Conducting a Literature Review
- Literature Review
- Developing a Topic
- Planning Your Literature Review
- Developing a Search Strategy
- Managing Citations
- Critical Appraisal Tools
- Writing a Literature Review
Appraise Your Research Articles
The structure of a literature review should include the following :
- An overview of the subject, issue, or theory under consideration, along with the objectives of the literature review,
- Division of works under review into themes or categories [e.g. works that support a particular position, those against, and those offering alternative approaches entirely],
- An explanation of how each work is similar to and how it varies from the others,
- Conclusions as to which pieces are best considered in their argument, are most convincing of their opinions, and make the greatest contribution to the understanding and development of their area of research.
The critical evaluation of each work should consider :
- Provenance -- what are the author's credentials? Are the author's arguments supported by evidence [e.g. primary historical material, case studies, narratives, statistics, recent scientific findings]?
- Methodology -- were the techniques used to identify, gather, and analyze the data appropriate to addressing the research problem? Was the sample size appropriate? Were the results effectively interpreted and reported?
- Objectivity -- is the author's perspective even-handed or prejudicial? Is contrary data considered or is certain pertinent information ignored to prove the author's point?
- Persuasiveness -- which of the author's theses are most convincing or least convincing?
- Value -- are the author's arguments and conclusions convincing? Does the work ultimately contribute in any significant way to an understanding of the subject?
Reviewing the Literature
While conducting a review of the literature, maximize the time you devote to writing this part of your paper by thinking broadly about what you should be looking for and evaluating. Review not just what the articles are saying, but how are they saying it.
Some questions to ask:
- How are they organizing their ideas?
- What methods have they used to study the problem?
- What theories have been used to explain, predict, or understand their research problem?
- What sources have they cited to support their conclusions?
- How have they used non-textual elements [e.g., charts, graphs, figures, etc.] to illustrate key points?
- When you begin to write your literature review section, you'll be glad you dug deeper into how the research was designed and constructed because it establishes a means for developing more substantial analysis and interpretation of the research problem.
Tools for Critical Appraisal
Now, that you have found articles based on your research question you can appraise the quality of those articles. These are resources you can use to appraise different study designs.
Centre for Evidence Based Medicine (Oxford)
University of Glasgow
"AFP uses the Strength-of-Recommendation Taxonomy (SORT), to label key recommendations in clinical review articles."
- SORT: Rating the Strength of Evidence American Family Physician and other family medicine journals use the Strength of Recommendation Taxonomy (SORT) system for rating bodies of evidence for key clinical recommendations.
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A guide to critical appraisal of evidence : Nursing2020 Critical Care
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A guide to critical appraisal of evidence
Fineout-Overholt, Ellen PhD, RN, FNAP, FAAN
Ellen Fineout-Overholt is the Mary Coulter Dowdy Distinguished Professor of Nursing at the University of Texas at Tyler School of Nursing, Tyler, Tex.
The author has disclosed no financial relationships related to this article.
Critical appraisal is the assessment of research studies' worth to clinical practice. Critical appraisal—the heart of evidence-based practice—involves four phases: rapid critical appraisal, evaluation, synthesis , and recommendation. This article reviews each phase and provides examples, tips, and caveats to help evidence appraisers successfully determine what is known about a clinical issue. Patient outcomes are improved when clinicians apply a body of evidence to daily practice.
How do nurses assess the quality of clinical research? This article outlines a stepwise approach to critical appraisal of research studies' worth to clinical practice: rapid critical appraisal, evaluation, synthesis , and recommendation. When critical care nurses apply a body of valid, reliable, and applicable evidence to daily practice, patient outcomes are improved.
Critical care nurses can best explain the reasoning for their clinical actions when they understand the worth of the research supporting their practices. In c ritical appraisal , clinicians assess the worth of research studies to clinical practice. Given that achieving improved patient outcomes is the reason patients enter the healthcare system, nurses must be confident their care techniques will reliably achieve best outcomes.
Nurses must verify that the information supporting their clinical care is valid, reliable, and applicable. Validity of research refers to the quality of research methods used, or how good of a job researchers did conducting a study. Reliability of research means similar outcomes can be achieved when the care techniques of a study are replicated by clinicians. Applicability of research means it was conducted in a similar sample to the patients for whom the findings will be applied. These three criteria determine a study's worth in clinical practice.
Appraising the worth of research requires a standardized approach. This approach applies to both quantitative research (research that deals with counting things and comparing those counts) and qualitative research (research that describes experiences and perceptions). The word critique has a negative connotation. In the past, some clinicians were taught that studies with flaws should be discarded. Today, it is important to consider all valid and reliable research informative to what we understand as best practice. Therefore, the author developed the critical appraisal methodology that enables clinicians to determine quickly which evidence is worth keeping and which must be discarded because of poor validity, reliability, or applicability.
Evidence-based practice process
The evidence-based practice (EBP) process is a seven-step problem-solving approach that begins with data gathering (see Seven steps to EBP ). During daily practice, clinicians gather data supporting inquiry into a particular clinical issue (Step 0). The description is then framed as an answerable question (Step 1) using the PICOT question format ( P opulation of interest; I ssue of interest or intervention; C omparison to the intervention; desired O utcome; and T ime for the outcome to be achieved). 1 Consistently using the PICOT format helps ensure that all elements of the clinical issue are covered. Next, clinicians conduct a systematic search to gather data answering the PICOT question (Step 2). Using the PICOT framework, clinicians can systematically search multiple databases to find available studies to help determine the best practice to achieve the desired outcome for their patients. When the systematic search is completed, the work of critical appraisal begins (Step 3). The known group of valid and reliable studies that answers the PICOT question is called the body of evidence and is the foundation for the best practice implementation (Step 4). Next, clinicians evaluate integration of best evidence with clinical expertise and patient preferences and values to determine if the outcomes in the studies are realized in practice (Step 5). Because healthcare is a community of practice, it is important that experiences with evidence implementation be shared, whether the outcome is what was expected or not. This enables critical care nurses concerned with similar care issues to better understand what has been successful and what has not (Step 6).
Critical appraisal of evidence
The first phase of critical appraisal, rapid critical appraisal, begins with determining which studies will be kept in the body of evidence. All valid, reliable, and applicable studies on the topic should be included. This is accomplished using design-specific checklists with key markers of good research. When clinicians determine a study is one they want to keep (a “keeper” study) and that it belongs in the body of evidence, they move on to phase 2, evaluation. 2
In the evaluation phase, the keeper studies are put together in a table so that they can be compared as a body of evidence, rather than individual studies. This phase of critical appraisal helps clinicians identify what is already known about a clinical issue. In the third phase, synthesis , certain data that provide a snapshot of a particular aspect of the clinical issue are pulled out of the evaluation table to showcase what is known. These snapshots of information underpin clinicians' decision-making and lead to phase 4, recommendation. A recommendation is a specific statement based on the body of evidence indicating what should be done—best practice. Critical appraisal is not complete without a specific recommendation. Each of the phases is explained in more detail below.
