Critical appraisal of published literature

Affiliations.

  • 1 Department of Anaesthesia, Dharwad Institute of Mental Health and Neuro Sciences, Dharwad, Karnataka, India.
  • 2 Department of Anaesthesiology, Universal Hospital, Abu Dhabi, UAE.
  • 3 Department of Pulmonary Medicine, Kasturba Medical College, Manipal University, Manipal, Karnataka, India.
  • PMID: 27729695
  • PMCID: PMC5037949
  • DOI: 10.4103/0019-5049.190624

With a large output of medical literature coming out every year, it is impossible for readers to read every article. Critical appraisal of scientific literature is an important skill to be mastered not only by academic medical professionals but also by those involved in clinical practice. Before incorporating changes into the management of their patients, a thorough evaluation of the current or published literature is an important step in clinical practice. It is necessary for assessing the published literature for its scientific validity and generalizability to the specific patient community and reader's work environment. Simple steps have been provided by Consolidated Standard for Reporting Trial statements, Scottish Intercollegiate Guidelines Network and several other resources which if implemented may help the reader to avoid reading flawed literature and prevent the incorporation of biased or untrustworthy information into our practice.

Keywords: Allocation concealment; bias; conflict of interest; critical appraisal; randomisation; study design.

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  • About RCS England

critical appraisal of published literature

  • Dissecting the literature: the importance of critical appraisal

08 Dec 2017

Kirsty Morrison

This post was updated  in 2023.

Critical appraisal is the process of carefully and systematically examining research to judge its trustworthiness, and its value and relevance in a particular context.

Amanda Burls, What is Critical Appraisal?

Critical Appraisal 1

Why is critical appraisal needed?

Literature searches using databases like Medline or EMBASE often result in an overwhelming volume of results which can vary in quality. Similarly, those who browse medical literature for the purposes of CPD or in response to a clinical query will know that there are vast amounts of content available. Critical appraisal helps to reduce the burden and allow you to focus on articles that are relevant to the research question, and that can reliably support or refute its claims with high-quality evidence, or identify high-level research relevant to your practice.

Critical Appraisal 2

Critical appraisal allows us to:

  • reduce information overload by eliminating irrelevant or weak studies
  • identify the most relevant papers
  • distinguish evidence from opinion, assumptions, misreporting, and belief
  • assess the validity of the study
  • assess the usefulness and clinical applicability of the study
  • recognise any potential for bias.

Critical appraisal helps to separate what is significant from what is not. One way we use critical appraisal in the Library is to prioritise the most clinically relevant content for our Current Awareness Updates .

How to critically appraise a paper

There are some general rules to help you, including a range of checklists highlighted at the end of this blog. Some key questions to consider when critically appraising a paper:

  • Is the study question relevant to my field?
  • Does the study add anything new to the evidence in my field?
  • What type of research question is being asked? A well-developed research question usually identifies three components: the group or population of patients, the studied parameter (e.g. a therapy or clinical intervention) and outcomes of interest.
  • Was the study design appropriate for the research question? You can learn more about different study types and the hierarchy of evidence here .
  • Did the methodology address important potential sources of bias? Bias can be attributed to chance (e.g. random error) or to the study methods (systematic bias).
  • Was the study performed according to the original protocol? Deviations from the planned protocol can affect the validity or relevance of a study, e.g. a decrease in the studied population over the course of a randomised controlled trial .
  • Does the study test a stated hypothesis? Is there a clear statement of what the investigators expect the study to find which can be tested, and confirmed or refuted.
  • Were the statistical analyses performed correctly? The approach to dealing with missing data, and the statistical techniques that have been applied should be specified. Original data should be presented clearly so that readers can check the statistical accuracy of the paper.
  • Do the data justify the conclusions? Watch out for definite conclusions based on statistically insignificant results, generalised findings from a small sample size, and statistically significant associations being misinterpreted to imply a cause and effect.
  • Are there any conflicts of interest? Who has funded the study and can we trust their objectivity? Do the authors have any potential conflicts of interest, and have these been declared?

And an important consideration for surgeons:

  • Will the results help me manage my patients?

At the end of the appraisal process you should have a better appreciation of how strong the evidence is, and ultimately whether or not you should apply it to your patients.

Further resources:

  • How to Read a Paper by Trisha Greenhalgh
  • The Doctor’s Guide to Critical Appraisal by Narinder Kaur Gosall
  • CASP checklists
  • CEBM Critical Appraisal Tools
  • Critical Appraisal: a checklist
  • Critical Appraisal of a Journal Article (PDF)
  • Introduction to...Critical appraisal of literature
  • Reporting guidelines for the main study types

Kirsty Morrison, Information Specialist

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Critical appraisal of published research: introductory guidelines.

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Best Practice for Literature Searching

  • Literature Search Best Practice
  • What is literature searching?
  • What are literature reviews?
  • Hierarchies of evidence
  • 1. Managing references
  • 2. Defining your research question
  • 3. Where to search
  • 4. Search strategy
  • 5. Screening results
  • 6. Paper acquisition
  • 7. Critical appraisal
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Deciding what to include in your review through critical appraisal

Once you have narrowed down your pool of results, it's time to begin critically appraising your articles.  Using a checklist helps you scrutinise articles in a consistent, structured way.  

