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Critical Appraisal Tools

Critical appraisal is an integral process in Evidence Based Practice. Critical appraisal aims to identify methodological flaws in the literature and provide consumers of research evidence the opportunity to make informed decisions about the quality of research evidence.

Below is a list of critical appraisal tools, linked to the websites where they were developed.  iCAHE staff will update this webpage as new critical appraisal tools are published.

Healthcare Improvement Scotland have a tutorial on how to best conduct a critical appraisal for those that feel they need a refresher, and the linked YouTube clip gives an introduction to critical appraisal including how to incorpotate evidence into clinical decisions. 

Please choose a type of study:


Randomised Controlled Trials

CASP: Randomised Controlled Trial Appraisal Tool
Summary: Critical Appraisal Skills Program (CASP): RCT CAT is a methodological checklist which provides key criteria relevant to randomised controlled trials.
Authors: Public Health Resource Unit, NHS, England
link (pdf)

PEDro Scale
Summary: PEDro (Physiotherapy Evidence Database) Scale is an excellent webpage which provides access to a range of appraisal resources including a tutorial and appraisal tool.
Authors: The Centre of Evidence-Based Physiotherapy (CEBP), Sydney, Australia
http://www.pedro.org.au/english/downloads/pedro-scale/

Validation of the PEDro tool: Maher, C. G., Sherrington, C., Herbert, R. D., Moseley, A. M., & Elkins, M. (2003). Reliability of the PEDro scale for rating quality of randomized controlled trials. Physical therapy, 83(8), 713-721.

link to Maher et al. 2003 article (pdf 301KB)

The CONSORT Statement
Summary: The Consolidated Standards of Reporting Trials (CONSORT) Statement is a detailed document which outlines an explanation and elaboration of the CONSORT statement for reporting randomized controlled trials. It also includes (in table two) the critical appraisal tool.
Authors: The CONSORT Group, Canada
http://www.consort-statement.org/consort-statement/

The JADAD Score
Summary: The Jadad scale assesses the quality of published clinical trials based methods relevant to random assignment, double blinding, and the flow of patients. There are 7 items in the scale, scored with a yes scoring 1 and a no scoring zero. The last 2 questions attract a negative score, which means that the range of possible scores is 0 (bad) to 5 (good).
link to JADAD Score (pdf)

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Non-Randomised Controlled Trials

The TREND Statement
Summary: The TREND (Transparent Reporting of Evaluations with Nonrandomized Designs) statement is a 22-item checklist specifically developed to guide standardized reporting of nonrandomized controlled trials. The TREND statement complements the widely adopted  CONSORT statement developed for randomized controlled trials. A collective effort in promoting transparent reporting is valuable to improve research synthesis and advance evidence-based recommendations for best practices and policies.
Authors: Centre for Disease Control and Prevention (CDC), United States of America
http://www.cdc.gov/trendstatement/docs/AJPH_Mar2004_Trendstatement.pdf (pdf)

McMaster Critical Review Form - Quantitative Studies
Summary: McMaster Critical Review Form for Qualitative studies contains a generic quantitative appraisal tool, accompanied by detailed guidelines for usage.
Authors: Occupational Therapy Evidence-Based Practice Research Group, McMaster University, Canada
Review Form: http://www.srs-mcmaster.ca/Portals/20/pdf/ebp/quanreview.pdf (pdf)
User Guideline: http://www.srs-mcmaster.ca/Portals/20/pdf/ebp/quanguidelines.pdf (pdf)

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Other Quantitative Research

CASP: Cohort Studies
Summary: Critical Appraisal Skills Program (CASP): Cohort Studies is a methodological checklist which provides key criteria relevant to cohort studies.
Authors: Public Health Resource Unit, NHS, England
link (pdf)

CASP: Economic Evaluation Studies
Summary: Critical Appraisal Skills Program (CASP): Economic Evaluation Studies is a methodological checklist which provides key criteria relevant to economic studies.
Authors: Public Health Resource Unit, NHS, England
link (pdf)