Phase 1: Rapid critical appraisal . Rapid critical appraisal involves using two tools that help clinicians determine if a research study is worthy of keeping in the body of evidence. The first tool, General Appraisal Overview for All Studies (GAO), covers the basics of all research studies (see Elements of the General Appraisal Overview for All Studies ). Sometimes, clinicians find gaps in knowledge about certain elements of research studies (for example, sampling or statistics) and need to review some content. Conducting an internet search for resources that explain how to read a research paper, such as an instructional video or step-by-step guide, can be helpful. Finding basic definitions of research methods often helps resolve identified gaps.
To accomplish the GAO, it is best to begin with finding out why the study was conducted and how it answers the PICOT question (for example, does it provide information critical care nurses want to know from the literature). If the study purpose helps answer the PICOT question, then the type of study design is evaluated. The study design is compared with the hierarchy of evidence for the type of PICOT question. The higher the design falls within the hierarchy or levels of evidence, the more confidence nurses can have in its finding, if the study was conducted well. 3,4 Next, find out what the researchers wanted to learn from their study. These are called the research questions or hypotheses. Research questions are just what they imply; insufficient information from theories or the literature are available to guide an educated guess, so a question is asked. Hypotheses are reasonable expectations guided by understanding from theory and other research that predicts what will be found when the research is conducted. The research questions or hypotheses provide the purpose of the study.
Next, the sample size is evaluated. Expectations of sample size are present for every study design. As an example, consider as a rule that quantitative study designs operate best when there is a sample size large enough to establish that relationships do not exist by chance. In general, the more participants in a study, the more confidence in the findings. Qualitative designs operate best with fewer people in the sample because these designs represent a deeper dive into the understanding or experience of each person in the study. 5 It is always important to describe the sample, as clinicians need to know if the study sample resembles their patients. It is equally important to identify the major variables in the study and how they are defined because this helps clinicians best understand what the study is about.
The final step in the GAO is to consider the analyses that answer the study research questions or confirm the study hypothesis. This is another opportunity for clinicians to learn, as learning about statistics in healthcare education has traditionally focused on conducting statistical tests as opposed to interpreting statistical tests. Understanding what the statistics indicate about the study findings is an imperative of critical appraisal of quantitative evidence.
The second tool is one of the variety of rapid critical appraisal checklists that speak to validity, reliability, and applicability of specific study designs, which are available at varying locations (see Critical appraisal resources ). When choosing a checklist to implement with a group of critical care nurses, it is important to verify that the checklist is complete and simple to use. Be sure to check that the checklist has answers to three key questions. The first question is: Are the results of the study valid? Related subquestions should help nurses discern if certain markers of good research design are present within the study. For example, identifying that study participants were randomly assigned to study groups is an essential marker of good research for a randomized controlled trial. Checking these essential markers helps clinicians quickly review a study to check off these important requirements. Clinical judgment is required when the study lacks any of the identified quality markers. Clinicians must discern whether the absence of any of the essential markers negates the usefulness of the study findings. 6-9
The second question is: What are the study results? This is answered by reviewing whether the study found what it was expecting to and if those findings were meaningful to clinical practice. Basic knowledge of how to interpret statistics is important for understanding quantitative studies, and basic knowledge of qualitative analysis greatly facilitates understanding those results. 6-9
The third question is: Are the results applicable to my patients? Answering this question involves consideration of the feasibility of implementing the study findings into the clinicians' environment as well as any contraindication within the clinicians' patient populations. Consider issues such as organizational politics, financial feasibility, and patient preferences. 6-9
When these questions have been answered, clinicians must decide about whether to keep the particular study in the body of evidence. Once the final group of keeper studies is identified, clinicians are ready to move into the phase of critical appraisal. 6-9
Phase 2: Evaluation . The goal of evaluation is to determine how studies within the body of evidence agree or disagree by identifying common patterns of information across studies. For example, an evaluator may compare whether the same intervention is used or if the outcomes are measured in the same way across all studies. A useful tool to help clinicians accomplish this is an evaluation table. This table serves two purposes: first, it enables clinicians to extract data from the studies and place the information in one table for easy comparison with other studies; and second, it eliminates the need for further searching through piles of periodicals for the information. (See Bonus Content: Evaluation table headings .) Although the information for each of the columns may not be what clinicians consider as part of their daily work, the information is important for them to understand about the body of evidence so that they can explain the patterns of agreement or disagreement they identify across studies. Further, the in-depth understanding of the body of evidence from the evaluation table helps with discussing the relevant clinical issue to facilitate best practice. Their discussion comes from a place of knowledge and experience, which affords the most confidence. The patterns and in-depth understanding are what lead to the synthesis phase of critical appraisal.
The key to a successful evaluation table is simplicity. Entering data into the table in a simple, consistent manner offers more opportunity for comparing studies. 6-9 For example, using abbreviations versus complete sentences in all columns except the final one allows for ease of comparison. An example might be the dependent variable of depression defined as “feelings of severe despondency and dejection” in one study and as “feeling sad and lonely” in another study. 10 Because these are two different definitions, they need to be different dependent variables. Clinicians must use their clinical judgment to discern that these different dependent variables require different names and abbreviations and how these further their comparison across studies.
Sample and theoretical or conceptual underpinnings are important to understanding how studies compare. Similar samples and settings across studies increase agreement. Several studies with the same conceptual framework increase the likelihood of common independent variables and dependent variables. The findings of a study are dependent on the analyses conducted. That is why an analysis column is dedicated to recording the kind of analysis used (for example, the name of the statistical analyses for quantitative studies). Only statistics that help answer the clinical question belong in this column. The findings column must have a result for each of the analyses listed; however, in the actual results, not in words. For example, a clinician lists a t -test as a statistic in the analysis column, so a t -value should reflect whether the groups are different as well as probability ( P -value or confidence interval) that reflects statistical significance. The explanation for these results would go in the last column that describes worth of the research to practice. This column is much more flexible and contains other information such as the level of evidence, the studies' strengths and limitations, any caveats about the methodology, or other aspects of the study that would be helpful to its use in practice. The final piece of information in this column is a recommendation for how this study would be used in practice. Each of the studies in the body of evidence that addresses the clinical question is placed in one evaluation table to facilitate the ease of comparing across the studies. This comparison sets the stage for synthesis .
Phase 3: Synthesis . In the synthesis phase, clinicians pull out key information from the evaluation table to produce a snapshot of the body of evidence. A table also is used here to feature what is known and help all those viewing the synthesis table to come to the same conclusion. A hypothetical example table included here demonstrates that a music therapy intervention is effective in reducing the outcome of oxygen saturation (SaO 2 ) in six of the eight studies in the body of evidence that evaluated that outcome (see Sample synthesis table: Impact on outcomes ). Simply using arrows to indicate effect offers readers a collective view of the agreement across studies that prompts action. Action may be to change practice, affirm current practice, or conduct research to strengthen the body of evidence by collaborating with nurse scientists.
When synthesizing evidence, there are at least two recommended synthesis tables, including the level-of-evidence table and the impact-on-outcomes table for quantitative questions, such as therapy or relevant themes table for “meaning” questions about human experience. (See Bonus Content: Level of evidence for intervention studies: Synthesis of type .) The sample synthesis table also demonstrates that a final column labeled synthesis indicates agreement across the studies. Of the three outcomes, the most reliable for clinicians to see with music therapy is SaO 2 , with positive results in six out of eight studies. The second most reliable outcome would be reducing increased respiratory rate (RR). Parental engagement has the least support as a reliable outcome, with only two of five studies showing positive results. Synthesis tables make the recommendation clear to all those who are involved in caring for that patient population. Although the two synthesis tables mentioned are a great start, the evidence may require more synthesis tables to adequately explain what is known. These tables are the foundation that supports clinically meaningful recommendations.
Phase 4: Recommendation . Recommendations are definitive statements based on what is known from the body of evidence. For example, with an intervention question, clinicians should be able to discern from the evidence if they will reliably get the desired outcome when they deliver the intervention as it was in the studies. In the sample synthesis table, the recommendation would be to implement the music therapy intervention across all settings with the population, and measure SaO 2 and RR, with the expectation that both would be optimally improved with the intervention. When the synthesis demonstrates that studies consistently verify an outcome occurs as a result of an intervention, however that intervention is not currently practiced, care is not best practice. Therefore, a firm recommendation to deliver the intervention and measure the appropriate outcomes must be made, which concludes critical appraisal of the evidence.
A recommendation that is off limits is conducting more research, as this is not the focus of clinicians' critical appraisal. In the case of insufficient evidence to make a recommendation for practice change, the recommendation would be to continue current practice and monitor outcomes and processes until there are more reliable studies to be added to the body of evidence. Researchers who use the critical appraisal process may indeed identify gaps in knowledge, research methods, or analyses, for example, that they then recommend studies that would fill in the identified gaps. In this way, clinicians and nurse scientists work together to build relevant, efficient bodies of evidence that guide clinical practice.
Evidence into action
Critical appraisal helps clinicians understand the literature so they can implement it. Critical care nurses have a professional and ethical responsibility to make sure their care is based on a solid foundation of available evidence that is carefully appraised using the phases outlined here. Critical appraisal allows for decision-making based on evidence that demonstrates reliable outcomes. Any other approach to the literature is likely haphazard and may lead to misguided care and unreliable outcomes. 11 Evidence translated into practice should have the desired outcomes and their measurement defined from the body of evidence. It is also imperative that all critical care nurses carefully monitor care delivery outcomes to establish that best outcomes are sustained. With the EBP paradigm as the basis for decision-making and the EBP process as the basis for addressing clinical issues, critical care nurses can improve patient, provider, and system outcomes by providing best care.
Seven steps to EBP
Step 0–A spirit of inquiry to notice internal data that indicate an opportunity for positive change.
Step 1– Ask a clinical question using the PICOT question format.
Step 2–Conduct a systematic search to find out what is already known about a clinical issue.
Step 3–Conduct a critical appraisal (rapid critical appraisal, evaluation, synthesis , and recommendation).
Step 4–Implement best practices by blending external evidence with clinician expertise and patient preferences and values.
Step 5–Evaluate evidence implementation to see if study outcomes happened in practice and if the implementation went well.
Step 6–Share project results, good or bad, with others in healthcare.
Adapted from: Steps of the evidence-based practice (EBP) process leading to high-quality healthcare and best patient outcomes. © Melnyk & Fineout-Overholt, 2017. Used with permission.
Critical appraisal resources
- The Joanna Briggs Institute http://joannabriggs.org/research/critical-appraisal-tools.html
- Critical Appraisal Skills Programme (CASP) www.casp-uk.net/casp-tools-checklists
- Center for Evidence-Based Medicine www.cebm.net/critical-appraisal
- Melnyk BM, Fineout-Overholt E. Evidence-Based Practice in Nursing and Healthcare: A Guide to Best Practice . 3rd ed. Philadelphia, PA: Wolters Kluwer; 2015.
A full set of critical appraisal checklists are available in the appendices.
Bonus content!
This article includes supplementary online-exclusive material. Visit the online version of this article at www.nursingcriticalcare.com to access this content.
critical appraisal; decision-making; evaluation of research; evidence-based practice; synthesis
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Systematic Reviews & Other Review Types
Tools for critical appraisal.
- Systematic Review Service
- Databases & Grey Literature
- What is a Systematic Review?
- What is a Rapid Review?
- What is a Scoping Review?
- What is a Mapping Review?
- What is a Meta-Synthesis?
- What is a Mixed Methods Review?
- What is an Integrative Review?
- What is an Overview of Reviews?
- What is a Review of Complex Interventions?
- What is a Diagnostic Test Accuracy Review?
- What is a Network Meta-Analysis?
- What is a Living Systematic Review?
"Critical appraisal skills enable you to assess the trustworthiness, relevance and results of published papers so that you can decide if they are believable and useful."
( http://www.casp-uk.net/criticalappraisal )
Learn more about Critical Appraisal
- Critical Appraisal article by Tod, Booth, Smith (2021)
- International Centre for Allied Health Evidence-A Guide to Critical Appraisal Tools A list of critical appraisal tools, linked to the websites where they were developed.
- JBI Reviewer's Manual-Critical Appraisal Checklists for Systematic Reviews types There are various types of systematic reviews, refer to the Joanna Briggs Institute Reviewer's Manual to locate the critical appraisal checklist located in the appendix section of each review type in the manual.
- How to Use the Evidence-Ebook Assessment and application of scientific evidence. [2000]
- You Tube video about Critical Appraisal This session looks briefly at how and why we appraise literature.
AHRQ-Assessing the Risk of Bias in Systematic Reviews of Healthcare Interventions
Critical Appraisal Checklists by specific Study Design type
Randomized Controlled Trials
ROB 2.0 Risk Of Bias Tool
There are 3 variations of the tool based on trial design. Choose the appropriate version.
1. Individually randomized, parallel group trials (traditional RCT)
2. Cluster randomized, parallel group trials (like traditional but randomized by groups)
3. Individual randomized, cross-over trials (randomization occurs to determine the order the patient receives both treatments)
https://www.riskofbias.info/welcome/rob-2-0-tool
CASP: Randomised Controlled Trial Appraisal Tool Summary: Critical Appraisal Skills Program (CASP): RCT CAT is a methodological checklist which provides key criteria relevant to randomised controlled trials. Authors: Public Health Resource Unit, NHS, England
http://media.wix.com/ugd/dded87_40b9ff0bf53840478331915a8ed8b2fb.pdf
Non-randomized Studies or Observational Studies:
ROBINS-I Risk of Bias for non-randomized (observational) studies or cohorts of Interventions
http://www.bristol.ac.uk/population-health-sciences/centres/cresyda/barr/riskofbias/robins-i/
ROBINS-E Risk of Bias for non-randomized (observational) studies or cohorts of Exposures other than interventions, including environmental and occupational exposures
http://www.bristol.ac.uk/population-health-sciences/centres/cresyda/barr/riskofbias/robins-e/
Newcastle-Ottawa scale (NOS) -most widely used for case control or cohort studies
http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp
IHE Case Series Studies Critical Appraisal Checklist
https://www.ihe.ca/research-programs/rmd/cssqac/cssqac-about
JBI Critical Appraisal Checklist for Case Series
https://wiki.joannabriggs.org/display/MANUAL/Appendix+7.3+Critical+appraisal+checklists+for+case+series
JBI Critical Appraisal Checklist for Case Reports
https://wiki.joannabriggs.org/display/MANUAL/Appendix+7.4+Critical+appraisal+checklist+for+case+reports
The Methodological Index for Non-Randomized Studies (MINOR) is a tool for assessing non-randomized interventional studies
This link will open a PDF document. http://cobe.paginas.ufsc.br/files/2014/10/MINORS.pdf
Agency for Healthcare Research and Quality (AHRQ) methodological checklist for cross-sectional/prevalence studies
https://www.ncbi.nlm.nih.gov/books/NBK35156/#_A157879_
AXIS-To assess the quality of cross-sectional/prevalence studies
This link will open a PDF document. http://bmjopen.bmj.com/content/bmjopen/6/12/e011458.full.pdf
The TREND Statement Summary: 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.