Questions to consider include: 

  • Are the aims of the study clearly stated?
  • Is the study design suitable for the aims?
  • Are the measurements and methods used clearly described?
  • Are the correct measurement tools used?
  • Are the statistical methods described?
  • Was the sample size adequate? 
  • Are the methods overall described in enough detail that you could replicate the study?
  • Does the discussion overall reflect the results?
  • Who funded this study?
  • What are the specific limitations of what can be concluded from the study?

Working through the questions will help you identify the strengths and weakness of each article, and also identify points to draw on when you write about the literature. 

  • DOWNLOAD THE CRITICAL APPRAISAL CHECKLIST

Additional critical appraisal checklists

critical appraisal of published literature

REFLECT provides a  checklist for evaluating randomized control trials in livestock and food safety. 

critical appraisal of published literature

CASP provides  checklists  for critical appraisal of studies related to health.

critical appraisal of published literature

JBI provides checklists for critical appraisal of studies related to health.

Documenting critical appraisal decisions

As you closely examine full articles, you will be making judgements about why to include  or exclude  each study from your review.  Documenting your reasoning will help you reassure yourself and demonstrate to others that you have been systematic and unbiased in your appr aisal decisions.

critical appraisal of published literature

Keeping track of what you have excluded, and why, will be very helpful if you must defend your work—for instance, if your literature review is part of a dissertation or thesis. 

critical appraisal of published literature

Pulling all the literature you will include in your review into a single chart is a good way to begin to synthesise the literature. 

  • DOWNLOAD THE FULL TEXT SCREENING CHART

Best practice!

BEST PRACTICE RECOMMENDATION :  If you include any direct quotes in your chart (or in any notes) be sure to use quotation marks so that you don’t later mistake the words for your own.

BEST PRACTICE RECOMMENDATION: The more carefully you record each of the steps of your process, the more easily reproducible it will be. This is especially important for research abstracts and articles found in conference proceedings.

  • << Previous: 6. Paper acquisition
  • Next: Further resources >>
  • Last Updated: Sep 15, 2023 2:17 PM
  • URL: https://ifis.libguides.com/literature_search_best_practice

Critical appraisal: how to evaluate research for use in clinical practice

Close up paper marketing research reports on table

Aleksandr Davydov / Alamy Stock Photo

After reading this article, you should be able to:

  • Appreciate the importance of critical appraisal skills;
  • Understand and apply principles of critical appraisal to support evidence-based practice;
  • Recognise the different types of studies found in research and their design;
  • Determine the quality, value and applicability of a research paper to clinical practice.

Not all data in healthcare research are of equal quality ​[1]​ . To incorporate evidence-based medicine (EBM) into practice, pharmacists must be able to assess the quality and reliability of evidence ​[2]​ . This requires the development of critical appraisal skills.

Critical appraisal

The critical appraisal of health-related literature by healthcare professionals is a multi-step process that requires ​[2]​ :

  • Formulation of a question that is important for improving patient health while advancing scientific and medical knowledge;
  • Searching the relevant literature to find the best available evidence;
  • Appraising research critically to evaluate quality and reliability, as well as applicability to the formulated question;
  • Applying the evidence to practice;
  • Monitoring the interventions to ensure the outcomes are reproducible and effective. 

Assessment and evaluation of publications can be daunting. However, this article aims to assist pharmacists when critically reviewing a research paper to support clinical decision making and evidence-based practice. 

This article focuses on the theory behind critical appraisal.

Types of studies in health research 

Cohort studies, case-control studies.

  • Cross-sectional studies
  • Randomised clinical trials

Systematic reviews

To undertake critical analysis, it is important to first understand the types of studies that are used to generate evidence, and how the data are analysed to provide standardised measurements of outcomes ​[3]​ . These can then be compared to evaluate whether an intervention is effective. A summary of the main research studies used in healthcare research, including their advantages and limitations, can be found in Table 1 .

The most common types of studies used to report healthcare research include:

These are observational studies that can either be retrospective (e.g examine historical records) or prospective. Here a group of people are selected for inclusion who do not have the outcome of interest (e.g. exploring the association between major depression and increased risk of advanced complications in type 2 diabetes) ​[4,5]​ . Over a period, they are observed to see if they develop the outcome of interest and, therefore, the relative risk can be determined when compared with a control group ​[6]​ . One of the biggest problems with cohort studies is the loss of participants (e.g. owing to personal reasons, or their condition not improving post-treatment). This can significantly affect the results and outcomes ​[7]​ . Most importantly, cohort studies are the best way to test a hypothesis, without experimental intervention ​[8]​ . 

A type of observational study and typically retrospective, where patients in a group with a particular outcome of interest are compared with another group that does not have the outcome, but the same degree of exposure as the test group ​[6,9]​ . Case-control studies determine the relative importance of a predictor variable in relation to the presence or absence of the disease ​[6,9]​ . An example of a case-control study is investigating the association of low serum vitamin D levels with migraine ​[10]​ .

