Critical Appraisal of the Literature
Critical appraisal is an essential component of EBM. Clinicians must
have the skills to evaluate a research study and the expertise to
determine the applicability of the study's results to a specific
patient. During the search process, you should search for the
appropriate study design for your clinical question. [See: Types of
Clinical Questions and Study Designs]. If you cannot find the best
study design for your question, you should move a step down to the next
best study design, and so on, until you find the best available
Once you have found an article that seems to address your question, Rosenthal suggests giving it an "initial
and relevance screen." This will help you determine whether to spend
the time reading and evaluating the study in depth. He offers the
following eight questions to help veterinarians decide whether the
article is worth an in depth review.
1. Is the article from a peer reviewed journal?
2. Is the location of the study similar to mine so that results, if
valid, would apply to my practice?
3. Is the study sponsored by an organization that might influence the
study design or results?
4. If the results are true, will there be a direct impact on the health
of my patients?
5. If there is an impact on the health of my patients, will the owner
of the animal care?
6. Is the problem addressed one that is common in my practice?
7. Is the test or intervention feasible and available to me?
8. If it is true, will the information require me to change my
JAMA published a series of User's Guides designed to teach clinicians
how to read and appraise research articles. These guides encourage
clinicians to ask the following three questions as a framework for
1. Are the results of the study valid?
2. How strong and/or useful are the recommendations?
3. Will the results help me in managing my patients?
Assembled here are some of the JAMA User Guides
which will be most useful to veterinarians. Accompanying a link to each
user guide is a corresponding Appraisal Guide and a link to the PubMed
citation for a sample article. The Appraisal Guides are part of an
Evidence Based Tool Kit are adapted from the Users' Guides series. The
Appraisal Guides will help to walk you through the critical appraisal.
If you do not have access to the sample article, feel free to appraise
a substitute article. The idea is to get you practicing those critical
Glossary: This glossary from the STEPS (STatistical Education
through Problem Solving) consortium may prove to be a good reference
tool as you refamiliarize yourself with statistical concepts and terms.
Therapy or Prevention: