Teresa Burgess Department of General Practice

1. Teresa BurgessDepartment of General Practice An Introduction to Critical Appraisal

2. Critical Appraisal “Forays into the library can be exhausting, as the reader is overwhelmed by the papers on offer” (1)

3. What is critical appraisal? All critical appraisal means is being able to look at a piece of research in a very objective and structured way in order to decide how valid it is compared to other research (2) It provides you with skills to help you interpret research and make decisions about the quality of an information source .

4. What is critical appraisal? There are two elements in critical appraisal: • A general skill for everyday academic work • A more comprehensive and in depth skill to assist in the implementation of Evidence Based Practice .

5. Critical Appraisal • Much of Critical Appraisal is common sense! What sort of questions might we ask ourselves about the research to decide if we think this is useful research? • If we are going to buy a car - do you just read the brochure from the car manufacturer?

6. Abstract Information BOOK/ DATABASE INFORMATION: Author Date Edition Journal Publisher Written description .

7. Content Information BOOKS/JOURNALS Intended Audience Objective reasoning Coverage Results Implications Writing Style .

8. Critically Appraising Literature Imagine you have read in the newspaper about this amazing new program which has a 95% success rate in helping participants to give up smoking. It involves a mixture of behaviour modification, support and a wonderful new drug and you wonder whether you should introduce it into your area. You do a quick literature search and find an article that describes the research. What questions might you ask about this paper?

9. Critically Appraising Literature 1. Who wrote the paper? 2. Did they come from what seems like a reputable research organisation? (university, health service, CSIRO) 3. Who funded the research? (eg was it the drug company that had developed the wonderful new drug?) 4. If it was, what does this mean? 5. How many people were involved in the research? 6. What country did they come from? Can this context be transferred to the Australian context? 7. Has there been any other research in this area? 8. Is one study enough for you to commit resources?

10. Critically Appraising Internet Resources • Internet sources very timely and useful • Evaluating Internet sources is particularly difficult because anyone can put up anything he or she wants to on the Internet. • This is particularly so in the area of grief and bereavment • Internet information should not be your sole source of information.

11. Critically Appraising Internet Resources • Authorship • Accuracy of information • What is the purpose of the site • Access • Include the date you accessed the material since it can be changed or updated later on

12. Critical Appraisal and Evidence Based Practice • What is evidence based practice? “Evidence based practice is a systematic process for using research findings to improve practice”(3) • How does critical appraisal link to evidence base practice?

13. Critical Appraisal and Evidence Based Practice • Critical Appraisal is a technique that increases the effectiveness of your reading by enabling you to exclude research studies that are too poorly designed to inform practice (4) • Appraising the paper for the things discussed above, tells us whether the research is useful and appropriate for the purposes we are looking at it for. If however, we want to use the paper as “evidence” - ie to say that what we are going to do has strong research supporting it, we need to be able to assess the validity of the research which has been done.

14. Critical Appraisal Questions The questions we need to ask then are: • Were the participants in this research appropriate? • Were there enough of them? • Did they use the right methods to answer their questions? • Did they analyse their data correctly? • Did they draw the correct conclusions from their data? • What were the results of the intervention? .

15. Critical Appraisal and Evidence Based Practice In some areas, the critical appraisal has already been done for us. The Cochrane Collaboration has been established for medical research and uses data from many studies analysed together (meta analysis) and systematic reviews. A systematic review is where a group of researchers: • identify all the research related to a particular review • assess the value of that research • look at what all the results put together mean and if possible reach a conclusion.

16. Critical Appraisal and Evidence Based Practice • Unfortunately, there’s not a lot of evidence in the area of Grief and Bereavement (compared to the more concrete and clinical areas - eg smoking, cervical smears, cancer etc) • There is one very recent excellent example of a systematic review in your area.

17. References 1. Crombie, I. A Pocket Guide to Critical Appraisal. London:BMJ 2 Harper, J. Critical Appraisal Resources for assessing Health and Medical Research http://library.kent.ac.uk/library/info/subjectg/healthinfo/critapprais.htm. 3. AORN. 2002 Evidence-based Practice FAQs. http://www.aorn.org/research/ebpfaqs.htm 4. Say, L. From research to practice: Postgraduate training in reproductive health/chronic disease. http://www.gfmer.ch/Endo/Course2003/PDF/Critical_appraisal.pdf Useful Resources: Olin and Uris Libraries. Cornell University http://library.cornell.edu/olinuris/ref/research/skill28.htm Owl Online Writing Lab. Purdue Universiyt. http://owl.english.purdue.edu/handouts/print/research/r_evalsource.html What Is Critical Appraisal? www.evidence-based-medicine.co.uk