- Are the aims stated?
- Literature reviewed?
- Relevant to GP, to my patients?
- Does study simply replicate others or offer something new?
Method
- Is study design appropriate?
- qualitative/quantitative
- observational/experimental
- retrospective/prospective
- longitudinal/cross-sectional
Instruments
- Are they appropriate to concepts?
- Have they been validated in practice?
Subjects
- Recruitment
- Are study and control groups equally matched?
- Age/sex/class
- Were they recruited in the same way?
- Sensible inclusions, clear criteria?
- Do exclusions influence applicability?
- Subjects studied in "real life" circumstances?
- Design
- Are the intervention and comparison clear?
- Are outcome criteria defined?
- What was actually measured or done? (Beware surrogate markers)
- Is sample size sufficient? (To indicate clinical and statistical
significance) was "power" calculated?
b-error = no effect seen when one exists -due to small sample
size
a-error = significant effect due to sampling error
- Is randomsation/allocation described? Is it concealed?
- Was assessment blind?
- Remember biases
- selection/inclusion
- performance
- exclusion
- detection
- Follow up - were completeness and duration OK?
Results
- Consider drop outs/exclusions (analysis by intention to treat?)
- Are tables and graphs honest?
- Are statistics appropriate? - CI's, p-values.
- Is clinical significance achieved?
- Were all subjects accounted for at the conclusion of the study?
Discussion
- Aware of methodological/design limitations?
- Conclusions justified?
- Compare with previous work?
- Are speculations appropriate and realistic?
Application of findings
- Are the patients comparable to your own?
- Is the setting comparable?
- Are the results clinically significant?
- Is the intervention feasible in your own practice setting?
- Is it affordable, available and sensible?
Appraisal
of a study