Cross-sectional studies  

These studies commonly employ interviews, questionnaires and surveys to collect data ​[10]​ . Although not rigorous enough to assess and measure clinical and medical interventions, they can be used to determine attitudes of a cross-section of the population that is representative of the outcome of interest ​[11]​ . For example, one cross-sectional study aimed to identify the main competencies and training needs of primary care pharmacists to inform a National Health Service Executive training programme ​[11]​ .

Randomised clinical trials (RCT)

The most rigorous and robust research methods for determining whether a cause–effect relationship exists between a new treatment or intervention and its outcome ​[12]​ . Although no study alone is likely to prove causality, randomisation reduces bias and the studies are often blinded, so the clinicians, patients and researchers do not know whether patients are in the control or intervention groups ​[12,13]​ . RCTs are considered the gold standard in clinical research studies and are positioned at the top of the evidence pyramid ​[14]​ (see Figure).

Figure: Evidence pyramid, illustrating the increasing strength of evidence in research.

The greatest advantage of RCTs is the minimisation of bias providing strong clinical evidence, which is favoured by healthcare professionals; however, there are some limitations to this type of study ​[15]​ (see Table 1 ).

These studies are robust, thorough and comprehensive. They obtain a more accurate and evidence-based assessment of a research question ​[16,17]​ . By comparing a large body of data, from a wide range of sources from primary literature, the results are analysed collectively (e.g. meta-analysis) to assess for consistency and reproducibility ​[16,17]​ . Study inclusion is set by an explicit selection criterion and reviews are typically, although not always, quantitatively analysed for statistical significance ​[17]​ . Systematic reviews are useful to obtain current, updated information regarding contemporary topics in healthcare. For example, in one review on the safety and efficacy of COVID-19 vaccines, data from several RCTs were analysed and the results were compared to obtain a more justified argument for vaccine use. 

Other studies used to gather evidence in healthcare research include:

  • i) case studies and case series — focusing on individuals or a collection of cases that are of interest to the author, but does not involve trying to find the answer to a hypothesis;
  • ii) qualitative studies — well-suited for investigating the meanings, interpretations, social and cultural norms and perceptions that impact health-related practice and behaviour;
  • iii) diagnostic tests — investigate the accuracy of a diagnostic test; it is common to compare to a ‘gold standard’ and measure either the specificity or sensitivity ​[17–20]​ .

Steps to follow when reviewing an article

Once an article has been identified as relevant to the topic of interest, it is essential to first determine the quality of the study by assessing its appropriateness, including whether the study design was able to answer the hypothesis/research question. 

The following steps outline the main considerations when validating a study and are summarised in Table 2.

1. Determine whether the study addressed a clearly focused issue

The introduction of the article should clearly state the aims and objectives of the research being undertaken, and background information should be provided so the reader understands the reasons why this research is needed, and how the research findings will contribute to advancing clinical and scientific knowledge.

Most research studies will evaluate one of the following:

  • Therapy — efficacy of a drug treatment, surgical procedure or other intervention;
  • Causation — if a suspected risk factor is related to a particular disease;
  • Prognosis — outcome of a disease following treatment/diagnosis;
  • Diagnosis — the validity and reliability of a new diagnostic test;
  • Screening — test applied to a population to detect disease.

2. Identify the study population

Particular attention must be given to the selection criteria used for RCTs. Exclusion of groups of patient populations can lead to impaired generalisability of results and over-inflation of the outcomes of the study ​[29]​ . Women, children, older people and people with medical conditions are often excluded from these studies, so caution must be applied when interpreting the results ​[30]​ .

Crucial to the selection criteria is that all study participants share common aspects other than the variable being studied so comparisons can be made ​[23]​ . For observational studies, such as cohort and cross-sectional, the individuals selected should be an accurate representation of a defined population ​[31]​ .

3. Interpret the results

Assessing the appropriateness of statistical analysis can be tricky, but for evidence-based practice it is necessary to have a basic understanding of  statistics  since errors have been known to occur in published manuscripts ​[28]​ . The ‘method’ section of the paper should be clear about the rationale for the approach and how the outcomes and results were obtained. The language used should be understandable to the journal’s readership.

There are two main uses for statistics in research. These are to provide general observations and to allow comparisons or conclusions to be made ​[32,33]​ . A previous article from The Pharmaceutical Journal offers a basic introduction to statistics, providing a practical overview of differential/inferential statistics and significance testing. These will not be discussed in detail in this article.

4) Assess for bias 

Bias can occur at any stage within a research study, and the ability to identify bias is an important skill in critical appraisal because it can lead to inaccurate results. Bias is the systematic (non-random) error in design, conduct or analysis of a study resulting in mistaken estimates. Different study designs require different steps to reduce bias. Bias can occur because of the way populations are sampled, or the way in which data are collected or analysed. Unlike random error, increasing the sample size will not decrease systematic bias ​[31]​ .

