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Nuffield Department of Primary Care Health Sciences, University of Oxford

Critical Appraisal tools

Critical appraisal worksheets to help you appraise the reliability, importance and applicability of clinical evidence.

Critical appraisal is the systematic evaluation of clinical research papers in order to establish:

  • Does this study address a  clearly focused question ?
  • Did the study use valid methods to address this question?
  • Are the valid results of this study important?
  • Are these valid, important results applicable to my patient or population?

If the answer to any of these questions is “no”, you can save yourself the trouble of reading the rest of it.

This section contains useful tools and downloads for the critical appraisal of different types of medical evidence. Example appraisal sheets are provided together with several helpful examples.

Critical Appraisal Worksheets

  • Systematic Reviews  Critical Appraisal Sheet
  • Diagnostics  Critical Appraisal Sheet
  • Prognosis  Critical Appraisal Sheet
  • Randomised Controlled Trials  (RCT) Critical Appraisal Sheet
  • Critical Appraisal of Qualitative Studies  Sheet
  • IPD Review  Sheet

Chinese - translated by Chung-Han Yang and Shih-Chieh Shao

  • Systematic Reviews  Critical Appraisal Sheet
  • Diagnostic Study  Critical Appraisal Sheet
  • Prognostic Critical Appraisal Sheet
  • RCT  Critical Appraisal Sheet
  • IPD reviews Critical Appraisal Sheet
  • Qualitative Studies Critical Appraisal Sheet 

German - translated by Johannes Pohl and Martin Sadilek

  • Systematic Review  Critical Appraisal Sheet
  • Diagnosis Critical Appraisal Sheet
  • Prognosis Critical Appraisal Sheet
  • Therapy / RCT Critical Appraisal Sheet

Lithuanian - translated by Tumas Beinortas

  • Systematic review appraisal Lithuanian (PDF)
  • Diagnostic accuracy appraisal Lithuanian  (PDF)
  • Prognostic study appraisal Lithuanian  (PDF)
  • RCT appraisal sheets Lithuanian  (PDF)

Portugese - translated by Enderson Miranda, Rachel Riera and Luis Eduardo Fontes

  • Portuguese – Systematic Review Study Appraisal Worksheet
  • Portuguese – Diagnostic Study Appraisal Worksheet
  • Portuguese – Prognostic Study Appraisal Worksheet
  • Portuguese – RCT Study Appraisal Worksheet
  • Portuguese – Systematic Review Evaluation of Individual Participant Data Worksheet
  • Portuguese – Qualitative Studies Evaluation Worksheet

Spanish - translated by Ana Cristina Castro

  • Systematic Review  (PDF)
  • Diagnosis  (PDF)
  • Prognosis  Spanish Translation (PDF)
  • Therapy / RCT  Spanish Translation (PDF)

Persian - translated by Ahmad Sofi Mahmudi

  • Prognosis  (PDF)
  • PICO  Critical Appraisal Sheet (PDF)
  • PICO Critical Appraisal Sheet (MS-Word)
  • Educational Prescription  Critical Appraisal Sheet (PDF)

Explanations & Examples

  • Pre-test probability
  • SpPin and SnNout
  • Likelihood Ratios

Hands typing on a laptop investigating the online JBI Critical Appraisal Tools

Critical Appraisal Tools

Jbi’s critical appraisal tools assist in assessing the trustworthiness, relevance and results of published papers..

These tools have been revised. Recently published articles detail the revision.

"Assessing the risk of bias of quantitative analytical studies: introducing the vision for critical appraisal within JBI systematic reviews"

"revising the jbi quantitative critical appraisal tools to improve their applicability: an overview of methods and the development process".

End to end support for developing systematic reviews

Analytical Cross Sectional Studies  

Checklist for analytical cross sectional studies, how to cite, associated publication(s), case control studies  , checklist for case control studies, case reports  , checklist for case reports, case series  , checklist for case series.

Munn Z, Barker TH, Moola S, Tufanaru C, Stern C, McArthur A, Stephenson M, Aromataris E. Methodological quality of case series studies: an introduction to the JBI critical appraisal tool. JBI Evidence Synthesis. 2020;18(10):2127-2133

Methodological quality of case series studies: an introduction to the JBI critical appraisal tool

Cohort studies  , checklist for cohort studies, diagnostic test accuracy studies  , checklist for diagnostic test accuracy studies.

Campbell JM, Klugar M, Ding S, Carmody DP, Hakonsen SJ, Jadotte YT, White S, Munn Z. Chapter 9: Diagnostic test accuracy systematic reviews. In: Aromataris E, Munn Z (Editors). JBI Manual for Evidence Synthesis. JBI, 2020

JBI Manual for Evidence Synthesis

Chapter 9: Diagnostic test accuracy systematic reviews

Economic Evaluations  

Checklist for economic evaluations, prevalence studies  , checklist for prevalence studies.

Munn Z, Moola S, Lisy K, Riitano D, Tufanaru C. Chapter 5: Systematic reviews of prevalence and incidence. In: Aromataris E, Munn Z (Editors). JBI Manual for Evidence Synthesis. JBI, 2020

Chapter 5: Systematic reviews of prevalence and incidence

Qualitative Research  

Checklist for qualitative research.

Lockwood C, Munn Z, Porritt K. Qualitative research synthesis: methodological guidance for systematic reviewers utilizing meta-aggregation. Int J Evid Based Healthc. 2015;13(3):179–187

Chapter 2: Systematic reviews of qualitative evidence

Qualitative research synthesis

Methodological guidance for systematic reviewers utilizing meta-aggregation

Quasi-Experimental Studies  

Checklist for quasi-experimental studies, randomized controlled trials  , randomized controlled trials.

Barker TH, Stone JC, Sears K, Klugar M, Tufanaru C, Leonardi-Bee J, Aromataris E, Munn Z. The revised JBI critical appraisal tool for the assessment of risk of bias for randomized controlled trials. JBI Evidence Synthesis. 2023;21(3):494-506

The revised JBI critical appraisal tool for the assessment of risk of bias for randomized controlled trials

Randomized controlled trials checklist (archive), systematic reviews  , checklist for systematic reviews.

Aromataris E, Fernandez R, Godfrey C, Holly C, Kahlil H, Tungpunkom P. Summarizing systematic reviews: methodological development, conduct and reporting of an Umbrella review approach. Int J Evid Based Healthc. 2015;13(3):132-40.

Chapter 10: Umbrella Reviews

Textual Evidence: Expert Opinion  

Checklist for textual evidence: expert opinion.

McArthur A, Klugarova J, Yan H, Florescu S. Chapter 4: Systematic reviews of text and opinion. In: Aromataris E, Munn Z (Editors). JBI Manual for Evidence Synthesis. JBI, 2020

Chapter 4: Systematic reviews of text and opinion

Textual Evidence: Narrative  

Checklist for textual evidence: narrative, textual evidence: policy  , checklist for textual evidence: policy.

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  • Volume 25, Issue 1
  • Critical appraisal of qualitative research: necessity, partialities and the issue of bias
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  • http://orcid.org/0000-0001-5660-8224 Veronika Williams ,
  • Anne-Marie Boylan ,
  • http://orcid.org/0000-0003-4597-1276 David Nunan
  • Nuffield Department of Primary Care Health Sciences , University of Oxford, Radcliffe Observatory Quarter , Oxford , UK
  • Correspondence to Dr Veronika Williams, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK; veronika.williams{at}phc.ox.ac.uk

https://doi.org/10.1136/bmjebm-2018-111132

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  • qualitative research

Introduction

Qualitative evidence allows researchers to analyse human experience and provides useful exploratory insights into experiential matters and meaning, often explaining the ‘how’ and ‘why’. As we have argued previously 1 , qualitative research has an important place within evidence-based healthcare, contributing to among other things policy on patient safety, 2 prescribing, 3 4 and understanding chronic illness. 5 Equally, it offers additional insight into quantitative studies, explaining contextual factors surrounding a successful intervention or why an intervention might have ‘failed’ or ‘succeeded’ where effect sizes cannot. It is for these reasons that the MRC strongly recommends including qualitative evaluations when developing and evaluating complex interventions. 6

Critical appraisal of qualitative research

Is it necessary.

Although the importance of qualitative research to improve health services and care is now increasingly widely supported (discussed in paper 1), the role of appraising the quality of qualitative health research is still debated. 8 10 Despite a large body of literature focusing on appraisal and rigour, 9 11–15 often referred to as ‘trustworthiness’ 16 in qualitative research, there remains debate about how to —and even whether to—critically appraise qualitative research. 8–10 17–19 However, if we are to make a case for qualitative research as integral to evidence-based healthcare, then any argument to omit a crucial element of evidence-based practice is difficult to justify. That being said, simply applying the standards of rigour used to appraise studies based on the positivist paradigm (Positivism depends on quantifiable observations to test hypotheses and assumes that the researcher is independent of the study. Research situated within a positivist paradigm isbased purely on facts and consider the world to be external and objective and is concerned with validity, reliability and generalisability as measures of rigour.) would be misplaced given the different epistemological underpinnings of the two types of data.