CASP: Diagnostic Test Studies
Summary: Critical Appraisal Skills Program (CASP): Diagnostic Test Studies is a methodological checklist which provides key criteria relevant to diagnostic studies.
Authors: Public Health Resource Unit, NHS, England
link (pdf)

Therapy CA Worksheet
Summary: Therapy Critical Appraisal Worksheet is a methodological checklist which provides key criteria relevant to therapy studies.
Authors: Centre for Evidence-Based Medicine, University of Toronto, Canada http://ktclearinghouse.ca/cebm/teaching/worksheets/therapy

Diagnostic CA Worksheet
Summary: Diagnostic Critical Appraisal Worksheet is a methodological checklist which provides key criteria relevant to diagnostic studies.
Authors: Centre for Evidence-Based Medicine, University of Toronto, Canada http://ktclearinghouse.ca/cebm/teaching/worksheets/diagnosis

Harm CA Worksheet
Summary: Harm Critical Appraisal Worksheet is a methodological checklist which provides key criteria relevant to harm studies.
Authors: Centre for Evidence-Based Medicine, University of Toronto, Canada http://ktclearinghouse.ca/cebm/teaching/worksheets/harm

Prognosis CA Worksheet
Summary: Prognosis Critical Appraisal Worksheet is a methodological checklist which provides key criteria relevant to prognostic studies.
Authors: Centre for Evidence-Based Medicine, University of Toronto, Canada http://ktclearinghouse.ca/cebm/teaching/worksheets/prognosis 

Evaluation Tool for Quantitative Research Studies
Summary: The Evaluation Tool for Quantitative Studies contains six sub-sections: study evaluative overview; study, setting and sample; ethics; group comparability and outcome measurement; policy and practice implications; and other comments.
Authors: Health Care Practice Research & Development Unit (HCPRDU), School of Nursing, University of Salford, UK
http://usir.salford.ac.uk/12969  

GATE
Summary: Graphic Appraisal Tool for Epidemiology (GATE) is a visual framework that illustrates the generic design of all epidemiologic studies.
Authors: School of Population Health, The University of Auckland, New Zealand
GATE Tool: http://www.fmhs.auckland.ac.nz/soph/depts/epi/epiq/_docs/gateframe.pdf (pdf)

CriSTal Checklist
Summary: This checklist evaluates the quality of various research designs, such as appraising a user study or appraising an information needs analysis.
Authors: The University of Sheffield, UK
Checklist for Appraising an Information Needs analysis (doc): http://nettingtheevidence.pbwiki.com/f/needs.doc
Checklist for Appraising a User Study (doc): http://nettingtheevidence.pbwiki.com/f/use.doc 

ReLIANT
Summary: Readers guide to the Literature on Interventions Addressing the Need for education and training (ReLIANT) is an innovative tool is aimed at appraising published reports of educational and training interventions.
Authors: Denise Koufogiannakis, Andrew Booth & Alison Brettle, University of Alberta, Canada http://eprints.rclis.org/7163/1/RELIANT__final_.pdf (pdf)

EBLIP Critical Appraisal Checklist
Summary: The EBLIP checklist for library research  provides provides a thorough, generic list of questions that one would ask when attempting to determine the validity, applicability and appropriateness of a study.
Authors: L Glynn, Authors: Memorial University of Newfoundland, Canada
http://www.nihs.ie/pdf/EBL Critical Appraisal Checklist.pdf (pdf)

READER Critical Appraisal Tool
Summary: This document outlines the READER Critical Appraisal tool. 
Authors: Macauley, Queen's University, Belfast, Northern Ireland http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1238789/pdf/brjgenprac00035-0039.pdf (pdf)

The STARD Checklist
Summary: STAndards for the Reporting of Diagnostic accuracy checklist is helps determine the accuracy and completeness of reporting of studies of diagnostic accuracy. The STARD Statement consists of a 25 item checklist and flow diagram.
Authors: Department of Clinical Epidemiology & Biostatistics, University of Amsterdam, The Netherlands.
Tool: http://www.stard-statement.org/pdf and word documents/Checklist.PDF (pdf)
Rational behind 25 items and flow diagram: http://www.stard-statement.org/

