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Critical Appraisal Tools 

Critical appraisal is an integral process in Evidence Based Practice. Critical appraisal aims to identify methodological flaws in the literature and provide consumers of research evidence the opportunity to make informed decisions about the quality of research evidence.

Below is a list of critical appraisal tools, linked to the websites where they were developed.  iCAHE staff will update this webpage as new critical appraisal tools are published.

Please choose a type of study:
Randomised Controlled Trials Non-Randomised Controlled Trials
Other Quantitative Research Case Studies
Qualitative Research Mixed Methods Research
Systematic Reviews Meta-Analysis
Outcome Measures Clinical Guidelines - featuring iCAHE's Guideline CAT
Assessing Treatment Choices Finding your own CATs
Constructing your own CATs  


Randomised Controlled Trials 
CAT Name Summary of the CAT Authors Link to CAT
CASP: Randomised Controlled Trial Appraisal Tool  Critical Appraisal Skills Program (CASP): RCT CAT is a methodological checklist which provides key criteria relevant to randomised controlled trials. Public Health Resource Unit, NHS, England http://www.sph.nhs.uk/sph-files/rct appraisal tool.pdf (pdf)
PEDro Scale PEDro (Physiotherapy Evidence Database) Scale is an excellent webpage which provides access to a range of appraisal resources including a tutorial and appraisal tool. The Centre of Evidence-Based Physiotherapy (CEBP), Sydney, Australia http://www.pedro.org.au/english/downloads/pedro-scale/ (htm)
The CONSORT Statement The Consolidated Standards of Reporting Trials (CONSORT) Statement is a detailed document which outlines an explanation and elaboration of the CONSORT statement for reporting randomized controlled trials. It also includes (in table two) the critical appraisal tool. The CONSORT Group, Canada http://www.consort-statement.org/consort-statement/ (htm)
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Non-Randomised Controlled Trials 
The TREND Statement The TREND (Transparent Reporting of Evaluations with Nonrandomized Designs) statement is a 22-item checklist specifically developed to guide standardized reporting of nonrandomized controlled trials. The TREND statement complements the widely adopted  CONSORT statement developed for randomized controlled trials. A collective effort in promoting transparent reporting is valuable to improve research synthesis and advance evidence-based recommendations for best practices and policies. Centre for Disease Control and Prevention (CDC), United States of America http://www.cdc.gov/trendstatement/ (pdf)
McMaster Critical Review Form - Quantitative Studies McMaster Critical Review Form for Qualitative studies contains a generic quantitative appraisal tool, accompanied by detailed guidelines for usage. Occupational Therapy Evidence-Based Practice Research Group, McMaster University, Canada Review Form: http://www.srs-mcmaster.ca/Portals/20/pdf/ebp/quanreview.pdf (pdf)
User Guideline:
http://www.srs-mcmaster.ca/Portals/20/pdf/ebp/quanguidelines.pdf (pdf)
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Other Quantitative Research
CASP: Cohort Studies Critical Appraisal Skills Program (CASP): Cohort Studies is a methodological checklist which provides key criteria relevant to cohort studies. Public Health Resource Unit, NHS, England http://www.sph.nhs.uk/sph-files/cohort 12 questions.pdf (pdf)
CASP: Economic Evaluation Studies Critical Appraisal Skills Program (CASP): Economic Evaluation Studies is a methodological checklist which provides key criteria relevant to economic studies. Public Health Resource Unit, NHS, England http://www.sph.nhs.uk/sph-files/Economic Evaluations 10 Questions.pdf (pdf)
CASP: Diagnostic Test Studies Critical Appraisal Skills Program (CASP): Diagnostic Test Studies is a methodological checklist which provides key criteria relevant to diagnostic studies. Public Health Resource Unit, NHS, England http://www.sph.nhs.uk/sph-files/Diagnostic Tests 12 Questions.pdf (pdf)
Therapy CA Worksheet Therapy Critical Appraisal Worksheet is a methodological checklist which provides key criteria relevant to therapy studies. Centre for Evidence-Based Medicine, University of Toronto, Canada http://ktclearinghouse.ca/cebm/teaching/worksheets/therapy (htm)
Diagnostic CA Worksheet Diagnostic Critical Appraisal Worksheet is a methodological checklist which provides key criteria relevant to diagnostic studies. Centre for Evidence-Based Medicine, University of Toronto, Canada http://ktclearinghouse.ca/cebm/teaching/worksheets/diagnosis (htm)
Harm CA Worksheet

Harm Critical Appraisal Worksheet is a methodological checklist which provides key criteria relevant to harm studies.