http://www.cdc.gov/trendstatement/
The STROBE Statement
Strengthening the reporting of observational studies (cohort, case-control, and cross-sectional)
http://www.strobe-statement.org/index.php?id=available-checklists
Mixed Methods Appraisal Tool (MMAT)-used for qualitative, quantitative, and/or mixed methods studies . Helpful for those working on a Mixed Methods Review .
This link will open a PDF document. http://mixedmethodsappraisaltoolpublic.pbworks.com/
w/file/fetch/127916259/MMAT_2018_criteria-manual_2018-08-01_ENG.pdf
Public Health:
MetaQat - Meta-Tool for appraising all types of public health evidence
http://www.publichealthontario.ca/en/ServicesAndTools/Pages/Critical-Appraisal-Tool.aspx
Qualitative:
CanChild for qualitative reviews
These links will open a PDF document. Guidelines and Form
Quantitative Research (Public Health Research)
EPHPP- Quality Assessment tool for Quantitative Studies
Animal Research:
Systematic Review Centre for Laboratory Animal Experimentation (SYRCLE) risk of bias assessment tool for assessing animal studies
Article: http://www.ncbi.nlm.nih.gov/pubmed/24667063
Checklist: https://www.radboudumc.nl/getmedia/60b8b9d8-84d7-4325-843c-6408cf065aca/SYRCLE-EFSA-course-1-okt-2016-(quality-assessment)_RoB-table.aspx
(invivo studies) Review the ARRIVE guidelines
https://www.nc3rs.org.uk/arrive-guidelines
Critical Appraisal of Studies using Animal Models http://ilarjournal.oxfordjournals.org/content/55/3/405.full.pdf+html
Diagnostic Accuracy
To evaluate the risk of bias and applicability of primary diagnostic accuracy studies.
This link will open a PDF document. http://www.bristol.ac.uk/media-library/sites/quadas/migrated/documents/quadas2.pdf
CASP: Diagnostic Test Studies
This link will open a PDF document. http://media.wix.com/ugd/dded87_3815f02af1b34c21b8c3b2b5020024c3.pdf
Centre for Evidence Based Medicine (CEBM) Diagnosis Critical Appraisal Worksheet
- SIGN checklist for diagnostic accuracy studies This link will open a PDF document.
Library and Information Science Research
https://librarysearch.temple.edu/articles/emerald_s10-dot-1108-slash-07378830610692154
Grey Literature
- Public Health Ontario guide to appraising grey literature
Critical Appraisal of Clinical Practice Guidelines
International tool for the assessment of practice guidelines
https://www.agreetrust.org/resource-centre/agree-ii/
Critical Appraisal of Systematic Reviews
ROBIS- A tool for assessing the risk of bias in systematic reviews.
http://www.bristol.ac.uk/social-community-medicine/projects/robis/robis-tool/
Joanna Briggs Critical Appraisal for Systematic Reviews Checklist-
This link will open a PDF document. https://joannabriggs.org/sites/default/files/2019-05/JBI_Critical_Appraisal-Checklist_for_Systematic_Reviews2017_0.pdf
AMSTAR 2-A Measurement Tool to Assess (quality assessment) of Systematic Reviews
http://amstar.ca/
Health-Evidence Appraisal Tool for Reviews
This link will open a PDF document. http://healthevidence.org/documents/our-appraisal-tools/QATool&Dictionary_01Jun16.pdf
https://effectivehealthcare.ahrq.gov/topics/methods-bias-update/methods
- Critical Appraisal of a Network Meta-Analysis
- Critical Appraisal of a Mixed Methods Systematic Review This link will open a PDF document.
Critical Appraisal Checklists
General Worksheets for Critical Appraisal of a variety of study designs:
- JBI Critical Appraisal tools
- CASP Worksheets
- Best Bets Critical Appraisal Worksheets
- Centre For Evidence-Based Medicine Worksheets (CEBM)
- Evidence-Based Medicine Toolbox
- SIGN Critical Appraisal Checklists
Grading the Strength of Evidence
- GRADE Approach GRADE: (Grading of Recommendations Assessment, Development & Evaluation) The GRADE Approach is used in a systematic review to make an overall recommendation of the evidence from strong to weak. Can also access at: https://gradepro.org/
- GRADE CERQual GRADE (Confidence in the Evidence from Reviews of Qualitative Research): GRADE for qualitative systematic reviews to assess the evidence or develop recommendations.
- ConQual approach Rating the confidence of qualitative systematic review findings
Tools for Creating Risk of Bias Figures
- robvis Web app designed for visualizing risk-of-bias assessments. The tool creates: “traffic light” plots of the domain-level judgements for each individual result; and weighted bar plots of the distribution of risk-of-bias judgements within each bias domain.
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- How to write a literature review
This example shows how a literature review from a PhD thesis can be analysed for its structure, purpose and content.
Three sections of the thesis are analysed to show the:
- relationship between the introduction and the literature review
- structure and purpose of dedicated literature review chapters
- inclusion of literature review in other chapters of the thesis.
Access the thesis
Co-witnesses and the effects of discussion on eyewitness memory by Helen M Paterson
Overview of thesis (introduction)
This introductory section is less than two pages long.
The first paragraph:
- states the overall objective of the thesis
- defines the introduced term
- provides broad motivation for interest in the area
- introduces the sections of the thesis that will address the overall objective.
The other paragraphs describe the content and purpose of each section of the thesis.
Literature review
The literature review is made of up of two chapters.
Chapter 1: Literature review of relevant research
The overall goals of this chapter are to firstly establish the significance of the general field of study, and then identify a place where a new contribution could be made.
The bulk of the chapter critically evaluates the methodologies used in this field to identify the appropriate approach for investigating the research questions.
Chapter 2: Theoretical explanations of memory conformity
Chapter 5, study 3: co-witness contamination.
This chapter has the following structure:
- Introduction
- Discussion.
The introduction introduces the particular study to be reported on, and includes a three-and-a-half page literature review.
The literature review in this chapter:
- links back to the relevant general findings of the earlier literature review chapters
- briefly reviews the broad motivation for this study
- identifies that two previously used methodologies in this field will be compared to resolve questions about the findings of previous studies which had only used a single methodology
- uses previous literature to generate specific hypotheses to test
- reviews additional literature to provide a justification for a second objective to be investigated in the study reported on in this chapter.