Given its scope and its place within health research, the robust and systematic appraisal of qualitative research to assess its trustworthiness is as paramount to its implementation in clinical practice as any other type of research. It is important to appraise different qualitative studies in relation to the specific methodology used because the methodological approach is linked to the ‘outcome’ of the research (eg, theory development, phenomenological understandings and credibility of findings). Moreover, appraisal needs to go beyond merely describing the specific details of the methods used (eg, how data were collected and analysed), with additional focus needed on the overarching research design and its appropriateness in accordance with the study remit and objectives.

Poorly conducted qualitative research has been described as ‘worthless, becomes fiction and loses its utility’. 20 However, without a deep understanding of concepts of quality in qualitative research or at least an appropriate means to assess its quality, good qualitative research also risks being dismissed, particularly in the context of evidence-based healthcare where end users may not be well versed in this paradigm.

How is appraisal currently performed?

Appraising the quality of qualitative research is not a new concept—there are a number of published appraisal tools, frameworks and checklists in existence. 21–23  An important and often overlooked point is the confusion between tools designed for appraising methodological quality and reporting guidelines designed to assess the quality of methods reporting. An example is the Consolidate Criteria for Reporting Qualitative Research (COREQ) 24 checklist, which was designed to provide standards for authors when reporting qualitative research but is often mistaken for a methods appraisal tool. 10

Broadly speaking there are two types of critical appraisal approaches for qualitative research: checklists and frameworks. Checklists have often been criticised for confusing quality in qualitative research with ‘technical fixes’ 21 25 , resulting in the erroneous prioritisation of particular aspects of methodological processes over others (eg, multiple coding and triangulation). It could be argued that a checklist approach adopts the positivist paradigm, where the focus is on objectively assessing ‘quality’ where the assumptions is that the researcher is independent of the research conducted. This may result in the application of quantitative understandings of bias in order to judge aspects of recruitment, sampling, data collection and analysis in qualitative research papers. One of the most widely used appraisal tools is the Critical Appraisal Skills Programme (CASP) 26 and along with the JBI QARI (Joanna Briggs Institute Qualitative Assessment and Assessment Instrument) 27 presents examples which tend to mimic the quantitative approach to appraisal. The CASP qualitative tool follows that of other CASP appraisal tools for quantitative research designs developed in the 1990s. The similarities are therefore unsurprising given the status of qualitative research at that time.

Frameworks focus on the overarching concepts of quality in qualitative research, including transparency, reflexivity, dependability and transferability (see box 1 ). 11–13 15 16 20 28 However, unless the reader is familiar with these concepts—their meaning and impact, and how to interpret them—they will have difficulty applying them when critically appraising a paper.

The main issue concerning currently available checklist and framework appraisal methods is that they take a broad brush approach to ‘qualitative’ research as whole, with few, if any, sufficiently differentiating between the different methodological approaches (eg, Grounded Theory, Interpretative Phenomenology, Discourse Analysis) nor different methods of data collection (interviewing, focus groups and observations). In this sense, it is akin to taking the entire field of ‘quantitative’ study designs and applying a single method or tool for their quality appraisal. In the case of qualitative research, checklists, therefore, offer only a blunt and arguably ineffective tool and potentially promote an incomplete understanding of good ‘quality’ in qualitative research. Likewise, current framework methods do not take into account how concepts differ in their application across the variety of qualitative approaches and, like checklists, they also do not differentiate between different qualitative methodologies.

On the need for specific appraisal tools

Current approaches to the appraisal of the methodological rigour of the differing types of qualitative research converge towards checklists or frameworks. More importantly, the current tools do not explicitly acknowledge the prejudices that may be present in the different types of qualitative research.

Concepts of rigour or trustworthiness within qualitative research 31

Transferability: the extent to which the presented study allows readers to make connections between the study’s data and wider community settings, ie, transfer conceptual findings to other contexts.

Credibility: extent to which a research account is believable and appropriate, particularly in relation to the stories told by participants and the interpretations made by the researcher.

Reflexivity: refers to the researchers’ engagement of continuous examination and explanation of how they have influenced a research project from choosing a research question to sampling, data collection, analysis and interpretation of data.

Transparency: making explicit the whole research process from sampling strategies, data collection to analysis. The rationale for decisions made is as important as the decisions themselves.

However, we often talk about these concepts in general terms, and it might be helpful to give some explicit examples of how the ‘technical processes’ affect these, for example, partialities related to:

Selection: recruiting participants via gatekeepers, such as healthcare professionals or clinicians, who may select them based on whether they believe them to be ‘good’ participants for interviews/focus groups.

Data collection: poor interview guide with closed questions which encourage yes/no answers and/leading questions.

Reflexivity and transparency: where researchers may focus their analysis on preconceived ideas rather than ground their analysis in the data and do not reflect on the impact of this in a transparent way.

The lack of tailored, method-specific appraisal tools has potentially contributed to the poor uptake and use of qualitative research for informing evidence-based decision making. To improve this situation, we propose the need for more robust quality appraisal tools that explicitly encompass both the core design aspects of all qualitative research (sampling/data collection/analysis) but also considered the specific partialities that can be presented with different methodological approaches. Such tools might draw on the strengths of current frameworks and checklists while providing users with sufficient understanding of concepts of rigour in relation to the different types of qualitative methods. We provide an outline of such tools in the third and final paper in this series.

As qualitative research becomes ever more embedded in health science research, and in order for that research to have better impact on healthcare decisions, we need to rethink critical appraisal and develop tools that allow differentiated evaluations of the myriad of qualitative methodological approaches rather than continuing to treat qualitative research as a single unified approach.

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  • Boylan AM ,
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  • ↵ CASP (Critical Appraisal Skills Programme). date unknown . http://www.phru.nhs.uk/Pages/PHD/CASP.htm .
  • ↵ The Joanna Briggs Institute . JBI QARI Critical appraisal checklist for interpretive & critical research . Adelaide : The Joanna Briggs Institute , 2014 .
  • Stephens J ,

Contributors VW and DN: conceived the idea for this article. VW: wrote the first draft. AMB and DN: contributed to the final draft. All authors approve the submitted article.

Competing interests None declared.

Provenance and peer review Not commissioned; externally peer reviewed.

Correction notice This article has been updated since its original publication to include a new reference (reference 1.)

Read the full text or download the PDF:

Critical Appraisal Tools and Reporting Guidelines for Evidence-Based Practice

Affiliations.

  • 1 Professor, School of Nursing & Health Professions, University of San Francisco, San Francisco, CA, USA.
  • 2 Reference Librarian and Primary Liaison, School of Nursing & Health Professions, Gleeson Library, Geschke Center, University of San Francisco, San Francisco, CA 94117, USA.
  • PMID: 28898556
  • DOI: 10.1111/wvn.12258

Background: Nurses engaged in evidence-based practice (EBP) have two important sets of tools: Critical appraisal tools and reporting guidelines. Critical appraisal tools facilitate the appraisal process and guide a consumer of evidence through an objective, analytical, evaluation process. Reporting guidelines, checklists of items that should be included in a publication or report, ensure that the project or guidelines are reported on with clarity, completeness, and transparency.

Purpose: The primary purpose of this paper is to help nurses understand the difference between critical appraisal tools and reporting guidelines. A secondary purpose is to help nurses locate the appropriate tool for the appraisal or reporting of evidence.

Methods: A systematic search was conducted to find commonly used critical appraisal tools and reporting guidelines for EBP in nursing.

Rationale: This article serves as a resource to help nurse navigate the often-overwhelming terrain of critical appraisal tools and reporting guidelines, and will help both novice and experienced consumers of evidence more easily select the appropriate tool(s) to use for critical appraisal and reporting of evidence. Having the skills to select the appropriate tool or guideline is an essential part of meeting EBP competencies for both practicing registered nurses and advanced practice nurses (Melnyk & Gallagher-Ford, 2015; Melnyk, Gallagher-Ford, & Fineout-Overholt, 2017).

Results: Nine commonly used critical appraisal tools and eight reporting guidelines were found and are described in this manuscript. Specific steps for selecting an appropriate tool as well as examples of each tool's use in a publication are provided.

Linking evidence to action: Practicing registered nurses and advance practice nurses must be able to critically appraise and disseminate evidence in order to meet EBP competencies. This article is a resource for understanding the difference between critical appraisal tools and reporting guidelines, and identifying and accessing appropriate tools or guidelines.

Keywords: critical appraisal tools; evidence-based nursing; evidence-based practice; reporting guidelines.

© 2017 Sigma Theta Tau International.

Publication types

  • Data Collection / methods
  • Evidence-Based Practice / methods
  • Evidence-Based Practice / standards*
  • Nurses / trends*
  • Practice Guidelines as Topic / standards*
  • Quality of Health Care / standards
  • Risk Management / methods
  • Risk Management / standards*
  • Research article
  • Open access
  • Published: 16 September 2004

A systematic review of the content of critical appraisal tools

  • Persis Katrak 1 ,
  • Andrea E Bialocerkowski 2 ,
  • Nicola Massy-Westropp 1 ,
  • VS Saravana Kumar 1 &
  • Karen A Grimmer 1  

BMC Medical Research Methodology volume  4 , Article number:  22 ( 2004 ) Cite this article

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Consumers of research (researchers, administrators, educators and clinicians) frequently use standard critical appraisal tools to evaluate the quality of published research reports. However, there is no consensus regarding the most appropriate critical appraisal tool for allied health research. We summarized the content, intent, construction and psychometric properties of published, currently available critical appraisal tools to identify common elements and their relevance to allied health research.