Centre for Evidence-Based Medicine, University of Toronto, Canada http://ktclearinghouse.ca/cebm/teaching/worksheets/harm (htm)
Prognosis CA Worksheet Prognosis Critical Appraisal Worksheet is a methodological checklist which provides key criteria relevant to prognostic studies. Centre for Evidence-Based Medicine, University of Toronto, Canada http://ktclearinghouse.ca/cebm/teaching/worksheets/prognosis
(htm)
Evaluation Tool for Quantitative Research Studies

The Evaluation Tool for Quantitative Studies contains six sub-sections: study evaluative overview; study, setting and sample; ethics; group comparability and outcome measurement; policy and practice implications; and other comments.

 Health Care Practice Research & Development Unit (HCPRDU), School of Nursing, University of Salford, UK http://usir.salford.ac.uk/12969 (htm)
GATE Graphic Appraisal Tool for Epidemiology (GATE) is a visual framework that illustrates the generic design of all epidemiologic studies. School of Population Health, The University of Auckland, New Zealand GATE Tool: http://www.fmhs.auckland.ac.nz/soph/depts/epi/epiq/_docs/gateframe.pdf (pdf)
CriSTal Checklist This checklist evaluates the quality of various research designs, such as appraising a user study or appraising an information needs analysis. The University of Sheffield, UK Checklist for Appraising an Information Needs analysis (doc):
http://nettingtheevidence.pbwiki.com/f/needs.doc
Checklist for Appraising a User Study (doc):
http://nettingtheevidence.pbwiki.com/f/use.doc
ReLIANT Readers guide to the Literature on Interventions Addressing the Need for education and training (ReLIANT) is an innovative tool is aimed at appraising published reports of educational and training interventions. Denise Koufogiannakis, Andrew Booth & Alison Brettle, University of Alberta, Canada http://eprints.rclis.org/7163/1/RELIANT__final_.pdf (pdf)
EBLIP Critical Appraisal Checklist The EBLIP checklist for library research  provides provides a thorough, generic list of questions that one would ask when attempting to determine the validity, applicability and appropriateness of a study. L Glynn, Memorial University of Newfoundland, Canada http://www.nihs.ie/pdf/EBL Critical Appraisal Checklist.pdf (pdf)
READER Critical Appraisal Tool

This document outlines the READER Critical Appraisal tool. 

