EIP - Critical Appraisal and CrowdCARE - Week 2

Question 1

Describe the 6 stages of the EBP process.

Answer 1

Assess - a question arises during patient care

Ask - completely articulate all parts of the question

Acquire - conduct a thorough focussed search and select the highest quality evidence

Appraise - evaluate the evidence for validity and clinical applicability

Apply - use clinical expertise to integrate applicable evidence with attention to patient values

Audit - self evaluation of performance

Question 2

Name 3 barriers to evidence based practice.

Answer 2

Lack of training/skill
Lack of time
Quantity of research evidence

Question 3

Define critical appraisal.

Answer 3

Determining the level of evidence provided by a study

Question 4

Describe the evidence hierarchy in order of evidence level (6).

Answer 4

• Systematic review
• Randomised controlled study or prospective cohort study
• Pseudo-randomised controlled study
• Cohort or case control study
• Comparative study without controls
• Case series or cross sectional study

Question 5

What is a systematic review?

Answer 5

It is a systematic approach to locating, appraising, and synthesising all studies that relate to a particular question. It may include a meta-analysis.

Question 6

Name three requirements to a good systematic review.

Answer 6

• The research question and inclusion criteria are established before the conduct of the review
• There are at least two independent data extractors and a consensus procedure is used to resolve disagreements
• At least two electronic sources are searched and all searches are supplemented by consulting other sources and by reviewing the references in the studies found

Question 7

Does a good systematic review use status of publication as an inclusion criteria?

Answer 7

No, it shouldnt exclude based on publication status or language.

Question 8

Does a good systematic review provide a list of studies?

Answer 8

Yes, a list of included and excluded studies is provided in a good review.

Question 9

How does a good systematic review treat data in included studies?

Answer 9

Data from the original studies is provided on the participants, interventions and outcomes.

Question 10

How is the scientific quality of included studies assessed and documented?

Answer 10

The a priori methods of assessment must be provided in a good review

Question 11

Does a good systematic review consider the scientific quality of included studies in formulating its conclusion?

Answer 11

Yes, the methodological rigour and scientific quality must be considered in its analysis.

Question 12

How are findings of multiple studies combined in a good systematic review?

Answer 12

A test must be done to ensure the studies are combinable, such as an I^2 test.

Question 13

How is publication bias addressed in a systematic review?

Answer 13

Funnel plot or Egger regression test

Question 14

Do systematic reviews need a conflict of interest statement?

Answer 14

Yes, it must be included in both the review and if they are present in the included studies.

Question 15

What kind of study is the gold standard methodology for intervention studies?

Answer 15

A randomised controlled trial

Question 16

Define randomised controlled trial.

Answer 16

Participants are randomly divided into separate groups, with the intervention applied to one group, and not the other group.
The only difference between the two groups must be the intervention.

Question 17

How should participants be allocated to groups in a good randomised controlled trial? What doesnt satisfy a good allocation (3)?

Answer 17

At random. Quasi-randomisation doesnt satisfy this criterion, such as allocation by:

• hospital record number
• birth date
• alternation

Question 18

When allocations are made in a good randomised controlled trial, should it be concealed or not?

Answer 18

In a good trial, it will be concealed from all individuals involved in the study.

Question 19

In a randomised controlled trial, how can variable severity of the condition amongst the participants be accounted for (2)?

Answer 19

The trial must include at least one measure of severity and at least one (different) key outcome measure at baseline.

Question 20

Must participants in a good randomised controlled trial be made blind to the group they are allocated?
Does this apply to the therapist administering the therapy? What about the assessors who measure the outcome?

Answer 20

Yes, a good trial is blinded, both the participants and the therapist.
Assessors must also be blind to the participant’s group.

Question 21

For a good randomised controlled trial, what percentage of participants must have a measured key outcome?

Answer 21

More than 85% of subjects initally allocated to groups must have a measure of at least one key outcome.

Question 22

How must the results of between-group statistical comparisons be reported for a good randomised controlled trial?

Answer 22

It must be reported either in the form of a hypothesis test (p-value) or an estimate and its confidence intervals (95% or greater).

Question 23

How does a good systematic review resolve duplicate study selection and data extraction?

Answer 23

Using at least two independent data extractors and a consensus procedure is sued to resolve disagreements

Question 24

Does a good systematic review require a comprehensive literature review? Explain.

Answer 24

Yes, it should have at least two electronic sources searched, with the search strategy explained.
All searches should be supplemented by consulting other sources and reviewing the references in the studies found.