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Case studies

CASP: Case Control Studies
Summary: Critical Appraisal Skills Program (CASP): Case Control Studies is a methodological checklist which provides key criteria relevant to case control studies.
Authors: Public Health Resource Unit, NHS, England
link (pdf)

MINORS Tool
Summary: MINORS is a valid instrument designed to assess the methodological quality of non-randomized surgical studies, whether comparative or non-comparative.
Authors: Slim et al, Department of General and Digestive Surgery, Hôtel-Dieu, France
http://onlinelibrary.wiley.com/doi/10.1046/j.1445-2197.2003.02748.x/pdf (pdf)

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Qualitative research

CASP: Qualitative Research
Summary: Critical Appraisal Skills Program (CASP): Qualitative Research is a methodological checklist which provides key criteria relevant to qualitative research studies.
Authors: Public Health Resource Unit, NHS, England
link (pdf)

McMaster Critical Review Form - Qualitative Studies
Summary: McMaster Critical Review Form for Qualitative studies contains a generic quantitative appraisal tool, accompanied by detailed guidelines for usage.
Authors: Occupational Therapy Evidence-Based Practice Research Group, McMaster University, Canada
Review Form: http://www.srs-mcmaster.ca/Portals/20/pdf/ebp/qualreview_version2.0.pdf (pdf)
User Guideline: http://www.srs-mcmaster.ca/Portals/20/pdf/ebp/qualguidelines_version2.0.pdf  (pdf)

JBI-NOTARI Critical Appraisal Tool
Summary: Narrative, Opinion and Text Assessment and Review Instrument (NOTARI) is a  useful tool to evaluate narrative, opinion and others textual evidence. However to use this tool a login is required.
Authors: The Joanna Briggs Institute, The University of Adelaide, Australia
To use this tool you must first register with JBI  http://www.nursingcenter.com/evidencebasedpracticenetwork/Home/JBI@LWW/JBI-SUMARI.aspx?id=1917714 (systematic review software) (htm)

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Mixed Methods research

Evaluation Tool for Mixed Methods Studies
Summary: The evaluation tool for mixed studies allows appraisal of both the qualitative data collection and analysis component and the wider quantitative research design. It is applicable where the aim of the qualitative component is to draw out the informants understandings and perceptions.
Authors: Health Care Practice Research & Development Unit (HCPRDU), School of Nursing, University of Salford, UK
http://usir.salford.ac.uk/13070

A Scoring system for Mixed Methods Research and Mixed Studies Reviews
Summary: A new form of literature review has emerged, Mixed Studies Review. These reviews include qualitative, quantitative and mixed methods studies. This scoring system assesses Qualitative, Quantitative experimental, Quantitative observational and Mixed Methods at the one time.
Authors: Pluye et al (2009) International Journal of Nursing Studies, 46: 529-46.
http://www.ncbi.nlm.nih.gov/pubmed/19233357 (link to abstract in NCBI)

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Systematic Reviews

CASP: Systematic Reviews
Summary: Critical Appraisal Skills Program (CASP): Systematic Reviews is a methodological checklist which provides key criteria relevant to systematic reviews.
Authors: Public Health Resource Unit, NHS, England
link (pdf)

Systematic Review (of Therapy) Worksheet
Summary: This methodological checklist provides key criteria relevant to systematic reviews.
Authors: Centre for Evidence-Based Medicine, University of Toronto, Canada http://ktclearinghouse.ca/cebm/teaching/worksheets/sr 
 
ARIF Checklist
Summary: Aggressive Research Intelligence Facility (ARIF) Checklist is a webpage which provides a list of questions to be asked which evaluates the quality of systematic reviews.
Authors: ARIF, University of Birmingham, UK
http://www.arif.bham.ac.uk/critical-appraisal-checklist.shtml

AMSTAR
Summary: Assessment of Multiple Systematic Reviews (AMSTAR) is a 37-item assessment tool used to assess the methodological quality of systematic reviews.
Authors: EMGO Institute, The Netherlands
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1810543/pdf/1471-2288-7-10.pdf (pdf)