A systematic review was undertaken of 121 published critical appraisal tools sourced from 108 papers located on electronic databases and the Internet. The tools were classified according to the study design for which they were intended. Their items were then classified into one of 12 criteria based on their intent. Commonly occurring items were identified. The empirical basis for construction of the tool, the method by which overall quality of the study was established, the psychometric properties of the critical appraisal tools and whether guidelines were provided for their use were also recorded.

Eighty-seven percent of critical appraisal tools were specific to a research design, with most tools having been developed for experimental studies. There was considerable variability in items contained in the critical appraisal tools. Twelve percent of available tools were developed using specified empirical research. Forty-nine percent of the critical appraisal tools summarized the quality appraisal into a numeric summary score. Few critical appraisal tools had documented evidence of validity of their items, or reliability of use. Guidelines regarding administration of the tools were provided in 43% of cases.

Conclusions

There was considerable variability in intent, components, construction and psychometric properties of published critical appraisal tools for research reports. There is no "gold standard' critical appraisal tool for any study design, nor is there any widely accepted generic tool that can be applied equally well across study types. No tool was specific to allied health research requirements. Thus interpretation of critical appraisal of research reports currently needs to be considered in light of the properties and intent of the critical appraisal tool chosen for the task.

Peer Review reports

Consumers of research (clinicians, researchers, educators, administrators) frequently use standard critical appraisal tools to evaluate the quality and utility of published research reports [ 1 ]. Critical appraisal tools provide analytical evaluations of the quality of the study, in particular the methods applied to minimise biases in a research project [ 2 ]. As these factors potentially influence study results, and the way that the study findings are interpreted, this information is vital for consumers of research to ascertain whether the results of the study can be believed, and transferred appropriately into other environments, such as policy, further research studies, education or clinical practice. Hence, choosing an appropriate critical appraisal tool is an important component of evidence-based practice.

Although the importance of critical appraisal tools has been acknowledged [ 1 , 3 – 5 ] there appears to be no consensus regarding the 'gold standard' tool for any medical evidence. In addition, it seems that consumers of research are faced with a large number of critical appraisal tools from which to choose. This is evidenced by the recent report by the Agency for Health Research Quality in which 93 critical appraisal tools for quantitative studies were identified [ 6 ]. Such choice may pose problems for research consumers, as dissimilar findings may well be the result when different critical appraisal tools are used to evaluate the same research report [ 6 ].

Critical appraisal tools can be broadly classified into those that are research design-specific and those that are generic. Design-specific tools contain items that address methodological issues that are unique to the research design [ 5 , 7 ]. This precludes comparison however of the quality of different study designs [ 8 ]. To attempt to overcome this limitation, generic critical appraisal tools have been developed, in an attempt to enhance the ability of research consumers to synthesise evidence from a range of quantitative and or qualitative study designs (for instance [ 9 ]). There is no evidence that generic critical appraisal tools and design-specific tools provide a comparative evaluation of research designs.

Moreover, there appears to be little consensus regarding the most appropriate items that should be contained within any critical appraisal tool. This paper is concerned primarily with critical appraisal tools that address the unique properties of allied health care and research [ 10 ]. This approach was taken because of the unique nature of allied health contacts with patients, and because evidence-based practice is an emerging area in allied health [ 10 ]. The availability of so many critical appraisal tools (for instance [ 6 ]) may well prove daunting for allied health practitioners who are learning to critically appraise research in their area of interest. For the purposes of this evaluation, allied health is defined as encompassing "...all occasions of service to non admitted patients where services are provided at units/clinics providing treatment/counseling to patients. These include units primarily concerned with physiotherapy, speech therapy, family panning, dietary advice, optometry occupational therapy..." [ 11 ].

The unique nature of allied health practice needs to be considered in allied health research. Allied health research thus differs from most medical research, with respect to:

• the paradigm underpinning comprehensive and clinically-reasoned descriptions of diagnosis (including validity and reliability). An example of this is in research into low back pain, where instead of diagnosis being made on location and chronicity of pain (as is common) [ 12 ], it would be made on the spinal structure and the nature of the dysfunction underpinning the symptoms, which is arrived at by a staged and replicable clinical reasoning process [ 10 , 13 ].

• the frequent use of multiple interventions within the one contact with the patient (an occasion of service), each of which requires appropriate description in terms of relationship to the diagnosis, nature, intensity, frequency, type of instruction provided to the patient, and the order in which the interventions were applied [ 13 ]

• the timeframe and frequency of contact with the patient (as many allied health disciplines treat patients in episodes of care that contain multiple occasions of service, and which can span many weeks, or even years in the case of chronic problems [ 14 ])

• measures of outcome, including appropriate methods and timeframes of measuring change in impairment, function, disability and handicap that address the needs of different stakeholders (patients, therapists, funders etc) [ 10 , 12 , 13 ].

Search strategy

In supplementary data [see additional file 1 ].

Data organization and extraction

Two independent researchers (PK, NMW) participated in all aspects of this review, and they compared and discussed their findings with respect to inclusion of critical appraisal tools, their intent, components, data extraction and item classification, construction and psychometric properties. Disagreements were resolved by discussion with a third member of the team (KG).

Data extraction consisted of a four-staged process. First, identical replica critical appraisal tools were identified and removed prior to analysis. The remaining critical appraisal tools were then classified according to the study design for which they were intended to be used [ 1 , 2 ]. The scientific manner in which the tools had been constructed was classified as whether an empirical research approach has been used, and if so, which type of research had been undertaken. Finally, the items contained in each critical appraisal tool were extracted and classified into one of eleven groups, which were based on the criteria described by Clarke and Oxman [ 4 ] as:

• Study aims and justification

• Methodology used , which encompassed method of identification of relevant studies and adherence to study protocol;

• Sample selection , which ranged from inclusion and exclusion criteria, to homogeneity of groups;

• Method of randomization and allocation blinding;

• Attrition : response and drop out rates;

• Blinding of the clinician, assessor, patient and statistician as well as the method of blinding;

• Outcome measure characteristics;

• Intervention or exposure details;

• Method of data analyses ;

• Potential sources of bias ; and

• Issues of external validity , which ranged from application of evidence to other settings to the relationship between benefits, cost and harm.

An additional group, " miscellaneous ", was used to describe items that could not be classified into any of the groups listed above.

Data synthesis

Data was synthesized using MS Excel spread sheets as well as narrative format by describing the number of critical appraisal tools per study design and the type of items they contained. Descriptions were made of the method by which the overall quality of the study was determined, evidence regarding the psychometric properties of the tools (validity and reliability) and whether guidelines were provided for use of the critical appraisal tool.

One hundred and ninety-three research reports that potentially provided a description of a critical appraisal tool (or process) were identified from the search strategy. Fifty-six of these papers were unavailable for review due to outdated Internet links, or inability to source the relevant journal through Australian university and Government library databases. Of the 127 papers retrieved, 19 were excluded from this review, as they did not provide a description of the critical appraisal tool used, or were published in languages other than English. As a result, 108 papers were reviewed, which yielded 121 different critical appraisal tools [ 1 – 5 , 7 , 9 , 15 – 102 , 116 ].

Empirical basis for tool construction

We identified 14 instruments (12% all tools) which were reported as having been constructed using a specified empirical approach [ 20 , 29 , 30 , 32 , 35 , 40 , 49 , 51 , 70 – 72 , 79 , 103 , 116 ]. The empirical research reflected descriptive and/or qualitative approaches, these being critical review of existing tools [ 40 , 72 ], Delphi techniques to identify then refine data items [ 32 , 51 , 71 ], questionnaires and other forms of written surveys to identify and refine data items [ 70 , 79 , 103 ], facilitated structured consensus meetings [ 20 , 29 , 30 , 35 , 40 , 49 , 70 , 72 , 79 , 116 ], and pilot validation testing [ 20 , 40 , 72 , 103 , 116 ]. In all the studies which reported developing critical appraisal tools using a consensus approach, a range of stakeholder input was sought, reflecting researchers and clinicians in a range of health disciplines, students, educators and consumers. There were a further 31 papers which cited other studies as the source of the tool used in the review, but which provided no information on why individual items had been chosen, or whether (or how) they had been modified. Moreover, for 21 of these tools, the cited sources of the critical appraisal tool did not report the empirical basis on which the tool had been constructed.

Critical appraisal tools per study design

Seventy-eight percent (N = 94) of the critical appraisal tools were developed for use on primary research [ 1 – 5 , 7 , 9 , 18 , 19 , 25 – 27 , 34 , 37 – 41 ], while the remainder (N = 26) were for secondary research (systematic reviews and meta-analyses) [ 2 – 5 , 15 – 36 , 116 ]. Eighty-seven percent (N = 104) of all critical appraisal tools were design-specific [ 2 – 5 , 7 , 9 , 15 – 90 ], with over one third (N = 45) developed for experimental studies (randomized controlled trials, clinical trials) [ 2 – 4 , 25 – 27 , 34 , 37 – 73 ]. Sixteen critical appraisal tools were generic. Of these, six were developed for use on both experimental and observational studies [ 9 , 91 – 95 ], whereas 11 were purported to be useful for any qualitative and quantitative research design [ 1 , 18 , 41 , 96 – 102 , 116 ] (see Figure 1 , Table 1 ).

figure 1

Number of critical appraisal tools per study design [1,2]

Critical appraisal items

One thousand, four hundred and seventy five items were extracted from these critical appraisal tools. After grouping like items together, 173 different item types were identified, with the most frequently reported items being focused towards assessing the external validity of the study (N = 35) and method of data analyses (N = 28) (Table 2 ). The most frequently reported items across all critical appraisal tools were:

Eligibility criteria (inclusion/exclusion criteria) (N = 63)

Appropriate statistical analyses (N = 47)

Random allocation of subjects (N = 43)

Consideration of outcome measures used (N = 43)

Sample size justification/power calculations (N = 39)

Study design reported (N = 36)

Assessor blinding (N = 36)

Design-specific critical appraisal tools

Systematic reviews.

Eighty-seven different items were extracted from the 26 critical appraisal tools, which were designed to evaluate the quality of systematic reviews. These critical appraisal tools frequently contained items regarding data analyses and issues of external validity (Tables 2 and 3 ).

Items assessing data analyses were focused to the methods used to summarize the results, assessment of sensitivity of results and whether heterogeneity was considered, whereas the nature of reporting of the main results, interpretation of them and their generalizability were frequently used to assess the external validity of the study findings. Moreover, systematic review critical appraisal tools tended to contain items such as identification of relevant studies, search strategy used, number of studies included and protocol adherence, that would not be relevant for other study designs. Blinding and randomisation procedures were rarely included in these critical appraisal tools.

Experimental studies

One hundred and twenty thirteen different items were extracted from the 45 experimental critical appraisal tools. These items most frequently assessed aspects of data analyses and blinding (Tables 1 and 2 ). Data analyses items were focused on whether appropriate statistical analysis was performed, whether a sample size justification or power calculation was provided and whether side effects of the intervention were recorded and analysed. Blinding was focused on whether the participant, clinician and assessor were blinded to the intervention.

Diagnostic studies

Forty-seven different items were extracted from the seven diagnostic critical appraisal tools. These items frequently addressed issues involving data analyses, external validity of results and sample selection that were specific to diagnostic studies (whether the diagnostic criteria were defined, definition of the "gold" standard, the calculation of sensitivity and specificity) (Tables 1 and 2 ).

Observational studies

Seventy-four different items were extracted from the 19 critical appraisal tools for observational studies. These items primarily focused on aspects of data analyses (see Tables 1 and 2 , such as whether confounders were considered in the analysis, whether a sample size justification or power calculation was provided and whether appropriate statistical analyses were preformed.

Qualitative studies

Thirty-six different items were extracted from the seven qualitative study critical appraisal tools. The majority of these items assessed issues regarding external validity, methods of data analyses and the aims and justification of the study (Tables 1 and 2 ). Specifically, items were focused to whether the study question was clearly stated, whether data analyses were clearly described and appropriate, and application of the study findings to the clinical setting. Qualitative critical appraisal tools did not contain items regarding sample selection, randomization, blinding, intervention or bias, perhaps because these issues are not relevant to the qualitative paradigm.

Generic critical appraisal tools

Experimental and observational studies.

Forty-two different items were extracted from the six critical appraisal tools that could be used to evaluate experimental and observational studies. These tools most frequently contained items that addressed aspects of sample selection (such as inclusion/exclusion criteria of participants, homogeneity of participants at baseline) and data analyses (such as whether appropriate statistical analyses were performed, whether a justification of the sample size or power calculation were provided).

All study designs

Seventy-eight different items were contained in the ten critical appraisal tools that could be used for all study designs (quantitative and qualitative). The majority of these items focused on whether appropriate data analyses were undertaken (such as whether confounders were considered in the analysis, whether a sample size justification or power calculation was provided and whether appropriate statistical analyses were preformed) and external validity issues (generalization of results to the population, value of the research findings) (see Tables 1 and 2 ).

Allied health critical appraisal tools

We found no critical appraisal instrument specific to allied health research, despite finding at least seven critical appraisal instruments associated with allied health topics (mostly physiotherapy management of orthopedic conditions) [ 37 , 39 , 52 , 58 , 59 , 65 ]. One critical appraisal development group proposed two instruments [ 9 ], specific to quantitative and qualitative research respectively. The core elements of allied health research quality (specific diagnosis criteria, intervention descriptions, nature of patient contact and appropriate outcome measures) were not addressed in any one tool sourced for this evaluation. We identified 152 different ways of considering quality reporting of outcome measures in the 121 critical appraisal tools, and 81 ways of considering description of interventions. Very few tools which were not specifically targeted to diagnostic studies (less than 10% of the remaining tools) addressed diagnostic criteria. The critical appraisal instrument that seemed most related to allied health research quality [ 39 ] sought comprehensive evaluation of elements of intervention and outcome, however this instrument was relevant only to physiotherapeutic orthopedic experimental research.

Overall study quality

Forty-nine percent (N = 58) of critical appraisal tools summarised the results of the quality appraisal into a single numeric summary score [ 5 , 7 , 15 – 25 , 37 – 59 , 74 – 77 , 80 – 83 , 87 , 91 – 93 , 96 , 97 ] (Figure 2 ). This was achieved by one of two methods:

figure 2

Number of critical appraisal tools with, and without, summary quality scores

An equal weighting system, where one point was allocated to each item fulfilled; or

A weighted system, where fulfilled items were allocated various points depending on their perceived importance.

However, there was no justification provided for any of the scoring systems used. In the remaining critical appraisal tools (N = 62), a single numerical summary score was not provided [ 1 – 4 , 9 , 25 – 36 , 60 – 73 , 78 , 79 , 84 – 90 , 94 , 95 , 98 – 102 ]. This left the research consumer to summarize the results of the appraisal in a narrative manner, without the assistance of a standard approach.

Psychometric properties of critical appraisal tools

Few critical appraisal tools had documented evidence of their validity and reliability. Face validity was established in nine critical appraisal tools, seven of which were developed for use on experimental studies [ 38 , 40 , 45 , 49 , 51 , 63 , 70 ] and two for systematic reviews [ 32 , 103 ]. Intra-rater reliability was established for only one critical appraisal tool as part of its empirical development process [ 40 ], whereas inter-rater reliability was reported for two systematic review tools [ 20 , 36 ] (for one of these as part of the developmental process [ 20 ]) and seven experimental critical appraisal tools [ 38 , 40 , 45 , 51 , 55 , 56 , 63 ] (for two of these as part of the developmental process [ 40 , 51 ]).

Critical appraisal tool guidelines

Forty-three percent (N = 52) of critical appraisal tools had guidelines that informed the user of the interpretation of each item contained within them (Table 2 ). These guidelines were most frequently in the form of a handbook or published paper (N = 31) [ 2 , 4 , 9 , 15 , 20 , 25 , 28 , 29 , 31 , 36 , 37 , 41 , 50 , 64 – 67 , 69 , 80 , 84 – 87 , 89 , 90 , 95 , 100 , 116 ], whereas in 14 critical appraisal tools explanations accompanied each item [ 16 , 26 , 27 , 40 , 49 , 51 , 57 , 59 , 79 , 83 , 91 , 102 ].

Our search strategy identified a large number of published critical appraisal tools that are currently available to critically appraise research reports. There was a distinct lack of information on tool development processes in most cases. Many of the tools were reported to be modifications of other published tools, or reflected specialty concerns in specific clinical or research areas, without attempts to justify inclusion criteria. Less than 10 of these tools were relevant to evaluation of the quality of allied health research, and none of these were based on an empirical research approach. We are concerned that although our search was systematic and extensive [ 104 , 105 ], our broad key words and our lack of ready access to 29% of potentially useful papers (N = 56) potentially constrained us from identifying all published critical appraisal tools. However, consumers of research seeking critical appraisal instruments are not likely to seek instruments from outdated Internet links and unobtainable journals, thus we believe that we identified the most readily available instruments. Thus, despite the limitations on sourcing all possible tools, we believe that this paper presents a useful synthesis of the readily available critical appraisal tools.

The majority of the critical appraisal tools were developed for a specific research design (87%), with most designed for use on experimental studies (38% of all critical appraisal tools sourced). This finding is not surprising as, according to the medical model, experimental studies sit at or near the top of the hierarchy of evidence [ 2 , 8 ]. In recent years, allied health researchers have strived to apply the medical model of research to their own discipline by conducting experimental research, often by using the randomized controlled trial design [ 106 ]. This trend may be the reason for the development of experimental critical appraisal tools reported in allied health-specific research topics [ 37 , 39 , 52 , 58 , 59 , 65 ].

