critical - worksheet.doc

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CRITICAL APPRAISAL OF A SYSTEMATIC REVIEW & META-ANALYSISSYSTEMATIC REVIEW WORKSHEET

Are the results of this systematic review valid?

1. Was the review question clearly and

explicitly stated? Was it a focused reviewquestion?

2. What was the review question?

3. Did the SR include a methods section thatdescribed:

a) a comprehensive, exhaustive searchstrategy for finding and including all therelevant studies? What databases andsources were searched? Was the searchadequate? Were non-English studiesexcluded?

b) the criteria used to decide which studiesto include in the review (i.e. were theinclusion criteria reported and justified?)Was study selection reproducibly done (i.e.by two independent reviewers)? Was biasin selection of studies avoided?

c) how the reviewers assessed the validity(i.e. quality) of each study included in thereview? Was study quality assessmentreproducibly done (i.e. by two independentreviewers)? Were all the included studies ofhigh methodologic quality?

4. If meta-analysis was done, how were thestudy results combined (pooled)? Were themeta-analysis methods appropriate? Whatstatistical model was used for meta-analysis?

5. Did the reviewers check for heterogeneity?What method was used?

6. Did the reviewers check for publicationbias? What method was used? Is it likely thatrelevant studies were missed?

7. Did the reviewers assess the potentialimpact of study quality on the results of theSR?

Any other potential biases or flaws in this systematic review?

Source: Adapted from 1) Centre for Evidence Based Medicine ( http://www.cebm.net/); 2) Badenoch & Heneghan,Evidence-based Medicine Toolkit, BMJ Books, 2002; 3) Guyatt & Rennie. Users Guides to the Medical Literature, AMA

Press, 2002; 4) Pai M et al. Natl Med J of India 2004;17:86-95.Compiled by Madhu Pai [[email protected]]

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Citation:
http://www.cebm.net/http://www.cebm.net/


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What are the results?

What are the results of the systematic review?

1. Were the results similar from study tostudy, both clinically and statistically?

Were the populations of the differentstudies similar?

Was the same exposure/interventionevaluated by the individual studies?

Was the same outcome evaluated bythe individual studies?

If heterogeneity was found, did thereviewers seek to explore reasons forheterogeneity?

What methods (e.g. subgroup analysisor meta-regression) were used to

ascertain reasons for heterogeneity?

2. What are the overall results of the review?

3. How precise were the results?

4. Were conclusions made by the reviewauthors supported by the data presented inthe review?



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Can you apply the results to patient care?

How can I apply the results to my patient?

1. Do these results apply to your patient? Isyour patient so different from those in thestudies included in the systematic review

that its results cant help you?

2. Were all clinically important outcomesconsidered in this review?

3. Are the benefits of the intervention (ifrelevant) worth the costs and potentialrisks?

In summary:

What are the major strengths of this systematic review?

What are the major limitations of this systematic review?

Based on your assessment of this systematic review, would you accept the conclusions of the

review?



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