See this YouTube video on how to critically appraise a systematic review

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Reporting standards

The PRISMA (formerly QUOROM) Statement
Summary: The PRISMA Statement provides an evidence-based minimum set of items for reporting systematic reviews and meta-analyses, and is an update and expansion of the QUOROM Statement. Although it focuses on randomized trials, the PRISMA Statement can also be used as a basis for reporting systematic reviews of other types of research, particularly evaluations of interventions. It consists of a checklist and a flow diagram.
Authors: Ottawa Hospital Research Institute (OHRI), Canada 
The PRISMA Statement Checklist: http://www.prisma-statement.org/2.1.2%20-%20PRISMA%202009%20Checklist.pdf (pdf)
Flow diagram: http://www.prisma-statement.org/2.1.4%20-%20PRISMA%20Flow%202009%20Diagram.pdf (pdf)
Explanatory and Elaboration Document: http://www.bmj.com/content/339/bmj.b2700.full?view=long&pmid=19622552

The STROBE Statement
Summary: Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement provides a checklist of items that should be addressed in articles reporting on the three main study designs of analytical epidemiology: cohort, case control, and cross-sectional studies, as well as guidance on how to report observational research well. 
Authors: the STROBE Group are based at the University of Bern in theInstitute of Social and Preventive Medicine (ISPM) 
STROBE reference: von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP; STROBE Initiative. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE)statement: guidelines for reporting observational studies. J Clin Epidemiol. 2008 Apr;61(4):344-9. PMID: 18313558
STROBE checklist for  cohort, case-control, and cross-sectional studies (combined) http://www.strobe-statement.org/fileadmin/Strobe/uploads/checklists/STROBE_checklist_v4_combined.pdf (pdf 19.3KB)
For other versions go to:  http://www.strobe-statement.org/index.php?id=available-checklists

STARD
The Standards for Reporting of Diagnostic Accuracy (STARD) 
Summary: The objective of the STARD initiative is to improve the completeness and transparency of reporting of studies of diagnostic accuracy, to allow readers to assess the potential for bias in the study (internal validity) and to evaluate its generalisability (external validity).
Authors: The STARD group
The STARD checklist and flow diagram can be found here: http://www.stard-statement.org/

The SAMPL guidelines 
Reporting Basic Statistical Analyses and Methods in the Published Literature: The SAMPL Guidelines for Biomedical Journals
Summary: a set of statistical reporting guidelines suitable for medical journals to include in their Instructions for Authors. These guidelines tell authors, journal editors, and reviewers how to report basic statistical methods and results.   
Authors:  Thomas A. Lang and Douglas G. Altman.
Reference:  Lang TA, Altman DG 2013. Basic Statistical Reporting for Articles Published in Biomedical Journals: The “Statistical Analyses and Methods in the Published Literature” or The SAMPL Guidelines”. Science Editors' Handbook, European Association of Science Editors. link to reference

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Outcome Measures 

Checklist for Reviewing the User Centredness of an Outcome Measure
Summary: This is a methodological checklist provides an overview of user centeredness of an outcome measures.
Authors: Health Care Practice Research & Development Unit (HCPRDU), School of Nursing, University of Salford, UK
[THIS TOOL IS NO LONGER AVAILABLE ONLINE]

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Clinical Guidelines

The iCAHE Guideline Quality Checklist
Summary: The iCAHE guideline checklist provides clinicians with a quick way of appraising the quality of a clinical guideline. It consists of 14 questions and can be used either as a checklist or a total score.
Authors: The International Centre for Allied Health Evidence (iCAHE), UniSA, Australia
Click here for the checklist (pdf) 
Validation paper (HTML link) 

AGREE II Instrument
Summary: The Appraisal of Guidelines for Research & Evaluation (AGREE) Instrument assesses both the quality of the reporting, and the quality of some aspects of recommendations. It provides an assessment of the predicted validity of a guideline, that is the likelihood that it will achieve its intended outcome. It does not assess the impact of a guideline on patients outcomes.
Authors: The AGREE Collaboration, St George's Hospital Medical School, London http://www.agreetrust.org/resource-centre/agree-ii/ 