We also found a considerable number of critical appraisal tools for systematic reviews (N = 26), which reflects the trend to synthesize research evidence to make it relevant for clinicians [ 105 , 107 ]. Systematic review critical appraisal tools contained unique items (such as identification of relevant studies, search strategy used, number of studies included, protocol adherence) compared with tools used for primary studies, a reflection of the secondary nature of data synthesis and analysis.

In contrast, we identified very few qualitative study critical appraisal tools, despite the presence of many journal-specific guidelines that outline important methodological aspects required in a manuscript submitted for publication [ 108 – 110 ]. This finding may reflect the more traditional, quantitative focus of allied health research [ 111 ]. Alternatively, qualitative researchers may view the robustness of their research findings in different terms compared with quantitative researchers [ 112 , 113 ]. Hence the use of critical appraisal tools may be less appropriate for the qualitative paradigm. This requires further consideration.

Of the small number of generic critical appraisal tools, we found few that could be usefully applied (to any health research, and specifically to the allied health literature), because of the generalist nature of their items, variable interpretation (and applicability) of items across research designs, and/or lack of summary scores. Whilst these types of tools potentially facilitate the synthesis of evidence across allied health research designs for clinicians, their lack of specificity in asking the 'hard' questions about research quality related to research design also potentially precludes their adoption for allied health evidence-based practice. At present, the gold standard study design when synthesizing evidence is the randomized controlled trial [ 4 ], which underpins our finding that experimental critical appraisal tools predominated in the allied health literature [ 37 , 39 , 52 , 58 , 59 , 65 ]. However, as more systematic literature reviews are undertaken on allied health topics, it may become more accepted that evidence in the form of other research design types requires acknowledgement, evaluation and synthesis. This may result in the development of more appropriate and clinically useful allied health critical appraisal tools.

A major finding of our study was the volume and variation in available critical appraisal tools. We found no gold standard critical appraisal tool for any type of study design. Therefore, consumers of research are faced with frustrating decisions when attempting to select the most appropriate tool for their needs. Variable quality evaluations may be produced when different critical appraisal tools are used on the same literature [ 6 ]. Thus, interpretation of critical analysis must be carefully considered in light of the critical appraisal tool used.

The variability in the content of critical appraisal tools could be accounted for by the lack of any empirical basis of tool construction, established validity of item construction, and the lack of a gold standard against which to compare new critical tools. As such, consumers of research cannot be certain that the content of published critical appraisal tools reflect the most important aspects of the quality of studies that they assess [ 114 ]. Moreover, there was little evidence of intra- or inter-rater reliability of the critical appraisal tools. Coupled with the lack of protocols for use, this may mean that critical appraisers could interpret instrument items in different ways over repeated occasions of use. This may produce variable results [123].

Based on the findings of this evaluation, we recommend that consumers of research should carefully select critical appraisal tools for their needs. The selected tools should have published evidence of the empirical basis for their construction, validity of items and reliability of interpretation, as well as guidelines for use, so that the tools can be applied and interpreted in a standardized manner. Our findings highlight the need for consensus to be reached regarding the important and core items for critical appraisal tools that will produce a more standardized environment for critical appraisal of research evidence. As a consequence, allied health research will specifically benefit from having critical appraisal tools that reflect best practice research approaches which embed specific research requirements of allied health disciplines.

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Beatie P: Measurement of health outcomes in the clinical setting: applications to physiotherapy. Phys Theory Pract. 2001, 17: 173-185. 10.1080/095939801317077632.

Charnock DF, (Ed): The DISCERN Handbook: Quality criteria for consumer health information on treatment choices. 1998, Radcliffe Medical Press

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Centre for Allied Health Evidence: A Collaborating Centre of the Joanna Briggs Institute, City East Campus, University of South Australia, North Terrace, Adelaide, 5000, Australia

Persis Katrak, Nicola Massy-Westropp, VS Saravana Kumar & Karen A Grimmer

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PK Sourced critical appraisal tools

Categorized the content and psychometric properties of critical appraisal tools

AEB Synthesis of findings

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NMW Sourced critical appraisal tools

VSK Sourced critical appraisal tools

KAG Study conception and design

Assisted with critiquing critical appraisal tools and categorization of the content and psychometric properties of critical appraisal tools

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Addressed reviewer's comments and re-submitted the article

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Katrak, P., Bialocerkowski, A.E., Massy-Westropp, N. et al. A systematic review of the content of critical appraisal tools. BMC Med Res Methodol 4 , 22 (2004). https://doi.org/10.1186/1471-2288-4-22

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DOI : https://doi.org/10.1186/1471-2288-4-22

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Tools for Critical Appraisal of Studies

critical appraisal research tools

“The purpose of critical appraisal is to determine the scientific merit of a research report and its applicability to clinical decision making.” 1 Conducting a critical appraisal of a study is imperative to any well executed evidence review, but the process can be time consuming and difficult. 2 The critical appraisal process requires “a methodological approach coupled with the right tools and skills to match these methods is essential for finding meaningful results.” 3 In short, it is a method of differentiating good research from bad research.

Critical Appraisal by Study Design (featured tools)

  • Non-RCTs or Observational Studies
  • Diagnostic Accuracy
  • Animal Studies
  • Qualitative Research
  • Tool Repository
  • AMSTAR 2 The original AMSTAR was developed to assess the risk of bias in systematic reviews that included only randomized controlled trials. AMSTAR 2 was published in 2017 and allows researchers to “identify high quality systematic reviews, including those based on non-randomised studies of healthcare interventions.” 4 more... less... AMSTAR 2 (A MeaSurement Tool to Assess systematic Reviews)
  • ROBIS ROBIS is a tool designed specifically to assess the risk of bias in systematic reviews. “The tool is completed in three phases: (1) assess relevance(optional), (2) identify concerns with the review process, and (3) judge risk of bias in the review. Signaling questions are included to help assess specific concerns about potential biases with the review.” 5 more... less... ROBIS (Risk of Bias in Systematic Reviews)
  • BMJ Framework for Assessing Systematic Reviews This framework provides a checklist that is used to evaluate the quality of a systematic review.
  • CASP Checklist for Systematic Reviews This CASP checklist is not a scoring system, but rather a method of appraising systematic reviews by considering: 1. Are the results of the study valid? 2. What are the results? 3. Will the results help locally? more... less... CASP (Critical Appraisal Skills Programme)
  • CEBM Systematic Reviews Critical Appraisal Sheet The CEBM’s critical appraisal sheets are designed to help you appraise the reliability, importance, and applicability of clinical evidence. more... less... CEBM (Centre for Evidence-Based Medicine)
  • JBI Critical Appraisal Tools, Checklist for Systematic Reviews JBI Critical Appraisal Tools help you assess the methodological quality of a study and to determine the extent to which study has addressed the possibility of bias in its design, conduct and analysis.
  • NHLBI Study Quality Assessment of Systematic Reviews and Meta-Analyses The NHLBI’s quality assessment tools were designed to assist reviewers in focusing on concepts that are key for critical appraisal of the internal validity of a study. more... less... NHLBI (National Heart, Lung, and Blood Institute)
  • RoB 2 RoB 2 “provides a framework for assessing the risk of bias in a single estimate of an intervention effect reported from a randomized trial,” rather than the entire trial. 6 more... less... RoB 2 (revised tool to assess Risk of Bias in randomized trials)
  • CASP Randomised Controlled Trials Checklist This CASP checklist considers various aspects of an RCT that require critical appraisal: 1. Is the basic study design valid for a randomized controlled trial? 2. Was the study methodologically sound? 3. What are the results? 4. Will the results help locally? more... less... CASP (Critical Appraisal Skills Programme)
  • CONSORT Statement The CONSORT checklist includes 25 items to determine the quality of randomized controlled trials. “Critical appraisal of the quality of clinical trials is possible only if the design, conduct, and analysis of RCTs are thoroughly and accurately described in the report.” 7 more... less... CONSORT (Consolidated Standards of Reporting Trials)
  • NHLBI Study Quality Assessment of Controlled Intervention Studies The NHLBI’s quality assessment tools were designed to assist reviewers in focusing on concepts that are key for critical appraisal of the internal validity of a study. more... less... NHLBI (National Heart, Lung, and Blood Institute)
  • JBI Critical Appraisal Tools Checklist for Randomized Controlled Trials JBI Critical Appraisal Tools help you assess the methodological quality of a study and to determine the extent to which study has addressed the possibility of bias in its design, conduct and analysis.
  • ROBINS-I ROBINS-I is a “tool for evaluating risk of bias in estimates of the comparative effectiveness… of interventions from studies that did not use randomization to allocate units… to comparison groups.” 8 more... less... ROBINS-I (Risk Of Bias in Non-randomized Studies – of Interventions)
  • NOS This tool is used primarily to evaluate and appraise case-control or cohort studies. more... less... NOS (Newcastle-Ottawa Scale)
  • AXIS Cross-sectional studies are frequently used as an evidence base for diagnostic testing, risk factors for disease, and prevalence studies. “The AXIS tool focuses mainly on the presented [study] methods and results.” 9 more... less... AXIS (Appraisal tool for Cross-Sectional Studies)
  • NHLBI Study Quality Assessment Tools for Non-Randomized Studies The NHLBI’s quality assessment tools were designed to assist reviewers in focusing on concepts that are key for critical appraisal of the internal validity of a study. • Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies • Quality Assessment of Case-Control Studies • Quality Assessment Tool for Before-After (Pre-Post) Studies With No Control Group • Quality Assessment Tool for Case Series Studies more... less... NHLBI (National Heart, Lung, and Blood Institute)
  • Case Series Studies Quality Appraisal Checklist Developed by the Institute of Health Economics (Canada), the checklist is comprised of 20 questions to assess “the robustness of the evidence of uncontrolled, [case series] studies.” 10
  • Methodological Quality and Synthesis of Case Series and Case Reports In this paper, Dr. Murad and colleagues “present a framework for appraisal, synthesis and application of evidence derived from case reports and case series.” 11
  • MINORS The MINORS instrument contains 12 items and was developed for evaluating the quality of observational or non-randomized studies. 12 This tool may be of particular interest to researchers who would like to critically appraise surgical studies. more... less... MINORS (Methodological Index for Non-Randomized Studies)
  • JBI Critical Appraisal Tools for Non-Randomized Trials JBI Critical Appraisal Tools help you assess the methodological quality of a study and to determine the extent to which study has addressed the possibility of bias in its design, conduct and analysis. • Checklist for Analytical Cross Sectional Studies • Checklist for Case Control Studies • Checklist for Case Reports • Checklist for Case Series • Checklist for Cohort Studies
  • QUADAS-2 The QUADAS-2 tool “is designed to assess the quality of primary diagnostic accuracy studies… [it] consists of 4 key domains that discuss patient selection, index test, reference standard, and flow of patients through the study and timing of the index tests and reference standard.” 13 more... less... QUADAS-2 (a revised tool for the Quality Assessment of Diagnostic Accuracy Studies)
  • JBI Critical Appraisal Tools Checklist for Diagnostic Test Accuracy Studies JBI Critical Appraisal Tools help you assess the methodological quality of a study and to determine the extent to which study has addressed the possibility of bias in its design, conduct and analysis.
  • STARD 2015 The authors of the standards note that “[e]ssential elements of [diagnostic accuracy] study methods are often poorly described and sometimes completely omitted, making both critical appraisal and replication difficult, if not impossible.”10 The Standards for the Reporting of Diagnostic Accuracy Studies was developed “to help… improve completeness and transparency in reporting of diagnostic accuracy studies.” 14 more... less... STARD 2015 (Standards for the Reporting of Diagnostic Accuracy Studies)
  • CASP Diagnostic Study Checklist This CASP checklist considers various aspects of diagnostic test studies including: 1. Are the results of the study valid? 2. What were the results? 3. Will the results help locally? more... less... CASP (Critical Appraisal Skills Programme)
  • CEBM Diagnostic Critical Appraisal Sheet The CEBM’s critical appraisal sheets are designed to help you appraise the reliability, importance, and applicability of clinical evidence. more... less... CEBM (Centre for Evidence-Based Medicine)
  • SYRCLE’s RoB “[I]mplementation of [SYRCLE’s RoB tool] will facilitate and improve critical appraisal of evidence from animal studies. This may… enhance the efficiency of translating animal research into clinical practice and increase awareness of the necessity of improving the methodological quality of animal studies.” 15 more... less... SYRCLE’s RoB (SYstematic Review Center for Laboratory animal Experimentation’s Risk of Bias)
  • ARRIVE 2.0 “The [ARRIVE 2.0] guidelines are a checklist of information to include in a manuscript to ensure that publications [on in vivo animal studies] contain enough information to add to the knowledge base.” 16 more... less... ARRIVE 2.0 (Animal Research: Reporting of In Vivo Experiments)
  • Critical Appraisal of Studies Using Laboratory Animal Models This article provides “an approach to critically appraising papers based on the results of laboratory animal experiments,” and discusses various “bias domains” in the literature that critical appraisal can identify. 17
  • CEBM Critical Appraisal of Qualitative Studies Sheet The CEBM’s critical appraisal sheets are designed to help you appraise the reliability, importance and applicability of clinical evidence. more... less... CEBM (Centre for Evidence-Based Medicine)
  • CASP Qualitative Studies Checklist This CASP checklist considers various aspects of qualitative research studies including: 1. Are the results of the study valid? 2. What were the results? 3. Will the results help locally? more... less... CASP (Critical Appraisal Skills Programme)
  • Quality Assessment and Risk of Bias Tool Repository Created by librarians at Duke University, this extensive listing contains over 100 commonly used risk of bias tools that may be sorted by study type.
  • Latitudes Network A library of risk of bias tools for use in evidence syntheses that provides selection help and training videos.

References & Recommended Reading

1.     Kolaski, K., Logan, L. R., & Ioannidis, J. P. (2024). Guidance to best tools and practices for systematic reviews .  British Journal of Pharmacology ,  181 (1), 180-210

2.    Portney LG.  Foundations of clinical research : applications to evidence-based practice.  Fourth edition. ed. Philadelphia: F A Davis; 2020.

3.     Fowkes FG, Fulton PM.  Critical appraisal of published research: introductory guidelines.   BMJ (Clinical research ed).  1991;302(6785):1136-1140.

4.     Singh S.  Critical appraisal skills programme.   Journal of Pharmacology and Pharmacotherapeutics.  2013;4(1):76-77.

5.     Shea BJ, Reeves BC, Wells G, et al.  AMSTAR 2: a critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both.   BMJ (Clinical research ed).  2017;358:j4008.

6.     Whiting P, Savovic J, Higgins JPT, et al.  ROBIS: A new tool to assess risk of bias in systematic reviews was developed.   Journal of clinical epidemiology.  2016;69:225-234.

7.     Sterne JAC, Savovic J, Page MJ, et al.  RoB 2: a revised tool for assessing risk of bias in randomised trials.  BMJ (Clinical research ed).  2019;366:l4898.

8.     Moher D, Hopewell S, Schulz KF, et al.  CONSORT 2010 Explanation and Elaboration: Updated guidelines for reporting parallel group randomised trials.  Journal of clinical epidemiology.  2010;63(8):e1-37.

9.     Sterne JA, Hernan MA, Reeves BC, et al.  ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions.  BMJ (Clinical research ed).  2016;355:i4919.

10.     Downes MJ, Brennan ML, Williams HC, Dean RS.  Development of a critical appraisal tool to assess the quality of cross-sectional studies (AXIS).   BMJ open.  2016;6(12):e011458.

11.   Guo B, Moga C, Harstall C, Schopflocher D.  A principal component analysis is conducted for a case series quality appraisal checklist.   Journal of clinical epidemiology.  2016;69:199-207.e192.

12.   Murad MH, Sultan S, Haffar S, Bazerbachi F.  Methodological quality and synthesis of case series and case reports.  BMJ evidence-based medicine.  2018;23(2):60-63.

13.   Slim K, Nini E, Forestier D, Kwiatkowski F, Panis Y, Chipponi J.  Methodological index for non-randomized studies (MINORS): development and validation of a new instrument.   ANZ journal of surgery.  2003;73(9):712-716.

14.   Whiting PF, Rutjes AWS, Westwood ME, et al.  QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies.   Annals of internal medicine.  2011;155(8):529-536.

15.   Bossuyt PM, Reitsma JB, Bruns DE, et al.  STARD 2015: an updated list of essential items for reporting diagnostic accuracy studies.   BMJ (Clinical research ed).  2015;351:h5527.

16.   Hooijmans CR, Rovers MM, de Vries RBM, Leenaars M, Ritskes-Hoitinga M, Langendam MW.  SYRCLE's risk of bias tool for animal studies.   BMC medical research methodology.  2014;14:43.

17.   Percie du Sert N, Ahluwalia A, Alam S, et al.  Reporting animal research: Explanation and elaboration for the ARRIVE guidelines 2.0.  PLoS biology.  2020;18(7):e3000411.

18.   O'Connor AM, Sargeant JM.  Critical appraisal of studies using laboratory animal models.   ILAR journal.  2014;55(3):405-417.

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Critical Appraisal Questionnaires

Critical Appraisal Questionnaires

Critical appraisal is the process of carefully and systematically assessing the outcome of scientific research (evidence) to judge its trustworthiness, value and relevance in a particular context. Critical appraisal looks at the way a study is conducted and examines factors such as internal validity, generalizability and relevance.

Some initial appraisal questions you could ask are:

  • Is the evidence from a known, reputable source?
  • Has the evidence been evaluated in any way? If so, how and by whom?
  • How up-to-date is the evidence?

Second, you could look at the study itself and ask the following general appraisal questions:

  • How was the outcome measured?
  • Is that a reliable way to measure?
  • How large was the effect size?
  • What implications does the study have for your practice? Is it relevant?
  • Can the results be applied to your organization?

Questionnaires

If you would like to critically appraise a study, we strongly recommend using the app we have developed for iOS and Android:  CAT Manager App

You could also consider using the following appraisal questionnaires (checklists) for specific study designs, but we do not recommend this. 