Learning Advisers
Our advisers can help undergraduate and postgraduate students in all programs clarify ideas from workshops, help you develop skills and give feedback on assignments.
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EBP Learning Module
Appraise, Apply, and Assess the Evidence
Critical appraisal of literature, what is critical appraisal.
“A process of carefully and systematically examining research to judge its trustworthiness, value, and relevance in a particular context” [1] .
Just because a study is the 'best' type of study for the clinical question, you cannot necessarily be confident of the study conclusions. Critical appraisal is the process of systematically examining research evidence to assess its validity, results, and relevance before using it to inform a decision.
If you have been fortunate enough to find a recent systematic review of evidence from a reliable source to answer your clinical question you will not have to undertake the process of critical appraisal. However, if you have found one or two individual studies you will need to assess the quality of the evidence to decide whether you wish to apply the evidence in practice.
For all non-urgent CIAP enquiries , please use the CIAP Request Form in SARA .
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Best Practice for Literature Searching
- Literature Search Best Practice
- What is literature searching?
- What are literature reviews?
- Hierarchies of evidence
- 1. Managing references
- 2. Defining your research question
- 3. Where to search
- 4. Search strategy
- 5. Screening results
- 6. Paper acquisition
- 7. Critical appraisal
- Further resources
- Training opportunities and videos
- Join FSTA student advisory board
Deciding what to include in your review through critical appraisal
Once you have narrowed down your pool of results, it's time to begin critically appraising your articles. Using a checklist helps you scrutinise articles in a consistent, structured way.
Questions to consider include:
- Are the aims of the study clearly stated?
- Is the study design suitable for the aims?
- Are the measurements and methods used clearly described?
- Are the correct measurement tools used?
- Are the statistical methods described?
- Was the sample size adequate?
- Are the methods overall described in enough detail that you could replicate the study?
- Does the discussion overall reflect the results?
- Who funded this study?
- What are the specific limitations of what can be concluded from the study?
Working through the questions will help you identify the strengths and weakness of each article, and also identify points to draw on when you write about the literature.
- DOWNLOAD THE CRITICAL APPRAISAL CHECKLIST
Additional critical appraisal checklists
REFLECT provides a checklist for evaluating randomized control trials in livestock and food safety.
CASP provides checklists for critical appraisal of studies related to health.
JBI provides checklists for critical appraisal of studies related to health.
Documenting critical appraisal decisions
As you closely examine full articles, you will be making judgements about why to include or exclude each study from your review. Documenting your reasoning will help you reassure yourself and demonstrate to others that you have been systematic and unbiased in your appr aisal decisions.
Keeping track of what you have excluded, and why, will be very helpful if you must defend your work—for instance, if your literature review is part of a dissertation or thesis.
Pulling all the literature you will include in your review into a single chart is a good way to begin to synthesise the literature.
- DOWNLOAD THE FULL TEXT SCREENING CHART
Best practice!
BEST PRACTICE RECOMMENDATION : If you include any direct quotes in your chart (or in any notes) be sure to use quotation marks so that you don’t later mistake the words for your own.
BEST PRACTICE RECOMMENDATION: The more carefully you record each of the steps of your process, the more easily reproducible it will be. This is especially important for research abstracts and articles found in conference proceedings.
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- About RCS England
- Dissecting the literature: the importance of critical appraisal
08 Dec 2017
Kirsty Morrison
Critical appraisal is the process of carefully and systematically examining research to judge its trustworthiness, and its value and relevance in a particular context.
Amanda Burls, What is Critical Appraisal?
Why is critical appraisal needed?
Literature searches using databases like Medline or EMBASE often result in an overwhelming volume of results which can vary in quality. Similarly, those who browse medical literature for the purposes of CPD or in response to a clinical query will know that there are vast amounts of content available. Critical appraisal helps to reduce the burden and allow you to focus on articles that are relevant to the research question, and that can reliably support or refute its claims with high-quality evidence, or identify high-level research relevant to your practice.
Critical appraisal allows us to:
- reduce information overload by eliminating irrelevant or weak studies
- identify the most relevant papers
- distinguish evidence from opinion, assumptions, misreporting, and belief
- assess the validity of the study
- assess the usefulness and clinical applicability of the study
- recognise any potential for bias.
Critical appraisal helps to separate what is significant from what is not. One way we use critical appraisal in the Library is to prioritise the most clinically relevant content for our Current Awareness Updates .
How to critically appraise a paper
There are some general rules to help you, including a range of checklists highlighted at the end of this blog. Some key questions to consider when critically appraising a paper:
- Is the study question relevant to my field?
- Does the study add anything new to the evidence in my field?
- What type of research question is being asked? A well-developed research question usually identifies three components: the group or population of patients, the studied parameter (e.g. a therapy or clinical intervention) and outcomes of interest.
- Was the study design appropriate for the research question? You can learn more about different study types and the hierarchy of evidence here .
- Did the methodology address important potential sources of bias? Bias can be attributed to chance (e.g. random error) or to the study methods (systematic bias).
- Was the study performed according to the original protocol? Deviations from the planned protocol can affect the validity or relevance of a study, e.g. a decrease in the studied population over the course of a randomised controlled trial .
- Does the study test a stated hypothesis? Is there a clear statement of what the investigators expect the study to find which can be tested, and confirmed or refuted.
- Were the statistical analyses performed correctly? The approach to dealing with missing data, and the statistical techniques that have been applied should be specified. Original data should be presented clearly so that readers can check the statistical accuracy of the paper.
- Do the data justify the conclusions? Watch out for definite conclusions based on statistically insignificant results, generalised findings from a small sample size, and statistically significant associations being misinterpreted to imply a cause and effect.
- Are there any conflicts of interest? Who has funded the study and can we trust their objectivity? Do the authors have any potential conflicts of interest, and have these been declared?
And an important consideration for surgeons:
- Will the results help me manage my patients?
At the end of the appraisal process you should have a better appreciation of how strong the evidence is, and ultimately whether or not you should apply it to your patients.
Further resources:
- How to Read a Paper by Trisha Greenhalgh
- The Doctor’s Guide to Critical Appraisal by Narinder Kaur Gosall
- CASP checklists
- CEBM Critical Appraisal Tools
- Critical Appraisal: a checklist
- Critical Appraisal of a Journal Article (PDF)
- Introduction to...Critical appraisal of literature
- Reporting guidelines for the main study types
Kirsty Morrison, Information Specialist
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Critical Appraisal of a Systematic Review: A Concise Review
Affiliations.
- 1 Division of Pulmonary and Critical Care Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI.
- 2 Department of Anesthesiology, University Hospital RWTH Aachen University, Aachen, Germany.
- 3 Department of Intensive Care Medicine, University Hospital RWTH Aachen University, Aachen, Germany.
- 4 Department of Anesthesiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
- 5 Clinical Evaluation Research Unit, Department of Critical Care Medicine, Queen's University, KGH Research Institute, Kingston Health Sciences Centre, Kingston, ON, Canada.
- 6 Department of Anesthesiology and Intensive Care Medicine, University Hospital Wuerzburg, Wuerzburg, Germany.
- PMID: 35853198
- DOI: 10.1097/CCM.0000000000005602
Objectives: Concise definitive review of how to read and critically appraise a systematic review.
