Critical appraisal of cohort

study
Dr Noha Saleh
Associate professor of public health
Consultant at MOH
1. Did the study address a clearly
focused issue?
Wasthe cohort recruited in an
acceptable way?
• selection bias
• everybody included who should have been
• something special about the cohort
• cohort representative of a defined population

Is it worth continuing?
Was the exposure accurately
measured to minimise bias?
• subjective or objective measurements
• Validated tool
• Standard tool applied to exposed and not exposed in the same way
Exposure

• History about participants’ entire working life. In this way,

exposures were standardised as ton-years (lifting 1000 kg
each day in 1 year), stand-years (standing/walking at work
for 6 h each day in 1 year) and kneel-years (kneeling at work
for 1 h each day in 1 year).
 Was the outcome accurately
measured to minimise bias?
• subjective or objective measurements
• Validated
• has a reliable system been established for detecting all the cases
(for measuring disease occurrence)
• Were the measurement methods similar in the different groups
Outcome

• Chair-rise performance was measured as the number of chair-

rises performed during a 30 s test. The test was performed using
a chair (height 45 cm) with a mechanical contact in the seat,
enabling automatic recording of the number of posture
transitions and the number of cycles completed, for example,
21.2 cycles in 30 s.19 As the test was somewhat tiresome each
participant made only a single attempt.
Have the authors identified all important
confounding factors?
Have theytaken account of the
confounding factors in the design
and/or analysis?
• Was the follow up of subjects complete enough?

• Was the follow up of subjects long enough?

 What are the results of this study?
How precise are the results?

• In this cohort, greater duration of physical exposures

throughout adult life was associated with poorer chair rise
performance in men with a mean age of 59 years
. Do you believe the results?

• can it be due to bias, chance or confounding

• are the design and methods of this study sufficiently

followed to make the results reliable
Can the results be applied to the local
population?
Do the results of this study fit with
other available evidence?
What are the implicationsof this study
for practice?
Thanks