There are many types of bias, but they can be considered under three main categories:

  • Selection bias is when the composition of the study subjects or participants in a research project systematically differs from the source population. A simple example would be during recruitment of participants for an influenza vaccine trial, where the participants are healthy adults. However, the sample population is not representative of a cross-section of the general population — missing out children, older people and adults with comorbidities; 
  • Information bias , or ‘misclassification’, occurs when outcomes, exposures of interest (factors measured) or other data are incorrectly classified or measured. This is particularly problematic in observational studies (cross-sectional, case or cohort studies) where data are gathered using questionnaires, surveys and interviews. The method of data collection is argued as unreliable; 
  • Confounding is often referred to as a ‘mixing of effects’, where the effects of the exposure under study on a given outcome are mixed in with the effects of an additional factor (or set of factors), resulting in a distortion of the true relationship. Confounding factors may mask an actual association or, more commonly, falsely demonstrate an apparent association between the treatment and outcome when no real association between them exists ​[34]​ . For example, alcohol intake has been identified as a cause of increased coronary heart disease ​[35]​ . However, there are many confounding factors that ‘blur’ the facts, such as differences in socio-economic and lifestyle characteristics, the type of drink consumed (beer, wine), and the fact that smokers are more likely to drink alcohol than non-smokers. These factors will confound the observed relationship between the amount of alcohol consumed and risk ​[36]​ . 

5) Determine whether the study can be applied to practice

Pharmacy professionals can determine the applicability of study results to clinical practice by:

  • Comparing research results to relevant guidelines (e.g. National Institute for Health and Care Excellence );
  • Identifying whether local or national clinical policies exist that are supported by EBM;
  • Discussing recommendations and the applicability of research findings with colleagues and peers;
  • Summarising and critically appraising the various interventions studied in relevant clinical trials and studies; 
  • Evaluating the cost-effectiveness of the interventions ​[37]​ .

Critical appraisal skills are necessary to extract the most relevant and useful information from published literature and it is the duty of all healthcare professionals to keep up to date with current research to identify gaps in knowledge and to ensure optimal patient outcomes. It is also particularly beneficial for pharmacists, as demand for such skills increases with the rise in opportunities to deliver advanced clinical services.

Additional resources — critical appraisal tools

Several user-friendly tools are available to assist individuals with developing critical appraisal skills. Table 3 summarises a selection of useful websites that provide checklists and guidance on critical appraisal skills.

