Epidemiology, part of the cross council Lifelong Health and Wellbeing Initiative (MR/L501530/1). Funding from the Biotechnology and Biological Sciences Research Council (BBSRC) and Medical Research Council (MRC) is gratefully acknowledged. T.J.Q. is supported by a joint Stroke Association/Chief Scientist Office Senior Clinical Lectureship. S.D.S. organises a systematic review methods course with accompanying online materials http://www.ccace.ed.ac.uk/research/software-resources/systematic-reviews-and-meta-analyses , but derives no financial benefit from this. The funders played no part in the writing of this review.

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