Macauley, Queen's University, Belfast, Northern Ireland http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1238789/pdf/brjgenprac00035-0039.pdf (pdf)
The STARD Checklist STAndards for the Reporting of Diagnostic accuracy checklist is helps determine the accuracy and completeness of reporting of studies of diagnostic accuracy. The STARD Statement consists of a 25 item checklist and flow diagram. Department of Clinical Epidemiology & Biostatistics, University of Amsterdam, The Netherlands. Tool:
http://www.stard-statement.org/pdf and word documents/Checklist.PDF (pdf)
Rational behind 25 items and flow diagram:
http://www.stard-statement.org/ (htm)
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Case Studies
CASP: Case Control Studies Critical Appraisal Skills Program (CASP): Case Control Studies is a methodological checklist which provides key criteria relevant to case control studies. Public Health Resource Unit, NHS, England http://www.sph.nhs.uk/sph-files/Case Control 11 Questions.pdf (pdf)
MINORS Tool MINORS is a valid instrument designed to assess the methodological quality of non-randomized surgical studies, whether comparative or non-comparative. Slim et al, Department of General and Digestive Surgery, Hรดtel-Dieu, France http://onlinelibrary.wiley.com/doi/10.1046/j.1445-2197.2003.02748.x/pdf (pdf)
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Qualitative Research
CASP: Qualitative Research Critical Appraisal Skills Program (CASP): Qualitative Research is a methodological checklist which provides key criteria relevant to qualitative research studies. Public Health Resource Unit, NHS, England http://www.sph.nhs.uk/sph-files/Qualitative Appraisal Tool.pdf (pdf)
McMaster Critical Review Form - Qualitative Studies McMaster Critical Review Form for Qualitative studies contains a generic quantitative appraisal tool, accompanied by detailed guidelines for usage. Occupational Therapy Evidence-Based Practice Research Group, McMaster University, Canada Review Form: http://www.srs-mcmaster.ca/Portals/20/pdf/ebp/qualreview_version2.0.pdf (pdf)
User Guideline: http://www.srs-mcmaster.ca/Portals/20/pdf/ebp/qualguidelines_version2.0.pdf  (pdf)
JBI-NOTARI Critical Appraisal Tool Narrative, Opinion and Text Assessment and Review Instrument (NOTARI) is a  useful tool to evaluate narrative, opinion and others textual evidence. However to use this tool a login is required. The Joanna Briggs Institute, The University of Adelaide, Australia To use this tool you must first register with JBI http://www.joannabriggs.edu.au/Appraise Evidence/JBI SUMARI (systematic review software) (htm)
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Mixed Methods Research
Evaluation Tool for Mixed Methods Studies The evaluation tool for mixed studies allows appraisal of both the qualitative data collection and analysis component and the wider quantitative research design. It is applicable where the aim of the qualitative component is to draw out the informants understandings and perceptions. Health Care Practice Research & Development Unit (HCPRDU), School of Nursing, University of Salford, UK http://usir.salford.ac.uk/13070 (htm)
A Scoring system for Mixed Methods Research and Mixed Studies Reviews A new form of literature review has emerged, Mixed Studies Review. These reviews include qualitative, quantitative and mixed methods studies. This scoring system assesses Qualitative, Quantitative experimental, Quantitative observational and Mixed Methods at the one time. Pluye et al (2009) International Journal of Nursing Studies, 46: 529-46. http://www.ncbi.nlm.nih.gov/pubmed/19233357 (link to abstract in NCBI)
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Systematic Reviews
CASP: Systematic Reviews Critical Appraisal Skills Program (CASP): Systematic Reviews is a methodological checklist which provides key criteria relevant to systematic reviews. Public Health Resource Unit, NHS, England http://www.sph.nhs.uk/sph-files/S.Reviews%20Appraisal%20Tool.pdf (pdf)
Systematic Review (of Therapy) Worksheet

This methodological checklist provides key criteria relevant to systematic reviews.

Centre for Evidence-Based Medicine, University of Toronto, Canada http://ktclearinghouse.ca/cebm/teaching/worksheets/sr (htm)
ARIF Checklist Aggressive Research Intelligence Facility (ARIF) Checklist is a webpage which provides a list of questions to be asked which evaluates the quality of systematic reviews. ARIF, University of Birmingham, UK http://www.arif.bham.ac.uk/critical-appraisal-checklist.shtml (htm)
AMSTAR Assessment of Multiple Systematic Reviews (AMSTAR) is a 37-item assessment tool used to assess the methodological quality of systematic reviews. EMGO Institute, The Netherlands http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1810543/pdf/1471-2288-7-10.pdf (pdf)
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Meta-Analyses
The PRISMA (formerly QUOROM) Statement The PRISMA Statement provides an evidence-based minimum set of items for reporting systematic reviews and meta-analyses, and is an update and expansion of the QUOROM Statement. Although it focuses on randomized trials, the PRISMA Statement can also be used as a basis for reporting systematic reviews of other types of research, particularly evaluations of interventions. It consists of a checklist and a flow diagram. Ottawa Hospital Research Institute (OHRI), Canada The PRISMA Statement Checklist: http://www.prisma-statement.org/2.1.2%20-%20PRISMA%202009%20Checklist.pdf (odf)

Flow diagram: http://www.prisma-statement.org/2.1.4%20-%20PRISMA%20Flow%202009%20Diagram.pdf (pdf)