Appraisal of a meta-analysis or systematic review

Appraisal of a controlled study, appraisal of a cohort or panel study, appraisal of a case control study, appraisal of a cross-sectional study (survey), appraisal of a qualitative study, appraisal of a case study.

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Critical Appraisal of Studies

Critical appraisal is the process of carefully and systematically examining research to judge its trustworthiness, and its value/relevance in a particular context by providing a framework to evaluate the research. During the critical appraisal process, researchers can:

  • Decide whether studies have been undertaken in a way that makes their findings reliable as well as valid and unbiased
  • Make sense of the results
  • Know what these results mean in the context of the decision they are making
  • Determine if the results are relevant to their patients/schoolwork/research

Burls, A. (2009). What is critical appraisal? In What Is This Series: Evidence-based medicine. Available online at  What is Critical Appraisal?

Critical appraisal is included in the process of writing high quality reviews, like systematic and integrative reviews and for evaluating evidence from RCTs and other study designs. For more information on systematic reviews, check out our  Systematic Review  guide.

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Which checklist or tool should I use?

There are hundreds of critical appraisal checklists and tools you can choose from, which can be very overwhelming. There are so many because there are many kinds of research, knowledge can be communicated in a wide range of ways, and whether something is appropriate to meet your information needs depends on your specific context. 

We have asked for recommendations from lecturers in different academic departments, to give you an idea about which checklists and tools may be the most relevant for you. Please hover over the drop-down menu at the top of the page, underneath 'Critical appraisal checklists and tools' to view the individual subject pages.

Below are lists of as many critical appraisal tools and checklists as we have been able to find. These are split into health sciences and social sciences because the two areas tend to take different approaches to evaluation, for various reasons!

To see a selection of checklists more suitable for your subject, hover over the top tab of this page.  

Critical appraisal checklists and tools for Health Sciences

  • AACODS  Checklist for appraising grey literature
  • AMSTAR 2  critical appraisal tool for systematic reviews that include randomised and non-randomised studies of healthcare interventions or both
  • AOTA Critically Appraised Papers  American Occupational Therapy Association 
  • Bandolier - "Evidence based thinking about healthcare"
  • BestBETS critical appraisal worksheet
  • BMJ critical appraisal checklists
  • CASP  Critical Appraisal Skills Programme includes checklists for case control studies, clinical prediction rule, cohort studies, diagnostic studies, economic evaluation, qualitative studies, RCTs and systematic reviews
  • Centre for Evidence Based Medicine (Oxford) Critical Appraisal Tools  CEBM's worksheets to assess systematic reviews, diagnostic, prognosis, and RCTs
  • Centre for Evidence Based Medicine (Oxford) CATmaker and EBM calculator  CEBM's computer assisted critical appraisal tool CATmaker 
  • CEMB critical appraisal sheets  (Centre for Evidence Based Medicine)
  • Cochrane Assessing Risk of Bias in a Randomized Trial
  • Critical appraisal: a checklist from Students for Best Evidence S4BE (student network with simple explanations of difficult concepts)
  • Critical appraisal and statistical skills (Knowledge for Healthcare)
  • Critical appraisal of clinical trials  from Testing Treatments International
  • Critical appraisal of clinical trials (Medicines Learning Portal)
  • Critical appraisal of quantitative research  
  • Critical appraisal of a quantitative paper  from Teeside University
  • Critical appraisal of a qualitative paper  from Teeside University
  • Critical appraisal tools  from the Centre for Evidence-Based Medicine
  • Critical Evaluation of Research Papers – Qualitative Studies from Teeside University
  • Critical Evaluation of Research Papers – RCTs/Experimental Studies from Teeside University
  • Evaluation tool for mixed methods study designs 
  • GRADE - The Grading of Recommendations Assessment, Development and Evaluation working group  guidelines and publications for grading the quality of evidence in healthcare research and policy
  • HCPRDU Evaluation Tool for Mixed Methods Studies  - University of Salford Health Care Practice R&D Unit 
  • HCPRDU Evaluation Tool for Qualitative Studies  - University of Salford Health Care Practice R&D Unit 
  • HCPRDU Evaluation Tool for Quantitative Studies  - University of Salford Health Care Practice R&D Unit 
  • JBI Joanna Briggs Institute critical appraisal tools  checklists for Analytical cross sectional studies, case control studies, case reports, case series, cohort studies, diagnostic test accuracy, economic evaluations, prevalence studies, qualitative research, quasi-experimental (non-randomised) studies, RCTs, systematic reviews and for text and opinion  
  • Knowledge Translation Program  - Toronto based KTP critical appraisal worksheets for systematic reviews, prognosis, diagnosis, harm and therapy
  • MATT Mixed Methods Appraisal Tool 
  • McMaster University Evidence Based Practice Research Group quantitative and qualitative review forms
  • NHLBI (National Heart, Blood and lung Institute) study quality assessment tools for case control studies, case series, controlled intervention, observational cohort and cross sectional studies, before-after (pre-post) studies with no control group, systematic reviews and meta analyses 
  • NICE Guidelines, The Manual Appendix H. pp9-24
  • QUADAS-2  tool for evaluating risk of bias in systematic reviews from the University of Bristol
  • PEDro  PEDro (Physiotherapy Evidence Database) Scale - appraisal resources including a tutorial and appraisal tool
  • RoB 2   A revised Cochrane risk-of-bias tool for randomized trials
  • ROBINS-I Risk Of Bias In Non-Randomized Studies of Interventions 
  • ROBIS  Risk of Bias in Systematic Reviews
  • ROB-ME   A tool for assessing Risk Of Bias due to Missing Evidence in a synthesis
  • SIGN  - Critical appraisal notes and checklists for case control studies, cohort studies, diagnostic studies, economic studies, RCTs, meta-analyses and systematic reviews
  • Strength of Recommendation Taxonomy  - the SORT scale for quality, quantity and consistency of evidence in individual studies or bodies of evidence
  • STROBE (Strengthening the Reporting of Observational studies in Epidemiology)  for cohort, case-control, and cross-sectional studies (combined),  cohort, case-control, cross-sectional studies and conference abstracts
  • SURE Case Controlled Studies Critical Appraisal checklist
  • SURE Case Series Studies Critical Appraisal checklist
  • SURE Cohort Studies Critical Appraisal checklist
  • SURE Cross-sectional Studies Critical Appraisal checklist
  • SURE Experimental Studies Critical Appraisal checklist
  • SURE Qualitative Studies Critical Appraisal checklist
  • SURE Systematic Review Critical Appraisal checklist

Critical appraisal checklists and tools for Social Sciences

  • CRAAP test to evaluate sources of information 
  • Educational Interventions Critical Appraisal worksheet  from BestBETs
  • PROVEN  - tool to evaluate any source of information 
  • SIFT (The Four Moves) to help students distinguish between truth and fake news 
  • Some Guidelines for the Critical Reviewing of Conceptual Papers
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Critical Appraisal

Use this guide to find information resources about critical appraisal including checklists, books and journal articles.

Key Resources

  • This online resource explains the sections commonly used in research articles. Understanding how research articles are organised can make reading and evaluating them easier View page
  • Critical appraisal checklists
  • Worksheets for appraising systematic reviews, diagnostics, prognostics and RCTs. View page
  • A free online resource for both healthcare staff and patients; four modules of 30–45 minutes provide an introduction to evidence based medicine, clinical trials and Cochrane Evidence. View page
  • This tool will guide you through a series of questions which will help you to evaluate a research article. View page
  • The PRISMA flow diagram depicts the flow of information through the different phases of a literature review. It maps out the number of records identified, included and excluded, and the reasons for exclusions. View page
  • A useful resource for methods and evidence in applied social science. View page
  • A comprehensive database of reporting guidelines. Covers all the main study types. View page
  • A tool to assess the methodological quality of systematic reviews. View page

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  • Chapter 5 covers critical appraisal of the literature. View this eBook

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  • Chapter 6 covers assessing the evidence base. Borrow from RCN Library services

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  • Section 1 covers an introduction to critical appraisal. Section 3 covers appraising difference types of papers including qualitative papers and observational studies. View this eBook

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  • Chapter 6 covers critically appraising the literature. Borrow from RCN Library services

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  • View this eBook

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  • Chapter 8 covers critical appraisal of the evidence. View this eBook

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  • Chapter 18 covers critical appraisal of nursing studies. View this eBook

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Journal articles

  • View article

Shea BJ and others (2017) AMSTAR 2: a critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions or both, British Medical Journal, 358.

  • An outline of AMSTAR 2 and its use for as a critical appraisal tool for systematic reviews. View article (open access)
  • View articles

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Critical Appraisal Checklists

We offer a number of free downloadable checklists to help you more easily and accurately perform critical appraisal across a number of different study types.

The CASP checklists are easy to understand but in case you need any further guidance on how they are structured, take a look at our guide on how to use our CASP checklists .

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Jbi’s critical appraisal tools assist in assessing the trustworthiness, relevance and results of published papers.

JBI’s critical appraisal tools assist in assessing the trustworthiness, relevance and results of published papers.

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Karlsson LE, Takahashi R. A Resource for Developing an Evidence Synthesis Report for Policy-Making [Internet]. Copenhagen: WHO Regional Office for Europe; 2017. (Health Evidence Network Synthesis Report, No. 50.)