  • 1 Simera I, Moher D, Hoey J, et al. A catalogue of reporting guidelines for health research. European Journal of Clinical Investigation 2010; 40 :35–53. doi: 10.1111/j.1365-2362.2009.02234.x
  • 2 Umesh G, Karippacheril J, Magazine R. Critical appraisal of published literature. Indian J Anaesth 2016; 60 :670–3. doi: 10.4103/0019-5049.190624
  • 3 Peinemann F, Tushabe D, Kleijnen J. Using multiple types of studies in systematic reviews of health care interventions–a systematic review. PLoS One 2013; 8 :e85035. doi: 10.1371/journal.pone.0085035
  • 4 Song J, Chung K. Observational studies: cohort and case-control studies. Plast Reconstr Surg 2010; 126 :2234–42. doi: 10.1097/PRS.0b013e3181f44abc
  • 5 Lin EHB, Rutter CM, Katon W, et al. Depression and Advanced Complications of Diabetes: A prospective cohort study. Diabetes Care 2009; 33 :264–9. doi: 10.2337/dc09-1068
  • 6 Mann C. Observational research methods. Research design II: cohort, cross sectional, and case-control studies. Emerg Med J [Internet] 2003; 20 :54–60. http://emj.bmj.com/content/20/1/54.abstract
  • 7 Fogel D. Factors associated with clinical trials that fail and opportunities for improving the likelihood of success: A review. Contemp Clin Trials Commun 2018; 11 :156–64. doi: 10.1016/j.conctc.2018.08.001
  • 8 Morrow B. An overview of cohort study designs and their advantages and disadvantages. International Journal of Therapy and Rehabilitation 2010; 17 :518–23. doi: 10.12968/ijtr.2010.17.10.78810
  • 9 Lu C. Observational studies: a review of study designs, challenges and strategies to reduce confounding. Int J Clin Pract 2009; 63 :691–7. doi: 10.1111/j.1742-1241.2009.02056.x
  • 10 Levin KA. Study design III: Cross-sectional studies. Evid Based Dent 2006; 7 :24–5. doi: 10.1038/sj.ebd.6400375
  • 11 Jesson J. Cross-sectional studies in prescribing research. J Clin Pharm Ther 2001; 26 :397–403. doi: 10.1046/j.1365-2710.2001.00373.x
  • 12 Bhide A, Shah PS, Acharya G. A simplified guide to randomized controlled trials. Acta Obstet Gynecol Scand 2018; 97 :380–7. doi: 10.1111/aogs.13309
  • 13 Hariton E, Locascio JJ. Randomised controlled trials – the gold standard for effectiveness research. BJOG: Int J Obstet Gy 2018; 125 :1716–1716. doi: 10.1111/1471-0528.15199
  • 14 Mulimani PS. Evidence-based practice and the evidence pyramid: A 21st century orthodontic odyssey. American Journal of Orthodontics and Dentofacial Orthopedics 2017; 152 :1–8. doi: 10.1016/j.ajodo.2017.03.020
  • 15 Deaton A, Cartwright N. Understanding and misunderstanding randomized controlled trials. Social Science & Medicine 2018; 210 :2–21. doi: 10.1016/j.socscimed.2017.12.005
  • 16 Chandler J, Hopewell S. Cochrane methods – twenty years experience in developing systematic review methods. Syst Rev 2013; 2 . doi: 10.1186/2046-4053-2-76
  • 17 Murad MH, Sultan S, Haffar S, et al. Methodological quality and synthesis of case series and case reports. BMJ EBM 2018; 23 :60–3. doi: 10.1136/bmjebm-2017-110853
  • 18 Munn Z, Barker TH, Moola S, et al. Methodological quality of case series studies: an introduction to the JBI critical appraisal tool. JBI Evidence Synthesis 2019; 18 :2127–33. doi: 10.11124/jbisrir-d-19-00099
  • 19 Daly J, Willis K, Small R, et al. A hierarchy of evidence for assessing qualitative health research. Journal of Clinical Epidemiology 2007; 60 :43–9. doi: 10.1016/j.jclinepi.2006.03.014
  • 20 Gluud C, Gluud LL. Evidence based diagnostics. BMJ 2005; 330 :724–6. doi: 10.1136/bmj.330.7493.724
  • 21 Rochon PA, Gurwitz JH, Sykora K, et al. Reader’s guide to critical appraisal of cohort studies: 1. Role and design. BMJ 2005; 330 :895–7. doi: 10.1136/bmj.330.7496.895
  • 22 Mamdani M, Sykora K, Li P, et al. Reader’s guide to critical appraisal of cohort studies: 2. Assessing potential for confounding. BMJ 2005; 330 :960–2. doi: 10.1136/bmj.330.7497.960
  • 23 Young JM, Solomon MJ. How to critically appraise an article. Nat Rev Gastroenterol Hepatol 2009; 6 :82–91. doi: 10.1038/ncpgasthep1331
  • 24 Sutton-Tyrrell K. Assessing bias in case-control studies. Proper selection of cases and controls. Stroke 1991; 22 :938–42. doi: 10.1161/01.str.22.7.938
  • 25 Sedgwick P. Bias in observational study designs: cross sectional studies. BMJ 2015; 350 :h1286–h1286. doi: 10.1136/bmj.h1286
  • 26 Pannucci CJ, Wilkins EG. Identifying and Avoiding Bias in Research. Plastic and Reconstructive Surgery 2010; 126 :619–25. doi: 10.1097/prs.0b013e3181de24bc
  • 27 Siedlecki SL. Understanding Descriptive Research Designs and Methods. Clin Nurse Spec 2020; 34 :8–12. doi: 10.1097/nur.0000000000000493
  • 28 Mulrow CD. Systematic Reviews: Rationale for systematic reviews. BMJ 1994; 309 :597–9. doi: 10.1136/bmj.309.6954.597
  • 29 Littlewood C. The RCT means nothing to me! Manual Therapy 2011; 16 :614–7. doi: 10.1016/j.math.2011.06.006
  • 30 Van Spall HGC, Toren A, Kiss A, et al. Eligibility Criteria of Randomized Controlled Trials Published in High-Impact General Medical Journals. JAMA 2007; 297 :1233. doi: 10.1001/jama.297.11.1233
  • 31 Pinchbeck GL, Archer DC. How to critically appraise a paper. Equine Vet Educ 2018; 32 :104–9. doi: 10.1111/eve.12896
  • 32 Greenhalgh T. How to read a paper: Statistics for the non-statistician. I: Different types of data need different statistical tests. BMJ 1997; 315 :364–6. doi: 10.1136/bmj.315.7104.364
  • 33 Greenhalgh T. How to read a paper: Statistics for the non-statistician. II: ‘Significant’ relations and their pitfalls. BMJ 1997; 315 :422–5. doi: 10.1136/bmj.315.7105.422
  • 34 Skelly A, Dettori J, Brodt E. Assessing bias: the importance of considering confounding. Evidence-Based Spine-Care Journal 2012; 3 :9–12. doi: 10.1055/s-0031-1298595
  • 35 Emberson JR, Bennett DA. Effect of alcohol on risk of coronary heart disease and stroke: causality, bias, or a bit of both? Vascular Health and Risk Management 2006; 2 :239–49. doi: 10.2147/vhrm.2006.2.3.239
  • 36 Corrao G, Rubbiati L, Bagnardi V, et al. Alcohol and coronary heart disease: a meta-analysis. Addiction 2000; 95 :1505–23. doi: 10.1046/j.1360-0443.2000.951015056.x
  • 37 Lewis SJ, Orland BI. The Importance and Impact of Evidence Based medicine. JMCP 2004; 10 :S3–5. doi: 10.18553/jmcp.2004.10.s5-a.s3

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  • Published: 08 April 2022

How to appraise the literature: basic principles for the busy clinician - part 1: randomised controlled trials

  • Aslam Alkadhimi 1 ,
  • Samuel Reeves 2 &
  • Andrew T. DiBiase 3  

British Dental Journal volume  232 ,  pages 475–481 ( 2022 ) Cite this article

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Critical appraisal is the process of carefully, judiciously and systematically examining research to adjudicate its trustworthiness and its value and relevance in clinical practice. The first part of this two-part series will discuss the principles of critically appraising randomised controlled trials. The second part will discuss the principles of critically appraising systematic reviews and meta-analyses.

