A network for students interested in evidence-based health care

Critical Appraisal: A Checklist

Posted on September 6, 2016 by Robert Will

Tutorials and Fundamentals

Critical appraisal of scientific literature is a necessary skill for healthcare students. Students can be overwhelmed by the vastness of search results. Database searching is a skill in itself, but will not be covered in this blog. This blog assumes that you have found a relevant journal article to answer a clinical question. After selecting an article, you must be able to sit with the article and critically appraise it. Critical appraisal of a journal article is a literary and scientific systematic dissection in an attempt to assign merit to the conclusions of an article. Ideally, an article will be able to undergo scrutiny and retain its findings as valid.

The specific questions used to assess validity change slightly with different study designs and article types. However, in an attempt to provide a generalized checklist, no specific subtype of article has been chosen. Rather, the 20 questions below should be used as a quick reference to appraise any journal article. The first four checklist questions should be answered “Yes.” If any of the four questions are answered “no,” then you should return to your search and attempt to find an article that will meet these criteria.

Critical appraisal of…the Introduction

  1. Does the article attempt to answer the same question as your clinical question?
  2. Is the article recently published (within 5 years) or is it seminal (i.e. an earlier article but which has strongly influenced later developments)?
  3. Is the journal peer-reviewed?
  4. Do the authors present a hypothesis?

Critical appraisal of…the Methods

  1. Is the study design valid for your question?
  2. Are both inclusion and exclusion criteria described?
  3. Is there an attempt to limit bias in the selection of participant groups?
  4. Are there methodological protocols (i.e. blinding) used to limit other possible bias?
  5. Do the research methods limit the influence of confounding variables?
  6. Are the outcome measures valid for the health condition you are researching?

Critical appraisal of…the Results

  1. Is there a table that describes the subjects’ demographics?
  2. Are the baseline demographics between groups similar?
  3. Are the subjects generalizable to your patient?
  4. Are the statistical tests appropriate for the study design and clinical question?
  5. Are the results presented within the paper?
  6. Are the results statistically significant and how large is the difference between groups?
  7. Is there evidence of significance fishing (i.e. changing statistical tests to ensure significance)?

Critical appraisal of…the Discussion/Conclusion

  1. Do the authors attempt to contextualise non-significant data in an attempt to portray significance? (e.g. talking about findings which had a trend towards significance as if they were significant).
  2. Do the authors acknowledge limitations in the article?
  3. Are there any conflicts of interests noted?

This is by no means a comprehensive checklist of how to critically appraise a scientific journal article. However, by answering the previous 20 questions based on a detailed reading of an article, you can appraise most articles for their merit, and thus determine whether the results are valid. I have attempted to list the questions based on the sections most commonly present in a journal article, starting at the introduction and progressing to the conclusion. I believe some of these items are weighted heavier than others (i.e. methodological questions vs journal reputation). However, without taking this list through rigorous testing, I cannot assign a weight to them. Maybe one day, you will be able to critically appraise my future paper: How Online Checklists Influence Healthcare Students’ Ability to Critically Appraise Journal Articles.

 

The image in this blog has been retrieved from clipart free collection and is free to re-use.

Robert Will

Robert Will is in his second year at The University of Colorado Anschutz Medical Campus enrolled in its Doctor of Physical Therapy program. He has several areas of interest, including biomechanics, manual physical therapy, exercise prescription, and assistive devices. He is a Colorado native who returned to school after stints in several non-healthcare related fields. He believes evidence-based medicine will make everyone a better clinician. He lives in Denver, Colorado and enjoys all the state has to offer, other than skiing, because he is a rebel and refuses to fall into that Colorado stereotype. View more posts from Robert

Leave a Reply

Your email address will not be published. Required fields are marked *

2 Comments on Critical Appraisal: A Checklist

  • Prof. Anthony Cummins

    Robert
    Thank you for your comptrehensive account of critical appraisal. I have just completed a teaching module on critical appraisal as part of a four module Evidence Based Medicine programme for undergraduate Meducal students at RCSI Perdana medical school in Malaysia. If you are agreeable I would like to cite it as a reference in our module.

    September 6, 2016 at 2:23 pm
    Reply to Prof.
    • Robert Will

      Anthony,
      Please feel free to cite my checklist. Thank you for asking. I hope that your students find it helpful.
      They should also browse around S4BE. There are numerous other helpful articles on this site.

      September 19, 2016 at 2:23 pm
      Reply to Robert

Subscribe to our newsletter

You will receive our monthly newsletter and free access to Trip Premium.