Systematic Review of CATs for Clinical Guidelines
Summary: This publication is a systematic review of appraisal tools for clinical guidelines. While there is no access to critical appraisal tools directly from this publication, it does provide an interesting and informative overview of appraisal tools for clinical guidelines.
Authors: Vlayen et al., (2005). International Journal of Quality in Health Care, 17(3): 235-242. http://intqhc.oxfordjournals.org/cgi/reprint/17/3/235 (pdf)

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Assessing treatment choices

DISCERN
Summary: DISCERN is a brief questionnaire which provides users with a valid and reliable way of assessing the quality of written information on treatment choices for a health problem. DISCERN can also be used by authors and publishers of information on treatment choices as a guide to the standard which users are entitled to expect.
Authors: Division of Public Health and Primary Health Care, University of Oxford, UK http://www.discern.org.uk/discern.pdf (pdf)

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Finding your own CATs

CAT WALK
Summary: This site provides an overview of critical appraisal process, including tools.
Authors: University of Alberta Libraries, Canada http://www.library.ualberta.ca/subject/physicaltherapy/catwalk/index.cfm

OT Seeker
Summary: This site provides access to a range of appraisal resources.
Authors: Department of Occupational Therapy The University of Queensland, Australia http://www.otseeker.com/Resources/EvidenceBasedPractice.aspx

STROBE Statement
Summary: STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) website provides access to a range of critical appraisal tools for a range of research methodologies (cohort, case-control, and cross-sectional studies).
Authors: University of Bern, Switerzland
http://www.strobe-statement.org/index.php?id=strobe-home

DynaMed
Summary: This unique, interactive website provides access to a range of critical appraisal solutions for various research designs.
Authors: DynaMed, United States of America
http://www.ebscohost.com/dynamed/

Delfini
Summary: This website provides access to a range of tools relevant evidence based practice, including critical appraisal tools.
Authors: Delfini Group, United States of America
http://www.delfini.org/delfiniTools.htm

Standard Quality Assessment Criteria for Evaluating Primary Research Papers
Summary: This document provides an overview of appraisal of primary research studies. It also includes examples of critical appraisal tools.
Authors: Alberta Heritage Foundation for Medical Research, Canada
http://www.ihe.ca/documents/HTA-FR13.pdf (pdf)

Critical Appraisal Tool
Summary: This document provides the reader with various critical appraisal tools. These include tools for meta-analyses and systematic reviews, randomised controlled trials, clinical guidelines and qualitative research papers.
Authors: Royal College of Psychiatrists, UK
http://www.rcpsych.ac.uk/pdf/app2.pdf (pdf)

NHS Research Design Service for the East Midlands
Summary: This webpage provides access to a range of resources on all things critical appraisal.
Authors: National Institute of Health Research, NHS, UK
http://www.rds-eastmidlands.org.uk/

RAPid
Summary: Rapid Appraisal Protocol Internet Database (RAPid) is a webpage which provides access to a range of appraisal resources. However, this webpage requires log in.
Authors:  The Joanna Briggs Institute, The University of Adelaide, Australia http://connect.jbiconnectplus.org/Appraise.aspx

Evidence Direct
Summary: This excellent webpage provides access to numerous critical appraisal resources including critical appraisal tools, examples and other reading materials.
Authors: The Royal Melbourne Hospital, Australia
http://www.mh.org.au/royal_melbourne_hospital/evidence-direct/w1/i1015432/

TOOLKIT
Summary: This interactive webpage provides access to numerous critical appraisal resources including critical appraisal tools, examples and other reading materials.
Authors: The University of Newcastle, Australia
http://libguides.newcastle.edu.au/sysreviews

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Constructing your own CATs

CATmaker
Summary: CATmaker is a software tool which helps you create Critically Appraised Topics, or CATs, for the key articles you encounter about Therapy, Diagnosis, Prognosis, Aetiology/Harm and Systematic Reviews of Therapy.
Authors: Centre for Evidence Based Medicine, University of Oxford, UK
http://www.cebm.net/?o=1216

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Areas of study and research

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