Evidence-based dentistry (EBD) is the integration of the dentist's clinical expertise, the patient's needs and preferences and the most current, clinically relevant evidence. Critical appraisal of the literature is an invaluable and indispensable skill that dentists should possess to help them deliver EBD.

This article seeks to act as a refresher and guide for generalists, specialists and the wider readership, so that they can efficiently and confidently appraise research - specifically, randomised controlled trials - that may be pertinent to their daily clinical practice.

Evidence-based dentistry is discussed.

Efficient techniques for critically appraising randomised controlled trials are described.

Important methodological and statistical considerations are explicated.

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critical appraisal of published literature

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Isham A, Bettiol S, Hoang H, Crocombe L. A Systematic Literature Review of the Information-Seeking Behaviour of Dentists in Developed Countries. J Dent Educ 2016; 80: 569-577.

Critical Appraisal Skills Programme. CASP Checklist. Available at https://casp-uk.net/wp-content/uploads/2018/01/CASP-Randomised-Controlled-Trial-Checklist-2018.pdf (accessed April 2021).

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Aslam Alkadhimi contributed to conceptualisation, literature search, original draft preparation and drafting and critically revising the manuscript; Samuel Reeves contributed to original draft preparation and editing; and Andrew DiBiase contributed to supervision, draft editing and critically revising the manuscript.

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Alkadhimi, A., Reeves, S. & DiBiase, A. How to appraise the literature: basic principles for the busy clinician - part 1: randomised controlled trials. Br Dent J 232 , 475–481 (2022). https://doi.org/10.1038/s41415-022-4096-y

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Research output : Contribution to journal › Review article › peer-review

With a large output of medical literature coming out every year, it is impossible for readers to read every article. Critical appraisal of scientific literature is an important skill to be mastered not only by academic medical professionals but also by those involved in clinical practice. Before incorporating changes into the management of their patients, a thorough evaluation of the current or published literature is an important step in clinical practice. It is necessary for assessing the published literature for its scientific validity and generalizability to the specific patient community and reader’swork environment. Simple steps have been provided by Consolidated Standard for Reporting Trial statements, Scottish Intercollegiate Guidelines Network and several other resources which if implemented may help the reader to avoid reading flawed literature and prevent the incorporation of biased or untrustworthy information into our practice.

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  • Anesthesiology and Pain Medicine

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  • patients INIS 100%
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N2 - With a large output of medical literature coming out every year, it is impossible for readers to read every article. Critical appraisal of scientific literature is an important skill to be mastered not only by academic medical professionals but also by those involved in clinical practice. Before incorporating changes into the management of their patients, a thorough evaluation of the current or published literature is an important step in clinical practice. It is necessary for assessing the published literature for its scientific validity and generalizability to the specific patient community and reader’swork environment. Simple steps have been provided by Consolidated Standard for Reporting Trial statements, Scottish Intercollegiate Guidelines Network and several other resources which if implemented may help the reader to avoid reading flawed literature and prevent the incorporation of biased or untrustworthy information into our practice.

AB - With a large output of medical literature coming out every year, it is impossible for readers to read every article. Critical appraisal of scientific literature is an important skill to be mastered not only by academic medical professionals but also by those involved in clinical practice. Before incorporating changes into the management of their patients, a thorough evaluation of the current or published literature is an important step in clinical practice. It is necessary for assessing the published literature for its scientific validity and generalizability to the specific patient community and reader’swork environment. Simple steps have been provided by Consolidated Standard for Reporting Trial statements, Scottish Intercollegiate Guidelines Network and several other resources which if implemented may help the reader to avoid reading flawed literature and prevent the incorporation of biased or untrustworthy information into our practice.

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JO - Indian Journal of Anaesthesia

JF - Indian Journal of Anaesthesia

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Literature Reviews

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Types of reviews and examples

Choosing a review type.

  • 1. Define your research question
  • 2. Plan your search
  • 3. Search the literature
  • 4. Organize your results
  • 5. Synthesize your findings
  • 6. Write the review
  • Thompson Writing Studio This link opens in a new window
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critical appraisal of published literature

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Overview of types of literature reviews

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  • Literature (narrative)
  • Scoping / Evidence map
  • Meta-analysis

Characteristics:

  • Provides examination of recent or current literature on a wide range of subjects
  • Varying levels of completeness / comprehensiveness, non-standardized methodology
  • May or may not include comprehensive searching, quality assessment or critical appraisal

Mitchell, L. E., & Zajchowski, C. A. (2022). The history of air quality in Utah: A narrative review.  Sustainability ,  14 (15), 9653.  doi.org/10.3390/su14159653

  • Assessment of what is already known about an issue
  • Similar to a systematic review but within a time-constrained setting
  • Typically employs methodological shortcuts, increasing risk of introducing bias, includes basic level of quality assessment
  • Best suited for issues needing quick decisions and solutions (i.e., policy recommendations)

Learn more about the method:

Khangura, S., Konnyu, K., Cushman, R., Grimshaw, J., & Moher, D. (2012). Evidence summaries: the evolution of a rapid review approach.  Systematic reviews, 1 (1), 1-9.  https://doi.org/10.1186/2046-4053-1-10

Virginia Commonwealth University Libraries. (2021). Rapid Review Protocol .