Data sources: None.
Study selection: Current literature describing the conduct, reporting, and appraisal of systematic reviews and meta-analyses.
Data extraction: Best practices for conducting, reporting, and appraising systematic review were summarized.
Data synthesis: A systematic review is a review of a clearly formulated question that uses systematic and explicit methods to identify, select, and critically appraise relevant original research, and to collect and analyze data from the studies that are included in the review. Critical appraisal methods address both the credibility (quality of conduct) and rate the confidence in the quality of summarized evidence from a systematic review. The A Measurement Tool to Assess Systematic Reviews-2 tool is a widely used practical tool to appraise the conduct of a systematic review. Confidence in estimates of effect is determined by assessing for risk of bias, inconsistency of results, imprecision, indirectness of evidence, and publication bias.
Conclusions: Systematic reviews are transparent and reproducible summaries of research and conclusions drawn from them are only as credible and reliable as their development process and the studies which form the systematic review. Applying evidence from a systematic review to patient care considers whether the results can be directly applied, whether all important outcomes have been considered, and if the benefits are worth potential harms and costs.
Copyright © 2022 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.
Conflict of interest statement
Dr. Hill’s institution received funding from Fresenius Kabi and the Medical Faculty Rheinisch-Westfälische Technische Hochschule Aachen; she received funding from Fresenius Kabi. The remaining authors have disclosed that they do not have any potential conflicts of interest.
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- Djulbegovic B, Guyatt GH: Progress in evidence-based medicine: A quarter century on. Lancet 2017; 390:415–423
- Doig GS, Roberts I, Bellomo R: The tens of thousands of lives saved by randomized clinical trials in critical care. Intensive Care Med 2015; 41:701–704
- Davidoff F, Haynes B, Sackett D, et al.: Evidence based medicine. BMJ 1995; 310:1085–1086
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- How to Write a Literature Review | Guide, Examples, & Templates
How to Write a Literature Review | Guide, Examples, & Templates
Published on January 2, 2023 by Shona McCombes .
What is a literature review? A literature review is a survey of scholarly sources on a specific topic. It provides an overview of current knowledge, allowing you to identify relevant theories, methods, and gaps in the existing research that you can later apply to your paper, thesis, or dissertation topic .
There are five key steps to writing a literature review:
- Search for relevant literature
- Evaluate sources
- Identify themes, debates, and gaps
- Outline the structure
- Write your literature review
A good literature review doesn’t just summarize sources—it analyzes, synthesizes , and critically evaluates to give a clear picture of the state of knowledge on the subject.
Table of contents
What is the purpose of a literature review, examples of literature reviews, step 1 – search for relevant literature, step 2 – evaluate and select sources, step 3 – identify themes, debates, and gaps, step 4 – outline your literature review’s structure, step 5 – write your literature review, free lecture slides, frequently asked questions, introduction.
- Quick Run-through
- Step 1 & 2
When you write a thesis , dissertation , or research paper , you will likely have to conduct a literature review to situate your research within existing knowledge. The literature review gives you a chance to:
- Demonstrate your familiarity with the topic and its scholarly context
- Develop a theoretical framework and methodology for your research
- Position your work in relation to other researchers and theorists
- Show how your research addresses a gap or contributes to a debate
- Evaluate the current state of research and demonstrate your knowledge of the scholarly debates around your topic.
Writing literature reviews is a particularly important skill if you want to apply for graduate school or pursue a career in research. We’ve written a step-by-step guide that you can follow below.
Writing literature reviews can be quite challenging! A good starting point could be to look at some examples, depending on what kind of literature review you’d like to write.
- Example literature review #1: “Why Do People Migrate? A Review of the Theoretical Literature” ( Theoretical literature review about the development of economic migration theory from the 1950s to today.)
- Example literature review #2: “Literature review as a research methodology: An overview and guidelines” ( Methodological literature review about interdisciplinary knowledge acquisition and production.)
- Example literature review #3: “The Use of Technology in English Language Learning: A Literature Review” ( Thematic literature review about the effects of technology on language acquisition.)
- Example literature review #4: “Learners’ Listening Comprehension Difficulties in English Language Learning: A Literature Review” ( Chronological literature review about how the concept of listening skills has changed over time.)
You can also check out our templates with literature review examples and sample outlines at the links below.
Download Word doc Download Google doc
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See an example
Before you begin searching for literature, you need a clearly defined topic .
If you are writing the literature review section of a dissertation or research paper, you will search for literature related to your research problem and questions .
Make a list of keywords
Start by creating a list of keywords related to your research question. Include each of the key concepts or variables you’re interested in, and list any synonyms and related terms. You can add to this list as you discover new keywords in the process of your literature search.
- Social media, Facebook, Instagram, Twitter, Snapchat, TikTok
- Body image, self-perception, self-esteem, mental health
- Generation Z, teenagers, adolescents, youth
Search for relevant sources
Use your keywords to begin searching for sources. Some useful databases to search for journals and articles include:
- Your university’s library catalogue
- Google Scholar
- Project Muse (humanities and social sciences)
- Medline (life sciences and biomedicine)
- EconLit (economics)
- Inspec (physics, engineering and computer science)
You can also use boolean operators to help narrow down your search.
Make sure to read the abstract to find out whether an article is relevant to your question. When you find a useful book or article, you can check the bibliography to find other relevant sources.
You likely won’t be able to read absolutely everything that has been written on your topic, so it will be necessary to evaluate which sources are most relevant to your research question.
For each publication, ask yourself:
- What question or problem is the author addressing?
- What are the key concepts and how are they defined?
- What are the key theories, models, and methods?
- Does the research use established frameworks or take an innovative approach?
- What are the results and conclusions of the study?
- How does the publication relate to other literature in the field? Does it confirm, add to, or challenge established knowledge?
- What are the strengths and weaknesses of the research?
Make sure the sources you use are credible , and make sure you read any landmark studies and major theories in your field of research.
You can use our template to summarize and evaluate sources you’re thinking about using. Click on either button below to download.
Take notes and cite your sources
As you read, you should also begin the writing process. Take notes that you can later incorporate into the text of your literature review.
It is important to keep track of your sources with citations to avoid plagiarism . It can be helpful to make an annotated bibliography , where you compile full citation information and write a paragraph of summary and analysis for each source. This helps you remember what you read and saves time later in the process.
To begin organizing your literature review’s argument and structure, be sure you understand the connections and relationships between the sources you’ve read. Based on your reading and notes, you can look for:
- Trends and patterns (in theory, method or results): do certain approaches become more or less popular over time?
- Themes: what questions or concepts recur across the literature?
- Debates, conflicts and contradictions: where do sources disagree?
- Pivotal publications: are there any influential theories or studies that changed the direction of the field?
- Gaps: what is missing from the literature? Are there weaknesses that need to be addressed?
This step will help you work out the structure of your literature review and (if applicable) show how your own research will contribute to existing knowledge.
- Most research has focused on young women.
- There is an increasing interest in the visual aspects of social media.
- But there is still a lack of robust research on highly visual platforms like Instagram and Snapchat—this is a gap that you could address in your own research.
