Critical Appraisal (CA) I Prepared by Dr. Hoda Abd El Azim

Lecture VI

Learning Outcomes (ILOs): Define critical appraisal (CA) State purpose of CA Identify the importance of CA Discuss the aspects of critical appraisal for EBP. Identify the factors to consider when assessing the quality of a study. Identify quality appraisal checklist.

Define Critical Appraisal (CA)? It is answering specific questions related to the care of a specific client or group of clients. What are the purpose of C A? Is to decide whether the quality of a research study is good enough for the results it provideds to be used to answer a questions by a health care practitioner or patient.

Why is critical appraisal necessary? To assess the Quality Importance Applicability

What are the aspects of critical appraisal for EBP? Is the quality of the study good enough to use the results? Are the findings applicable in my setting? What do the results mean for my clients?

Worked example: Assessing the quality of studies answering questions about the effectiveness of therapy or interventions You are apart of the nursing team that works on a busy children's word. Sally an 11 year old who has been admitted with acute asthma four times in the last 6 months. The team discussed the different possible reasons for sally’s repeated admissions, there was some assumption that both sally and her family may not be managing her medication and attacks of breathlessness very well.

The team decides to find out more about whether educational interventions can be effective at reducing repeat admissions. Your clinical practice question Does a structured nurse led discharge package result in reduced levels of readmission to hospital of children with acute asthma?

Finding the evidence Paper indicated to the effects of a structured nurse led discharge package include patient education program and self management plan were compared with standard care. Outcome measures include rates of readmission to the accident and emergency department.

What are the factors to consider when assessing the quality of a study?  Appropriate randomization methods (two groups are similar apart from intervention). The difference in outcome between two groups due to intervention.  Bias (the group to which the patient has been allocated must be concealed from the researcher until the client has been accepted into the trial.

Demographic and health status for two groups are of interest (the group should ideally to be similar on average for any variables that are likely to influence outcome. e.g Differences in age, gender, disease severity could potentially affect the results of the study.

 The intervention is described in sufficient detail to allow clinicians to reproduce it in their own setting.  Measurement tools validity (measure what they purport to measure).  Keeping patients, clinicians and researcher blinded as to whether a patient is in the treatment or control group to minimizing bias.

Quality appraisal checklist Are the client randomly allocated the groups in the study? Was allocation to control or intervention group concealed from the patient, investigator until patient had been accepted into trial. Random allocation Concealment of randomization until allocation occurs Sample Are outcomes in two or more randomly selected groups compared? Comparative ideally RCTs Design QA questionsCriteriaItems

Are the characteristics of both groups in the sample described ? Baseline group comparability

Were participant analyzed in the groups to which they were randomized Analysis carried out on an intention to treat basis. Data analysis Was data analysis carried out using all people who entered in the study? All entrance adequately accounted for at the end of the study Data collection What is the intervention, under investigation? Intervention and outcomes clearly specified Measures

Thank You