What is Critical Appraisal?

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. All of us would like to enjoy the best possible health we can. To achieve this, we need reliable information about what might harm or help us when we make healthcare decisions.

Why is Critical Appraisal important?

Critical appraisal skills are important as they enable you to assess systematically the trustworthiness, relevance and results of published papers. Where an article is published, or who wrote it should not be an indication of its trustworthiness and relevance.

Critical appraisals can be applied to different study and research formats including:

Randomised Controlled Trials (RCTs): An experiment that randomises participants into two groups: one that receives the treatment and another that serves as the control. RCTs are often used in healthcare to test the efficacy of different treatments.
Systematic Reviews: A thorough and structured analysis of all relevant studies on a particular research question. These are often used in evidence-based practice to evaluate the effects of health and social interventions.
Cohort Studies: This is an observational study where two or more groups (cohorts) of individuals are followed over time and their outcomes are compared. It's used often in medical research to investigate the potential causes of disease.
Case-Control Studies: This is an observational study where two groups differing in outcome are identified and compared on the basis of some supposed causal attribute. These are often used in epidemiological research.
Cross-Sectional Studies: An observational study that examines the relationship between health outcomes and other variables of interest in a defined population at a single point in time. They're useful for determining prevalence and risk factors.
Qualitative Research: An in-depth analysis of a phenomenon based on unstructured data, such as interviews, observations, or written material. It's often used to gain insights into behaviours, value systems, attitudes, motivations, or culture.
Economic Evaluation: A comparison of two or more alternatives in terms of their costs and consequences. Often used in healthcare decision making to maximise efficiency and equity.
Diagnostic Studies: Evaluates the performance of a diagnostic test in predicting the presence or absence of a disease. It is commonly used to validate the accuracy and utility of a new diagnostic procedure.
Case Series: Describes characteristics of a group of patients with a particular disease or who have undergone a specific procedure. Used in clinical medicine to present preliminary observations.
Case Studies: Detailed examination of a single individual or group. Common in psychology and social sciences, this can provide in-depth understanding of complex phenomena in their real-life context.

Aren’t we already doing it?

To some extent, the answer to this question is “yes”. Evidence-based journals can give us reliable, relevant summaries of recent research; guidelines, protocols, and pathways can synthesise the best evidence and present it in the context of a clinical problem. However, we still need to be able to assess research quality to be able to adapt what we read to what we do.

There are still significant gaps in access to evidence.

The main issues we need to address are:

Skills in assessing the quality of evidence
Integrating the evidence with clinical expertise and patient values in shared decision-making
The time it takes to get hold of evidence-based information

Health and Social Care provision must be based on sound decisions.

In order to make well-informed and sensible choices, we need evidence that is rigorous in methodology and robust in findings.

What types of questions does a critical appraisal encourage you to ask?

What is the main objective of the research?
Who conducted the research and are they reputable?
How was the research funded? Are there any potential conflicts of interest?
How was the study designed?
Was the sample size large enough to provide accurate results?
Were the participants or subjects selected appropriately?
What data collection methods were used and were they reliable and valid?
Was the data analysed accurately and rigorously?
Were the results and conclusions drawn directly from the data or were there assumptions made?
Can the findings be generalised to the broader population?
How does this research contribute to existing knowledge in this field?
Were ethical standards maintained throughout the study?
Were any potential biases accounted for in the design, data collection or data analysis?
Have the researchers made suggestions for future research based on their findings?
Are the findings of the research replicable?
Are there any implications for policy or practice based on the research findings?
Were all aspects of the research clearly explained and detailed?

These types of questions can help ensure the research is credible, reliable, and valid, contributing significantly to its respective field of study.

How do you critically appraise a paper?

Critically appraising a paper involves examining the quality, validity, and relevance of a published work to identify its strengths and weaknesses.

This allows the reader to judge its trustworthiness and applicability to their area of work or research. Below are general steps for critically appraising a paper:

Decide how trustworthy a piece of research is (Validity)
Determine what the research is telling us (Results)
Weigh up how useful the research will be in your context (Relevance)

You need to understand the research question, do a methodology evaluation, analyse the results, check the conclusion and review the implications and limitations.

That's just a quick summary but we provide a range of in-depth training courses, workshops and train-the-trainer sessions to help you improve your knowledge around how to successfully perform critical appraisals so book onto one today or contact us for more information.

Is Critical Appraisal In Research Different To Front-Line Usage In Nursing, Etc?

Critical appraisal in research is different from front-line usage in nursing.

Critical appraisal in research involves a careful analysis of a study's methodology, results, and conclusions to assess the quality and validity of the study. This helps researchers to determine if the study's findings are robust, reliable and applicable in their own research context. It requires a specific set of skills including understanding of research methodology, statistics, and evidence-based practices.

Front-line usage in nursing refers to the direct application of evidence-based practice and research findings in patient care settings. Nurses need to appraise the evidence critically too but their focus is on the direct implications of the research on patient care and health outcomes. The skills required here would be the ability to understand the clinical implications of research findings, communicate these effectively to patients, and incorporate these into their practice.

Both require critical appraisal but the purpose, context, and skills involved are different. Critical appraisal in research is more about evaluating research for validity and reliability whereas front-line usage in nursing is about effectively applying valid and reliable research findings to improve patient care.

How do you know if you're performing critical appraisals correctly?

Performing critical appraisals of research is not an exact science, and it often involves a high level of subjective judgment. However, there are some ways to determine whether or not you're doing it correctly.

Thorough Understanding: You've thoroughly read and understood the research, its aims, methodology, and conclusions. You should also be aware of the limitations or potential bias in the research.
Using a Framework or Checklist: Various frameworks exist for critically appraising research (including CASP’s own!). Using these can provide structure and make sure all key points are considered. By keeping a record of your appraisal you will be able to show your reasoning behind whether you’ve implemented a decision based on research.
Identifying Research Methods: Recognising the research design, methods used, sample size, and how data was collected and analysed are crucial in assessing the research's validity and reliability.
Checking Results and Conclusions: Check if the conclusions drawn from the research are justified by the results and data provided, and if any biases could have influenced these conclusions.
Relevance and applicability: Determine if the research's results and conclusions can be applied to other situations, particularly those relevant to your context or question.
Updating Skills: Continually updating your skills in research methods and statistical analysis will improve your confidence and ability in critically appraising research.

Finally, getting feedback from colleagues or mentors on your critical appraisals can also provide a good check on how well you're doing. They can provide an additional perspective and catch anything you might have missed. If possible, we would always recommend doing appraisals in small groups or pairs, working together is always helpful for another perspective, or if you can – join and take part in a journal club.

Ready to Learn more?

At CASP we offer a range of training courses and workshops which are perfect to help you learn more about critical appraisal, when and how to perform one, and the different approaches and methodologies.

Need more information?

If you have a general query about the Critical Appraisal Skills Programme, or would like to book on to a workshop please get in touch.

Get in touch

This email address is being protected from spambots. You need JavaScript enabled to view it.

Critical Appraisal Skills Programme

59 Lakeside
Oxford
OX2 8JQ