There are various approaches to organizing the body of a literature review. Depending on the length of your literature review, you can combine several of these strategies (for example, your overall structure might be thematic, but each theme is discussed chronologically).
Chronological
The simplest approach is to trace the development of the topic over time. However, if you choose this strategy, be careful to avoid simply listing and summarizing sources in order.
Try to analyze patterns, turning points and key debates that have shaped the direction of the field. Give your interpretation of how and why certain developments occurred.
If you have found some recurring central themes, you can organize your literature review into subsections that address different aspects of the topic.
For example, if you are reviewing literature about inequalities in migrant health outcomes, key themes might include healthcare policy, language barriers, cultural attitudes, legal status, and economic access.
Methodological
If you draw your sources from different disciplines or fields that use a variety of research methods , you might want to compare the results and conclusions that emerge from different approaches. For example:
- Look at what results have emerged in qualitative versus quantitative research
- Discuss how the topic has been approached by empirical versus theoretical scholarship
- Divide the literature into sociological, historical, and cultural sources
Theoretical
A literature review is often the foundation for a theoretical framework . You can use it to discuss various theories, models, and definitions of key concepts.
You might argue for the relevance of a specific theoretical approach, or combine various theoretical concepts to create a framework for your research.
Like any other academic text , your literature review should have an introduction , a main body, and a conclusion . What you include in each depends on the objective of your literature review.
The introduction should clearly establish the focus and purpose of the literature review.
Depending on the length of your literature review, you might want to divide the body into subsections. You can use a subheading for each theme, time period, or methodological approach.
As you write, you can follow these tips:
- Summarize and synthesize: give an overview of the main points of each source and combine them into a coherent whole
- Analyze and interpret: don’t just paraphrase other researchers — add your own interpretations where possible, discussing the significance of findings in relation to the literature as a whole
- Critically evaluate: mention the strengths and weaknesses of your sources
- Write in well-structured paragraphs: use transition words and topic sentences to draw connections, comparisons and contrasts
In the conclusion, you should summarize the key findings you have taken from the literature and emphasize their significance.
When you’ve finished writing and revising your literature review, don’t forget to proofread thoroughly before submitting. Not a language expert? Check out Scribbr’s professional proofreading services !
This article has been adapted into lecture slides that you can use to teach your students about writing a literature review.
Scribbr slides are free to use, customize, and distribute for educational purposes.
Open Google Slides Download PowerPoint
A literature review is a survey of scholarly sources (such as books, journal articles, and theses) related to a specific topic or research question .
It is often written as part of a thesis, dissertation , or research paper , in order to situate your work in relation to existing knowledge.
There are several reasons to conduct a literature review at the beginning of a research project:
- To familiarize yourself with the current state of knowledge on your topic
- To ensure that you’re not just repeating what others have already done
- To identify gaps in knowledge and unresolved problems that your research can address
- To develop your theoretical framework and methodology
- To provide an overview of the key findings and debates on the topic
Writing the literature review shows your reader how your work relates to existing research and what new insights it will contribute.
The literature review usually comes near the beginning of your thesis or dissertation . After the introduction , it grounds your research in a scholarly field and leads directly to your theoretical framework or methodology .
A literature review is a survey of credible sources on a topic, often used in dissertations , theses, and research papers . Literature reviews give an overview of knowledge on a subject, helping you identify relevant theories and methods, as well as gaps in existing research. Literature reviews are set up similarly to other academic texts , with an introduction , a main body, and a conclusion .
An annotated bibliography is a list of source references that has a short description (called an annotation ) for each of the sources. It is often assigned as part of the research process for a paper .
Cite this Scribbr article
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McCombes, S. (2023, January 02). How to Write a Literature Review | Guide, Examples, & Templates. Scribbr. Retrieved March 19, 2023, from https://www.scribbr.com/dissertation/literature-review/
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Critical Appraisal
Use this guide to find information resources about critical appraisal including checklists, books and journal articles.
Key Resources
- Approach to research in 3 steps
- Critical appraisal checklists
- Worksheets for appraising systematic reviews, diagnostics, prognostics and RCTs. View page
- A free online for both healthcare staff and patients; four modules of 30–45 minutes provide an introduction to evidence based medicine, clinical trials and Cochrane Evidence. View page
- The PRISMA flow diagram depicts the flow of information through the different phases of a literature review. It maps out the number of records identified, included and excluded, and the reasons for exclusions. View page
- A useful resource for methods and evidence in applied social science. View page
- A comprehensive database of reporting guidelines. Covers all the main study types. View page
- A tool to assess the methodological quality of systematic reviews. View page
- Chapter 5 covers critical appraisal of the literature. View this eBook
- Borrow from RCN Library services
- Chapter 6 covers assessing the evidence base. Borrow from RCN Library services
- Section 1 covers an introduction to critical appraisal. Section 3 covers appraising difference types of papers including qualitative papers and observational studies. View this eBook
- Chapter 2 covers critical thinking and chapter 4 covers finding and critiquing literature. View this eBook
- Chapter 6 covers critically appraising the literature. Borrow from RCN Library services
- View this eBook
- Chapter 8 covers critical appraisal of the evidence. View this eBook
- Chapter 18 covers critical appraisal of nursing studies. View this eBook
- Chapter 18 covers critical appraisal of nursing studies. Borrow from RCN Library services
- Chapers 6-8 cover critical appraisal of quantitative and qualitative research. Borrow from RCN Library services
- Chapter 7 covers appraising qualitative research and chapter 18 covers appraising quantitative methods. Borrow from RCN Library services
- Chapter 15 covers weighing the evidence. View this eBook
Book subject search
- Critical appraisal
Journal articles
- View article
Shea BJ and others (2017) AMSTAR 2: a critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions or both, British Medical Journal, 358.
- An outline of AMSTAR 2 and its use for as a critical appraisal tool for systematic reviews. View article (open access)
- View articles
- Journal of Research in Nursing
- Nurse Researcher
- Worldviews on Evidence-based Nursing
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Literature Reviewing
- Getting Started
- Last Updated: Nov 14, 2022 12:01 PM
- URL: https://libguides.napier.ac.uk/litrev
Writing in the Health and Social Sciences: Literature Reviews and Synthesis Tools
- Journal Publishing
- Style and Writing Guides
- Readings about Writing
- Citing in APA Style
- Resources for Dissertation Authors
- Citation Management and Formatting Tools
- What are Literature Reviews?
- Conducting & Reporting Systematic Reviews
- Finding Systematic Reviews
- Tutorials & Tools for Literature Reviews
Systematic Literature Reviews: Steps & Resources
These steps for conducting a systematic literature review are listed below .
Also see subpages for more information about:
- The different types of literature reviews, including systematic reviews and other evidence synthesis methods
- Tools & Tutorials
Literature Review & Systematic Review Steps
- Develop a Focused Question
- Scope the Literature
- Refine & Expand the Search
- Limit the Results
- Download Citations
- Abstract & Analyze
- Create Flow Diagram
- Synthesize & Report Results
1. Develop a Focused Question
Consider the PICO Format: Population/Problem, Intervention, Comparison, Outcome
Focus on defining the Population or Problem and Intervention (don't narrow by Comparison or Outcome just yet!)