Quarmby, S., Santos, G., & Mathias, M. (2019). Air quality strategies and technologies: A rapid review of the international evidence.  Sustainability, 11 (10), 2757.  https://doi.org/10.3390/su11102757

  • Compiles evidence from multiple reviews into one document
  • Often defines a broader question than is typical of a traditional systematic review.

Choi, G. J., & Kang, H. (2022). The umbrella review: a useful strategy in the rain of evidence.  The Korean Journal of Pain ,  35 (2), 127–128.  https://doi.org/10.3344/kjp.2022.35.2.127

Aromataris, E., Fernandez, R., Godfrey, C. M., Holly, C., Khalil, H., & Tungpunkom, P. (2015). Summarizing systematic reviews: Methodological development, conduct and reporting of an umbrella review approach. International Journal of Evidence-Based Healthcare , 13(3), 132–140. https://doi.org/10.1097/XEB.0000000000000055

Rojas-Rueda, D., Morales-Zamora, E., Alsufyani, W. A., Herbst, C. H., Al Balawi, S. M., Alsukait, R., & Alomran, M. (2021). Environmental risk factors and health: An umbrella review of meta-analyses.  International Journal of Environmental Research and Public Dealth ,  18 (2), 704.  https://doi.org/10.3390/ijerph18020704

  • Main purpose is to map out and categorize existing literature, identify gaps in literature
  • Search comprehensiveness determined by time/scope constraints, could take longer than a systematic review
  • No formal quality assessment or critical appraisal

Learn more about the methods :

Arksey, H., & O'Malley, L. (2005) Scoping studies: towards a methodological framework.  International Journal of Social Research Methodology ,  8 (1), 19-32.  https://doi.org/10.1080/1364557032000119616

Levac, D., Colquhoun, H., & O’Brien, K. K. (2010). Scoping studies: Advancing the methodology. Implementation Science: IS, 5, 69. https://doi.org/10.1186/1748-5908-5-69

Miake-Lye, I. M., Hempel, S., Shanman, R., & Shekelle, P. G. (2016). What is an evidence map? A systematic review of published evidence maps and their definitions, methods, and products.  Systematic reviews, 5 (1), 1-21.  https://doi.org/10.1186/s13643-016-0204-x

Example : 

Rahman, A., Sarkar, A., Yadav, O. P., Achari, G., & Slobodnik, J. (2021). Potential human health risks due to environmental exposure to nano-and microplastics and knowledge gaps: A scoping review.  Science of the Total Environment, 757 , 143872.  https://doi.org/10.1016/j.scitotenv.2020.143872

  • Seeks to systematically search for, appraise, and synthesize research evidence
  • Adheres to strict guidelines, protocols, and frameworks
  • Time-intensive and often take months to a year or more to complete. 
  • The most commonly referred to type of evidence synthesis. Sometimes confused as a blanket term for other types of reviews.

Gascon, M., Triguero-Mas, M., Martínez, D., Dadvand, P., Forns, J., Plasència, A., & Nieuwenhuijsen, M. J. (2015). Mental health benefits of long-term exposure to residential green and blue spaces: a systematic review.  International Journal of Environmental Research and Public Health ,  12 (4), 4354–4379.  https://doi.org/10.3390/ijerph120404354

  • Statistical technique for combining results of quantitative studies to provide more precise effect of results
  • Aims for exhaustive, comprehensive searching
  • Quality assessment may determine inclusion/exclusion criteria
  • May be conducted independently or as part of a systematic review

Berman, N. G., & Parker, R. A. (2002). Meta-analysis: Neither quick nor easy. BMC Medical Research Methodology , 2(1), 10. https://doi.org/10.1186/1471-2288-2-10

Hites R. A. (2004). Polybrominated diphenyl ethers in the environment and in people: a meta-analysis of concentrations.  Environmental Science & Technology ,  38 (4), 945–956.  https://doi.org/10.1021/es035082g

Flowchart of review types

  • Review Decision Tree - Cornell University For more information, check out Cornell's review methodology decision tree.
  • LitR-Ex.com - Eight literature review methodologies Learn more about 8 different review types (incl. Systematic Reviews and Scoping Reviews) with practical tips about strengths and weaknesses of different methods.
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Critical appraisal of published research: introductory guidelines.

Full text is available as a scanned copy of the original print version. Get a printable copy (PDF file) of the complete article (1.0M), or click on a page image below to browse page by page. Links to PubMed are also available for Selected References .

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Selected References

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COMMENTS

  1. Critical appraisal of published literature

    Critical appraisal of literature may help distinguish between useful and flawed studies. Although substantial resources of peer-reviewed literature are available, flawed studies may abound in unreliable sources. Flawed studies if used to guide clinical decisions may end up with no benefit or at worse result in significant harm.

  2. Critical appraisal of published literature

    Critical appraisal of published literature doi: 10.4103/0019-5049.190624. Authors Goneppanavar Umesh 1 , John George Karippacheril 2 , Rahul Magazine 3 Affiliations 1 Department of Anaesthesia, Dharwad Institute of Mental Health and Neuro Sciences, Dharwad, Karnataka, India. 2 Department of Anaesthesiology, Universal Hospital, Abu Dhabi, UAE.