Cover of A Resource for Developing an Evidence Synthesis Report for Policy-Making

A Resource for Developing an Evidence Synthesis Report for Policy-Making [Internet].

Annex 4. selection of tools for appraising evidence.

The tools outlined here are examples of existing tools; new tools are constantly appearing and existing ones are revised.

  • Appraising quantitative studies

Methods are available for specific study types:

  • systematic reviews and meta-analyses ( 1 – 7 )
  • randomized controlled trials ( 8 , 9 )
  • cohort studies ( 10 – 14 )
  • case–control studies ( 15 , 16 )
  • economic evaluations ( 17 , 18 ) .
  • Appraising qualitative studies

Saini & Shlonsky ( 19 ) have suggested a 25-item quality appraisal tool (QRQC) to evaluate the credibility, dependability, confirmability, transferability, authenticity and relevance of qualitative studies; this tool is applicable for variety of qualitative research methods. The National Institute for Health and Care Excellence (NICE) also has guidelines ( 20 ) as does the Critical Appraisal Skills programme (CASP) ( 21 ) .

  • Mixed method appraisal tool

The MMAT Mixed Methods Appraisal Tool ( 22 ) is designed for systematic reviews that include qualitative, quantitative and mixed methods studies ( 23 , 24 ) . The tool is used worldwide because it allows researchers to overcome the difficulties associated with using different critical appraisal tools for different designs.

  • Appraising grey literature

Grey literature includes productions in print and electronic formats by governments, academics, business and industry that are not part of the peer-reviewed publications from commercial publishers. It can also include theses or dissertations (reviewed by examiners who are subject specialists), conference papers (often peer reviewed or presented by those with specialist knowledge) and various types of report from specialists. The AACODS checklist (authority, accuracy, coverage, objectivity, date, significance) is designed to enable evaluation and critical appraisal of such grey literature ( 25 ) .

  • Cite this Page Karlsson LE, Takahashi R. A Resource for Developing an Evidence Synthesis Report for Policy-Making [Internet]. Copenhagen: WHO Regional Office for Europe; 2017. (Health Evidence Network Synthesis Report, No. 50.) ANNEX 4. SELECTION OF TOOLS FOR APPRAISING EVIDENCE.
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IMAGES

  1. Summary table of the most well known Critical Appraisal Tools (CAT

    critical appraisal research tools

  2. CASP eight critical appraisal tools

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  3. Critical Appraisal Of A Cross Sectional Study Survey

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  4. This set of eight critical appraisal tools are designed to be used when

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  5. Critical appraisal tools used.

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  6. Critical Appraisal Tools and Reporting Guidelines for Evidence‐Based

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COMMENTS

  1. Critical Appraisal Tools and Reporting Guidelines

    The main aims for this paper are to (a) describe steps involved in selecting appropriate critical appraisal tools and research evidence reporting guidelines; and (b) identify a list of commonly used critical appraisal tools and reporting guidelines in health research.

  2. Critical Appraisal tools

    This section contains useful tools and downloads for the critical appraisal of different types of medical evidence. Example appraisal sheets are provided together with several helpful examples. Critical Appraisal Worksheets English Systematic Reviews Critical Appraisal Sheet Diagnostics Critical Appraisal Sheet Prognosis Critical Appraisal Sheet

  3. A guide to critical appraisal of evidence : Nursing2020 Critical Care

    Critical appraisal is the assessment of research studies' worth to clinical practice. Critical appraisal—the heart of evidence-based practice—involves four phases: rapid critical appraisal, evaluation, synthesis, and recommendation.

  4. Critical Appraisal of Clinical Research

    Critical appraisal is the course of action for watchfully and systematically examining research to assess its reliability, value and relevance in order to direct professionals in their vital clinical decision making [ 1 ]. Critical appraisal is essential to: Combat information overload; Identify papers that are clinically relevant;

  5. JBI Critical Appraisal Tools

    Critical Appraisal Tools JBI's critical appraisal tools assist in assessing the trustworthiness, relevance and results of published papers. These tools have been revised. Recently published articles detail the revision.

  6. Full article: Critical appraisal

    The steps involved in a sound critical appraisal include: (a) identifying the study type (s) of the individual paper (s), (b) identifying appropriate criteria and checklist (s), (c) selecting an appropriate set of criteria and checklist, (d) performing the appraisal, and (e) summarizing and using the results.

  7. Critical appraisal of published research papers

    Critical appraisal of a research paper is defined as "The process of carefully and systematically examining research to judge its trustworthiness, value and relevance in a particular context."

  8. Critical Appraisal Tools & Resources

    Critical Appraisal is the process of carefully and systematically examining research to judge its trustworthiness, and its value and relevance in a particular context. It is an essential skill for evidence-based medicine because it allows people to find and use research evidence reliably and efficiently.

  9. Scientific writing: Critical Appraisal Toolkit (CAT) for assessing

    The CAT consists of: algorithms to identify the type of study design, three separate tools (for appraisal of analytic studies, descriptive studies and literature reviews), additional tools to support the appraisal process, and guidance for summarizing evidence and drawing conclusions about a body of evidence.

  10. Critical appraisal of qualitative research

    How is appraisal currently performed? Appraising the quality of qualitative research is not a new concept—there are a number of published appraisal tools, frameworks and checklists in existence.21-23 An important and often overlooked point is the confusion between tools designed for appraising methodological quality and reporting guidelines designed to assess the quality of methods reporting.

  11. Critical Appraisal Tools and Reporting Guidelines for Evidence-Based

    Critical Appraisal Tools and Reporting Guidelines for Evidence-Based Practice 2017 Dec;14 (6):463-472. doi: 10.1111/wvn.12258. Robin K Buccheri 10.1111/wvn.12258 Practicing registered nurses and advance practice nurses must be able to critically appraise and disseminate evidence in order to meet EBP competencies.

  12. A systematic review of the content of critical appraisal tools

    The majority of the critical appraisal tools were developed for a specific research design (87%), with most designed for use on experimental studies (38% of all critical appraisal tools sourced). This finding is not surprising as, according to the medical model, experimental studies sit at or near the top of the hierarchy of evidence [ 2 , 8 ].

  13. Systematic Reviews: Critical Appraisal by Study Design

    ROBIS is a tool designed specifically to assess the risk of bias in systematic reviews. "The tool is completed in three phases: (1) assess relevance (optional), (2) identify concerns with the review process, and (3) judge risk of bias in the review.

  14. Critical Appraisal Questionnaires » CEBMa

    Critical appraisal is the process of carefully and systematically assessing the outcome of scientific research (evidence) to judge its trustworthiness, value and relevance in a particular context. Critical appraisal looks at the way a study is conducted and examines factors such as internal validity, generalizability and relevance. Some initial ...

  15. Introduction

    Introduction Critical Appraisal Tools This guide describes tools to critically evaluate evidenced based reviews and study designs Critical Appraisal Tools Related Guides Getting Help Critical Appraisal of Studies

  16. Critical appraisal full list of checklists and tools

    There are hundreds of critical appraisal checklists and tools you can choose from, which can be very overwhelming. There are so many because there are many kinds of research, knowledge can be communicated in a wide range of ways, and whether something is appropriate to meet your information needs depends on your specific context.

  17. Critical Appraisal

    A tool to assess the methodological quality of systematic reviews. View page Books Aveyard H, Preston N and Farquhar M (2022) How to read and critique research: a guide for nursing and healthcare students. Los Angeles: SAGE. Borrow from RCN Library services

  18. CASP Checklists

    Critical Appraisal Checklists We offer a number of free downloadable checklists to help you more easily and accurately perform critical appraisal across a number of different study types.

  19. ebp

    JBI's critical appraisal tools assist in assessing the trustworthiness, relevance and results of published papers. Critical Appraisal Tools. ... Checklist for Qualitative Research Checklist for Quasi-Experimental Studies (non-randomized experimental studies)

  20. Optimising the value of the critical appraisal skills programme (CASP

    The Critical Appraisal Skills Programme (CASP) tool is the most commonly used tool for quality appraisal in health-related qualitative evidence syntheses, with endorsement from the Cochrane Qualitative and Implementation Methods Group.

  21. A systematic review of the content of critical appraisal tools

    The majority of the critical appraisal tools were developed for a specific research design (87%), with most designed for use on experimental studies (38% of all critical appraisal tools sourced). This finding is not surprising as, according to the medical model, experimental studies sit at or near the top of the hierarchy of evidence [ 2 , 8 ].

  22. Critiquing Research Evidence for Use in Practice: Revisited

    There are numerous ways to appraise research and practice guidelines that are designed to inform clinical practice with the overall goals of improving patient outcomes. This article presents existing tools to appraise the research evidence in addition to a guide for providers on critical appraisal of a research study.

  23. Annex 4. Selection of Tools for Appraising Evidence

    Mixed method appraisal tool. The MMAT Mixed Methods Appraisal Tool is designed for systematic reviews that include qualitative, quantitative and mixed methods studies (23,24). The tool is used worldwide because it allows researchers to overcome the difficulties associated with using different critical appraisal tools for different designs.