Review

Evidence-Based Medicine: Specific Skills Necessary for Developing Expertise in Critical Appraisal

Authors: Michael J. Morris, MD, Allyson E. Fewell, CPT, MC, USA, Ryan T. Oleszewski, CPT, MC, USA

Abstract

The concept of evidence-based medicine (EBM), defined as the integration of best research evidence with clinical expertise and patient values, is essential to the review, understanding, and application of clinical principles into the practice of medicine. Critical appraisal includes recognizing and evaluating various study designs and their ranking in order of priority, judging relevance to the question at hand, identifying potential sources of bias, and determining whether the data presentation, statistical analysis, and conclusions are appropriate. The focus of this article is on the quality of the evidence and how each step in critical appraisal is important to the overall concept and application of EBM.

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References

1. Sackett DL, Strauss SE, Richardson WS, et al. Evidence-Based Medicine: How to Practice and Teach EBM. London, Churchill Livingstone, 2000.
 
2. Sackett DL. Evidence-based medicine. Semin Perinatol 1997; 21: 3–5.
 
3. Akobeng AK. Principles of evidence based medicine. Arch Dis Child 2005; 90: 837–840.
 
4. Oxman AD, Sackett DL, Guyatt GH, et al. Users’ guides to the medical literature: I. How to get started. JAMA 1993; 270: 2093–2095.
 
5. Guyatt GH, Sackett DL, Cook DJ, et al. Users’ guides to the medical literature: II. How to use an article about therapy or prevention. B. What were the results and will they help me in caring for my patients? JAMA 1994; 271: 59–63.
 
6. Jaeschke R, Guyatt GH, Sackett DL, et al. Users’ guides to the medical literature: III. How to use an article about a diagnostic test. B. What are the results and will they help me in caring for my patients? JAMA 1994; 271: 703–707.
 
7. Akobeng AK. Understanding randomised controlled trials. Arch Dis Child 2005; 90: 840–844.
 
8. Hulley SB, Cummings SR, Browner WS, et al. Designing Clinical Research. 3rd ed. Philadelphia, Lippincott Williams & Wilkins, 2007, pp 97–146.
 
9. Upshur REG, Tracy CS. Legitimacy, authority, and hierarchy: critical challenges for evidence-based medicine. Brief Treatment Crisis Intervention 2004; 4: 197–204.
 
10. Guyatt GH, Haynes RB, Jaeschke RZ, et al. Users’ guides to the medical literature: XXV. Evidence-based medicine: principles for applying the users’ guides to patient care. JAMA 2000; 284: 1290–1296.
 
11. Upshur REG. Are all evidence-based practices alike? Problems in the ranking of evidence. CMAJ 2003; 169: 672–673.
 
12. University of Oxford, Centre for Evidence Based Medicine. Levels of evidence table. Available at: http://www.cebm.net/index.aspx?o=5653. Accessed October 4, 2010.
 
13. Glasziou P, Vandenbroucke J, Chalmers I. Assessing the quality of research. BMJ 2004; 328: 39–41.
 
14. Sanderlin BW, Abdul Rahim N. Evidence-based medicine, part 6. An introduction to critical appraisal of clinical practice guidelines. J Am Osteopath Assoc 2007; 107: 321–324.
 
15. Dans AL, Dans LF, Guyatt GH, et al. Users’ guides to the medical literature: XIV. How to decide on the applicability of clinical trial results to your patient. JAMA 1998; 279: 545–547.
 
16. Wilson MC, Hayward RS, Tunis SR, et al. Users’ guides to the medical literature. VIII. How to use clinical guidelines. B. What are the recommendations and will they help you in caring for your patients? JAMA 1995; 274: 1630–1632.
 
17. Cardarelli R, Virgilio RF, Taylor L. Evidence-based medicine, part 2. An introduction to critical appraisal of articles on therapy. J Am Osteopath Assoc 2007; 107: 299–303.
 
18. Richardson WS, Wilson MC, Nishikawa J, et al. The well-built clinical question: a key to evidence-based decisions. ACP J Club 1995; 123: A–12.
 
19. Hsu JL, Banerjee D, Kuschner WG. Understanding and identifying bias and confounding in the medical literature. South Med J 2008; 101: 1240–1245.
 
20. Citrome L. Show me the evidence: using number needed to treat. South Med J 2007; 100: 881–884.
 
21. McAlister FA, Straus SE, Guyatt GH, et al. Users’ guides to the medical literature: XX. Integrating research evidence with the care of the individual patient. JAMA 2000; 283: 2829–2836.
 
22. Moher D, Dulberg CS, Wells GA. Statistical power, sample size, and their reporting in randomized controlled trials. JAMA 1994; 272: 122–124.
 
23. Hollis S, Campbell F. What is meant by intention to treat analysis? Survey of published randomised controlled trials. BMJ 1999; 319: 670–674.