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OCC311 - Completing a critical appraisal

A presentation for student in OCC311 at USC - explaining the process of completing a critical appraisal.

Anita Hamilton

on 13 March 2016

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Transcript of OCC311 - Completing a critical appraisal

OCC311 Completing a critical appraisal
What is a critical appraisal?
Critical appraisal is the process of systematically examining
research evidence to assess its validity, results and relevance
before using it to inform a decision.

●Critical appraisal is an essential part of evidence-based
clinical practice that includes the process of systematically
finding, appraising and acting on evidence of effectiveness.

Critical appraisal allows us to make sense of research evidence and thus begins to close the gap between research and practice.
How are critical appraisals used?
Critical appraisals enable you to assess the trustworthiness, relevance and results of published papers so that you can decide if they are believable and useful for your practice.
How is a critical appraisal completed?
Construct an answerable question using PICO
Writing up
A critical appraisal paper will contain
Clear topic/question
Relevant to occupational therapy practice with adults
Description of how the topic was researched
Explanation about how the research articles were selected
Demonstration of knowledge obtained from a formal critique of each paper
Synthesis of information about the topic overall and the papers critiqued
A response to the topic/question
Critical Appraisal of an
Intervention Approach

What is a critical appraisal?
How are critical appraisals used?
How is a critical appraisal completed?

Q: Do I have to show that the intervention is effective?
A: The intention of a critical appraisal is to examine the current level of knowledge about a particular topic and report the evidence objectively.
Plan a search for best evidence
What are "levels" of research?
“An evidence-based clinical information system integrates and concisely summarizes all relevant and important research evidence about a clinical problem, is updated as new research evidence becomes available, and automatically links (through an electronic medical record) a specific patient’s circumstances to the relevant information."

"These include clinical pathways or textbook summaries that integrate evidence-based information about specific clinical problems and provide regular updating."

Synthesis - Systematic review:
"A synthesis or systematic review is a comprehensive summary of all the research evidence related to a focused clinical question."

“...a synopsis that summarizes the findings of a high-quality systematic review can often provide sufficient information to support clinical action... the synopsis of a single study provides a brief, but often sufficiently detailed, summary of a high-quality study that can inform clinical practice."
Single studies:
Individual studies conducted and then published in journals, government reports and websites.

Critically appraise the evidence selected
Select the best papers to respond to your topic/question
Construct a question using PICO
What is a brief description of the population I am interested in?
e.g. Adults with RA who have associated joint pain and deformity.
What is the intervention that I am considering?
e.g. Education program
What is an alternative intervention I am comparing?
e.g. No comparison
What is the outcome I am trying to achieve with this intervention?
e.g. Improved joint protection to reduce deformity and pain
Prepared by Anita Hamilton
See: http://www.casp-uk.net/#!criticalappraisal/c1tsl
The following online videos are great resources that can help you before you define your question or start your search:

Plan a search for best evidence
Critically appraise the selected evidence
Create a set of criteria that will help you select the best evidence to include in your paper. Include this information in your paper.
Based on your topic/question
identify search terms

Watch this video to see an example of a search: http://www.healthknowledge.org.uk/interactive-learning/fae/finding-the-evidence/sample-searches
Creating a table that outlines your search makes it easy to track your search and report on it later
Carry out a search for best evidence
Carry out a search for best evidence
Databases that have literature relevant to occupational therapy

Note: using an asterisk* denotes that the word can be completed multiple ways e.g. deform, deformed or deformity
See: http://plus.mcmaster.ca/macplusfs/Default.aspx?Page=1

Select the best papers to respond to your topic/question
If your search yields a large number of articles:
Reduce the number of papers using limits or inclusion/exclusion criteria
If your search yields a low number of articles:
Widen your search terms and try again.

Document each search, yield, number excluded, number included
Cochrane Database
Document each search occasion and outcomes
Selecting the best evidence to critique
Examples of criteria: Relevance to your PICO, language of article, date of publication, location of research, level of research.
Some examples of different ways of categorising "levels of research" in quantitative research
Further Resources
Evidence-based Practice in Health Sciences:
Trisha Greenhalgh's papers are very helpful:
e.g. Greenhalgh, T. (1997). How to read a paper: Assessing the methodological quality of published papers BMJ (315), 305-308.
A range of critical appraisal tools exist for reviewing both qualitative research and quantitative research.
Qualitative research
e.g. Letts et al. (2007) http://www.srs-mcmaster.ca/Portals/20/pdf/ebp/qualguidelines_version2.0.pdf
& http://www.srs-mcmaster.ca/Portals/20/pdf/ebp/qualreview_version2.0.pdf
Quantitative research
e.g. Law et al. (1998) http://www.srs-mcmaster.ca/Portals/20/pdf/ebp/quanguidelines.pdf
& http://tinyurl.com/quanreviewform

Note that "levels of evidence" do NOT APPLY to evaluating qualitative research
The NHS Critical Appraisal Skills Program CASP has very similar tools and is and excellent resource:
Summarise the process and the findings in a paper
Frequently Asked Questions
Q: I am not an experienced researcher, so how do I know if the research process was appropriate?
A: Review research methods and support your statements by citing experts (e.g. using a research text book or an article about the specific research method)
Q: There appears to be bias in the research process or the reporting of the research outcomes, what do I do?
A: Identify and report the types of bias you have detected and back up your statement(s) with evidence that you understand what type of bias it is and how bias might impact the findings.
Further resources shared by OCC311 students
Use this space to add to this resource for your colleagues!
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Q: What if I need to review a mixed methods research paper (i.e. Qual & Quant)?
A: Tools to evaluate mixed methods studies exist too! e.g. http://usir.salford.ac.uk/13070/1/Evaluative_Tool_for_Mixed_Method_Studies.pdf
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