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Critical Appraisal Teaching
Critical Appraisal Teaching
Critical Appraisal Teaching
E r i c a
Ro e b b e l e n
CRITICAL APPRAISAL
January 16,
2 0 15
B a n d a Ac e h
Qualitative
Studies
Cohort Study
Meta-analysis
ASSESSING EVIDENCE
What types of studies give us the strongest evidence?
ASSESSING EVIDENCE
ASSESSING VALIDITY
What is validity?
The degree to which the
outcome observed in the study
can be attributed to the
intervention.
ASSESSING VALIDITY
5 questions to ask about the validity of
primary studies:
1. Were the patients randomized?
2. Was the follow-up of patients suffi ciently
long enough and complete?
3. Were all patients analyzed in the groups to
which they were randomized? (intention to
treat analysis)
4. Were the groups treated equally except for
the intervention?
5. Were the patients and clinicians kept blind to
treatment? (was the study double
blinded?)
ANALYSIS
Per-Protocol Analysis (PP)
Strategy of analysis in which only patients
who complete the entire study are counted
towards the results
Intention to Treat Analysis (ITT)
When groups are analyzed exactly as they
existed upon randomization (i.e. using data
from all patients, including those who did not
complete the study)
ASSESSING VALIDITY
Some more questions to consider:
Were the groups similar at the start of the trial?
(think about gender, comorbidities, age, etc.)
Were the appropriate and valid exposure and
outcome measures obtained?
Were outcome assessors aware of group
allocation?
Was the study conducted in an ethical way?
Who funded the study?
Do the authors have any confl icts of interest?
ASSESSING VALIDITY
Internal Validity
the degree to which the findings of the
sample truly represent the findings in the
study population
External Validity
degree to which the results of the study can
be generalized to other situations or
populations
EFFECTIVENESS OF INTERVENTIONS
Relative Risk Reduction (RRR)
Absolute Risk Reduction (ARR)
Number Needed to Treat (NNT)
Number Needed to Harm (NNH)
EFFECTIVENESS OF A TEST
SPIN: Specificity use a SPecific test to rule IN a
hypothesis. Specific tests have very few false
positives.
SNOUT: Sensitivity use a SENsitive test to rule
OUT a hypothesis. Sensitive tests have few false
negatives.