For each study appraised, one critical appraisal tool and the associated tool-specific feedback form were completed. Each participant also completed a single general feedback form. A total of of critical appraisals were conducted and returned, with 81 tool-specific feedback forms and 14 general feedback forms returned.
Four of the six studies with mismatches were observational studies. The differences were minor. None of the mismatches included a study that was rated as both high and low quality by different participants. Based on the comments provided by participants, most mismatches could likely have been resolved through discussion with peers.
Mismatched ratings were not an issue for the descriptive studies and literature reviews. In summary, the pilot test provided useful feedback on different aspects of the toolkit. Revisions were made to address the issues identified from the pilot test and thus strengthen the CAT. The Infection Prevention and Control Guidelines Critical Appraisal Tool Kit was developed in response to the needs of infection control professionals reviewing literature that generally did not include clinical trial evidence.
The toolkit was designed to meet the identified needs for training in critical appraisal with extensive instructions and dictionaries, and tools applicable to all three types of studies analytic studies, descriptive studies and literature reviews. The toolkit provided a method to progress from assessing individual studies to summarizing and assessing the strength of a body of evidence and assigning a grade.
Recommendations are then developed based on the graded body of evidence. This grading system has been used by the Public Health Agency of Canada in the development of recent infection prevention and control guidelines 5 , 7. The toolkit has also been used for conducting critical appraisal for other purposes, such as addressing a practice problem and serving as an educational tool 8 , 9.
The CAT has a number of strengths. It is applicable to a wide variety of study designs. The criteria that are assessed allow for a comprehensive appraisal of individual studies and facilitates critical appraisal of a body of evidence.
The dictionaries provide reviewers with a common language and criteria for discussion and decision making. The CAT also has a number of limitations. The tools do not address all study designs e. Like the majority of critical appraisal tools 10 , 11 , these tools have not been tested for validity and reliability.
Nonetheless, the criteria assessed are those indicated as important in textbooks and in the literature 12 , The grading scale used in this toolkit does not allow for comparison of evidence grading across organizations or internationally, but most reviewers do not need such comparability. It is more important that strong evidence be rated higher than weak evidence, and that reviewers provide rationales for their conclusions; the toolkit enables them to do so.
Overall, the pilot test reinforced that the CAT can help with critical appraisal training and can increase comfort levels for those with limited experience. Further evaluation of the toolkit could assess the effectiveness of revisions made and test its validity and reliability.
A frequent question regarding this toolkit is how it differs from GRADE as both distinguish stronger evidence from weaker evidence and use similar concepts and terminology. Key differences include the focus of the CAT on rating the quality of individual studies, and the detailed instructions and supporting tools that assist those with limited experience in critical appraisal.
When clinical trials and well controlled intervention studies are or become available, GRADE and related tools from Cochrane would be more appropriate 2 , 3. When descriptive studies are all that is available, the CAT is very useful. The Infection Prevention and Control Guidelines Critical Appraisal Tool Kit was developed in response to needs for training in critical appraisal, assessing evidence from a wide variety of research designs, and a method for going from assessing individual studies to characterizing the strength of a body of evidence.
Clinician researchers, policy makers and students can use these tools for critical appraisal of studies whether they are trying to develop policies, find a potential solution to a practice problem or critique an article for a journal club.
The toolkit adds to the arsenal of critical appraisal tools currently available and is especially useful in assessing evidence from a wide variety of research designs. DM — Conceptualization, methodology, investigation, data collection and curation and writing — original draft, review and editing. TO — Conceptualization, methodology, investigation, data collection and curation and writing — original draft, review and editing.
KD — Conceptualization, review and editing, supervision and project administration. We thank Dr. Patricia Huston, Canada Communicable Disease Report Editor-in-Chief, for a thorough review and constructive feedback on the draft manuscript. Conflict of interest: None. National Center for Biotechnology Information , U. Can Commun Dis Rep. Published online Sep 7. Author information Copyright and License information Disclaimer. Copyright notice. This article has been cited by other articles in PMC.
Abstract Healthcare professionals are often expected to critically appraise research evidence in order to make recommendations for practice and policy development. Introduction Healthcare professionals, researchers and policy makers are often involved in the development of public health policies or guidelines.
Overview Following a review of existing critical appraisal tools, studies informing infection prevention and control guidelines that were in development were reviewed to identify the types of studies that would need to be appraised using the CAT. Tools for critically appraising individual studies The first step in the critical appraisal of an individual study is to identify the study design; this can be surprisingly problematic, since many published research studies are complex.
Open in a separate window. Figure 1. Table 1 Aspects appraised in analytic study critical appraisal tool. Aspect Type of assessment Sample and sampling methods Representativeness of participants, control of selection bias Internal validity Control of biases: misclassification, information Validity and reliability of data collection instruments Adequacy of retention and follow-up Control of confounding Comparability of control and intervention groups Adequacy of control of major confounders Ethics Adequacy of ethical conduct Analysis Adequacy and interpretation of statistical testing Power and sample size Screening and applicability questions Generalizability of results Feasibility of implementation.
Table 2 Definition of terms used to evaluate evidence. Tools for summarizing the evidence The second phase in the critical appraisal process involves summarizing the results of the critical appraisal of individual studies. Rating the quality of the overall body of evidence The third phase in the critical appraisal process is rating the quality of the overall body of evidence.
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