  3. 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."

  4. Full article: Critical appraisal

    Critical appraisal David Tod , Andrew Booth & Brett Smith Pages 52-72 | Received 20 Feb 2021, Accepted 30 Jun 2021, Published online: 12 Jul 2021 Cite this article https://doi.org/10.1080/1750984X.2021.1952471 In this article Full Article Figures & data References Citations Metrics Licensing Reprints & Permissions View PDF View EPUB

  5. What is critical appraisal?

    In the context of a literature search, critical appraisal is the process of systematically evaluating and assessing the research you have found in order to determine its quality and validity. It is essential to evidence-based practice.

  6. 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.

  7. 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.

  8. (PDF) How to critically appraise an article

    Critical appraisal is a systematic process used to identify the strengths and weaknesses of a research article in order to assess the usefulness and validity of research findings.

  9. Dissecting the literature: the importance of critical appraisal

    Critical appraisal allows us to: reduce information overload by eliminating irrelevant or weak studies. identify the most relevant papers. distinguish evidence from opinion, assumptions, misreporting, and belief. assess the validity of the study. assess the usefulness and clinical applicability of the study. recognise any potential for bias.

  10. The importance of critical appraisal

    View it here and find related resources. Critical appraisal of research papers is a component of everyday academic life, whether as a student as part of an assignment, as a researcher as part of a literature review or as a teacher preparing a lecture. For health care professionals it is also a component of evidence-based practice - assessing ...

  11. Writing a literature review

    A formal literature review is an evidence-based, in-depth analysis of a subject. There are many reasons for writing one and these will influence the length and style of your review, but in essence a literature review is a critical appraisal of the current collective knowledge on a subject. Rather than just being an exhaustive list of all that ...

  12. Critical appraisal of published research: introductory guidelines

    You are going to email the following Critical appraisal of published research: introductory guidelines. Your Personal Message . CAPTCHA . This question is for testing whether or not you are a human visitor and to prevent automated spam submissions. Topics ...

  13. 7. Critical appraisal

    Documenting your reasoning will help you reassure yourself and demonstrate to others that you have been systematic and unbiased in your appraisal decisions. Keeping track of what you have excluded, and why, will be very helpful if you must defend your work—for instance, if your literature review is part of a dissertation or thesis.

  14. Critical appraisal: how to evaluate research for use in clinical

    Critical appraisal skills are necessary to extract the most relevant and useful information from published literature and it is the duty of all healthcare professionals to keep up to date with current research to identify gaps in knowledge and to ensure optimal patient outcomes.

  15. (PDF) Critical appraisal of published literature

    Critical appraisal of published literature Authors: Umesh Goneppanavar Dharwad Institute of Mental Health and Neurosciences John George Karippacheril Manipal Academy of Higher Education Rahul...

  16. Critical appraisal of published literature : Indian Journal of Anaesthesia

    Critical appraisal of scientific literature is an important skill to be mastered not only by academic medical professionals but also by those involved in clinical practice. Before incorporating changes into the management of their patients, a thorough evaluation of the current or published literature is an important step in clinical practice.

  17. 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;

  18. How to appraise the literature: basic principles for the busy clinician

    1 Citations 2 Altmetric Metrics Abstract Critical appraisal is the process of carefully, judiciously and systematically examining research to adjudicate its trustworthiness and its value and...

  19. Critical review and appraisal of published clinical literature: Useful

    Critical review of published literature may be necessary during several stages of biotechnology product development. The reviewer should develop a standardized method for reviewing and comparing published papers on a given topic and should be aware of common errors found in published papers.

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    Critical appraisal of scientific literature is an important skill to be mastered not only by academic medical professionals but also by those involved in clinical practice. ... {Critical appraisal of published literature}, author={Goneppanavar Umesh and John George Karippacheril and Rahul Magazine}, journal={Indian Journal of Anaesthesia}, year ...

  21. Critical appraisal of the literature. Why do we care?

    Critical appraisal is the systematic evaluation of clinical research papers that helps us establish if the results are valid and if they could be used to inform medical decision in a given local population and context. There are several published guidelines for critically appraising the scientific literature, most of which are structured as ...

  22. Critical appraisal of published literature

    Critical appraisal of scientific literature is an important skill to be mastered not only by academic medical professionals but also by those involved in clinical practice. Before incorporating changes into the management of their patients, a thorough evaluation of the current or published literature is an important step in clinical practice.

  23. Types of reviews

    Provides examination of recent or current literature on a wide range of subjects; Varying levels of completeness / comprehensiveness, non-standardized methodology; May or may not include comprehensive searching, quality assessment or critical appraisal; Example: Mitchell, L. E., & Zajchowski, C. A. (2022).

  24. Critical appraisal of published research: introductory guidelines

    Critical appraisal of published research: introductory guidelines. - PMC Journal List BMJ v.302 (6785); 1991 May 11 PMC1669795 As a library, NLM provides access to scientific literature. Inclusion in an NLM database does not imply endorsement of, or agreement with, the contents by NLM or the National Institutes of Health.