Explanatory and Elaboration Document: http://www.bmj.com/content/339/bmj.b2700.full?view=long&pmid=19622552 (htm)
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Outcome Measures
Checklist for Reviewing the User Centredness of an Outcome Measure This is a methodological checklist provides an overview of user centeredness of an outcome measures. [THIS TOOL IS NO LONGER AVAILABLE ONLINE] Health Care Practice Research & Development Unit (HCPRDU), School of Nursing, University of Salford, UK http://www.fhsc.salford.ac.uk/hcprdu/outcome-measures.htm (htm)
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Clinical Guidelines
The iCAHE Guideline Checklist The iCAHE guideline checklist provides clinicians with a quick way of appraising the quality of a clinical guideline. It consists of 14 questions and can be used either as a checklist or a total score. The International Centre for Allied Health Evidence (iCAHE), UniSA, Australia http:///www.unisa.edu.au/cahe/Resources/iCAHE-GuidelineCH/iCAHE_guideline_checklist.pdf (pdf)
AGREE II Instrument The Appraisal of Guidelines for Research & Evaluation (AGREE) Instrument assesses both the quality of the reporting, and the quality of some aspects of recommendations. It provides an assessment of the predicted validity of a guideline, that is the likelihood that it will achieve its intended outcome. It does not assess the impact of a guideline on patients outcomes. The AGREE Collaboration, St George's Hospital Medical School, London http://www.agreetrust.org/index.aspx?o=1397 (pdf)
Systematic Review of CATs for Clinical Guidelines This publication is a systematic review of appraisal tools for clinical guidelines. While there is no access to critical appraisal tools directly from this publication, it does provide an interesting and informative overview of appraisal tools for clinical guidelines. Vlayen et al., (2005). International Journal of Quality in Health Care, 17(3): 235-242. http://intqhc.oxfordjournals.org/cgi/reprint/17/3/235 (pdf)
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Assessing Treatment Choices
DISCERN DISCERN is a brief questionnaire which provides users with a valid and reliable way of assessing the quality of written information on treatment choices for a health problem. DISCERN can also be used by authors and publishers of information on treatment choices as a guide to the standard which users are entitled to expect. Division of Public Health and Primary Health Care, University of Oxford, UK http://www.discern.org.uk/discern.pdf (pdf)
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Finding Your Own CATs
CAT WALK This site provides an overview of critical appraisal process, including tools. University of Alberta Libraries, Canada http://www.library.ualberta.ca/subject/physicaltherapy/catwalk/index.cfm (htm)
OT Seeker This site provides access to a range of appraisal resources. Department of Occupational Therapy The University of Queensland , Australia http://www.otseeker.com/resources/default.asp#4 (htm)
STROBE Statement

STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) website provides access to a range of critical appraisal tools for a range of research methodologies (cohort, case-control, and cross-sectional studies).

University of Bern, Switerzland http://www.strobe-statement.org/index.php?id=strobe-home (htm)
DynaMed This unique, interactive website provides access to a range of critical appraisal solutions for various research designs. DynaMed, United States of America http://www.ebscohost.com/dynamed/ (htm)
Delfini This website provides access to a range of tools relevant evidence based practice, including critical appraisal tools. Delfini Group, United States of America http://www.delfini.org/delfiniTools.htm (htm)
Standard Quality Assessment Criteria for Evaluating Primary Research Papers

This document provides an overview of appraisal of primary research studies. It also includes examples of critical appraisal tools.

Alberta Heritage Foundation for Medical Research, Canada http://www.ihe.ca/documents/HTA-FR13.pdf (pdf)
Critical Appraisal Tool This document provides the reader with various critical appraisal tools. These include tools for meta-analyses and systematic reviews, randomised controlled trials, clinical guidelines and qualitative research papers. Royal College of Psychiatrists, UK http://www.rcpsych.ac.uk/pdf/app2.pdf (pdf)
NHS Research Design Service for the East Midlands

This webpage provides access to a range of resources on all things critical appraisal.

National Institute of Health Research, NHS, UK http://www.rds-eastmidlands.org.uk/  (htm)
RAPid

Rapid Appraisal Protocol Internet Database (RAPid) is a webpage which provides access to a range of appraisal resources. However, this webpage requires log in.

The Joanna Briggs Institute, The University of Adelaide, Australia http://connect.jbiconnectplus.org/Appraise.aspx (htm)
Evidence Direct

This excellent webpage provides access to numerous critical appraisal resources including critical appraisal tools, examples and other reading materials.

The Royal Melbourne Hospital, Australia http://www.mh.org.au/royal_melbourne_hospital/evidence-direct/w1/i1015432/ (htm)
TOOLKIT This interactive webpage provides access to numerous critical appraisal resources including critical appraisal tools, examples and other reading materials. The University of Newcastle, Australia http://libguides.newcastle.edu.au/sysreviews (htm)
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Constructing Your Own CATs
CATmaker CATmaker is a software tool which helps you create Critically Appraised Topics, or CATs, for the key articles you encounter about Therapy, Diagnosis, Prognosis, Aetiology/Harm and Systematic Reviews of Therapy. Centre for Evidence Based Medicine, University of Oxford, UK http://www.cebm.net/?o=1216 (htm)
 

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