"What are the effects of the Pilates method for patients with low back pain?"
Tools & Additional Resources:
- PICO Question Help
- Stillwell, Susan B., DNP, RN, CNE; Fineout-Overholt, Ellen, PhD, RN, FNAP, FAAN; Melnyk, Bernadette Mazurek, PhD, RN, CPNP/PMHNP, FNAP, FAAN; Williamson, Kathleen M., PhD, RN Evidence-Based Practice, Step by Step: Asking the Clinical Question, AJN The American Journal of Nursing : March 2010 - Volume 110 - Issue 3 - p 58-61 doi: 10.1097/01.NAJ.0000368959.11129.79
2. Scope the Literature
A "scoping search" investigates the breadth and/or depth of the initial question or may identify a gap in the literature.
Eligible studies may be located by searching in:
- Background sources (books, POC tools)
- Article databases
- Trial registries
- Grey literature
- Cited reference searching
- Reference lists
When searching, if possible, translate terms to controlled vocabulary of the database. Use text word searching when necessary.
Use Boolean operators to connect search terms:
- Combine separate concepts with AND (resulting in a narrower search)
- Connecting synonyms with OR (resulting in an expanded search)
Search: pilates AND ("low back pain" OR backache )
Download a Boolean worksheet (PDF)
3. Refine & Expand Your Search
Expand your search strategy with synonymous search terms harvested from:
- database thesauri
- reference lists
- relevant studies
Example:
(pilates OR exercise movement techniques) AND ("low back pain" OR backache* OR sciatica OR lumbago OR spondylosis)
As you develop a final, reproducible strategy for each database, save your strategies in a:
- a personal database account (e.g., MyNCBI for PubMed)
- Log in with your NYU credentials
- Open and "Make a Copy" to create your own tracker for your literature search strategies
4. Limit Your Results
Use database filters to limit your results based on your defined inclusion/exclusion criteria. In addition to relying on the databases' categorical filters, you may also need to manually screen results.
- Limit to Article type, e.g.,: "randomized controlled trial" OR multicenter study
- Limit by publication years, age groups, language, etc.
NOTE: Many databases allow you to filter to "Full Text Only". This filter is not recommended . It excludes articles if their full text is not available in that particular database (CINAHL, PubMed, etc), but if the article is relevant, it is important that you are able to read its title and abstract, regardless of 'full text' status. The full text is likely to be accessible through another source (a different database, or Interlibrary Loan).
- Filters in PubMed
- CINAHL Advanced Searching Tutorial
5. Download Citations
Selected citations and/or entire sets of search results can be downloaded from the database into a citation management tool. If you are conducting a systematic review that will require reporting according to PRISMA standards, a citation manager can help you keep track of the number of articles that came from each database, as well as the number of duplicate records.
In Zotero, you can create a Collection for the combined results set, and sub-collections for the results from each database you search. You can then use Zotero's 'Duplicate Items" function to find and merge duplicate records.
- Citation Managers - General Guide
6. Abstract and Analyze
- Migrate citations to data collection/extraction tool
- Screen Title/Abstracts for inclusion/exclusion
- Screen and appraise full text for relevance, methods,
- Resolve disagreements by consensus
Covidence is a web-based tool that enables you to work with a team to screen titles/abstracts and full text for inclusion in your review, as well as extract data from the included studies.
- Covidence Support
- Critical Appraisal Tools
- Data Extraction Tools
7. Create Flow Diagram
The PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) flow diagram is a visual representation of the flow of records through different phases of a systematic review. It depicts the number of records identified, included and excluded. It is best used in conjunction with the PRISMA checklist .
Example from: Stotz, S. A., McNealy, K., Begay, R. L., DeSanto, K., Manson, S. M., & Moore, K. R. (2021). Multi-level diabetes prevention and treatment interventions for Native people in the USA and Canada: A scoping review. Current Diabetes Reports, 2 (11), 46. https://doi.org/10.1007/s11892-021-01414-3
- PRISMA Flow Diagram Generator (Theta Collaborative, U Toronto)
- PRISMA Diagram Templates (Word and PDF)
- Make a copy of the file to fill out the template
- Image can be downloaded as PDF, PNG, JPG, or SVG
- Covidence generates a PRISMA diagram that is automatically updated as records move through the review phases
8. Synthesize & Report Results
There are a number of reporting guideline available to guide the synthesis and reporting of results in systematic literature reviews.
It is common to organize findings in a matrix, also known as a Table of Evidence (ToE).
- Reporting Guidelines for Systematic Reviews
- Download a sample template of a health sciences review matrix (MS Excel)
Steps modified from:
Cook, D. A., & West, C. P. (2012). Conducting systematic reviews in medical education: a stepwise approach. Medical Education , 46 (10), 943–952.
- << Previous: Citation Management and Formatting Tools
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Structure of a Critical Review
Critical reviews, both short (one page) and long (four pages), usually have a similar structure. Check your assignment instructions for formatting and structural specifications. Headings are usually optional for longer reviews and can be helpful for the reader.
Introduction
The length of an introduction is usually one paragraph for a journal article review and two or three paragraphs for a longer book review. Include a few opening sentences that announce the author(s) and the title, and briefly explain the topic of the text. Present the aim of the text and summarise the main finding or key argument. Conclude the introduction with a brief statement of your evaluation of the text. This can be a positive or negative evaluation or, as is usually the case, a mixed response.
Present a summary of the key points along with a limited number of examples. You can also briefly explain the author’s purpose/intentions throughout the text and you may briefly describe how the text is organised. The summary should only make up about a third of the critical review.
The critique should be a balanced discussion and evaluation of the strengths, weakness and notable features of the text. Remember to base your discussion on specific criteria. Good reviews also include other sources to support your evaluation (remember to reference).
You can choose how to sequence your critique. Here are some examples to get you started:
- Most important to least important conclusions you make about the text.
- If your critique is more positive than negative, then present the negative points first and the positive last.
- If your critique is more negative than positive, then present the positive points first and the negative last.
- If there are both strengths and weakness for each criterion you use, you need to decide overall what your judgement is. For example, you may want to comment on a key idea in the text and have both positive and negative comments. You could begin by stating what is good about the idea and then concede and explain how it is limited in some way. While this example shows a mixed evaluation, overall you are probably being more negative than positive.
- In long reviews, you can address each criterion you choose in a paragraph, including both negative and positive points. For very short critical reviews (one page or less), where your comments will be briefer, include a paragraph of positive aspects and another of negative.
- You can also include recommendations for how the text can be improved in terms of ideas, research approach; theories or frameworks used can also be included in the critique section.
Conclusion & References
This is usually a very short paragraph.
- Restate your overall opinion of the text.
- Briefly present recommendations.
- If necessary, some further qualification or explanation of your judgement can be included. This can help your critique sound fair and reasonable.
If you have used other sources in you review you should also include a list of references at the end of the review.
Summarising and paraphrasing for the critical review
The best way to summarise
- Scan the text. Look for information that can be deduced from the introduction, conclusion, title, and headings. What do these tell you about the main points of the article?
- Locate the topic sentences and highlight the main points as you read.
- Reread the text and make separate notes of the main points. Examples and evidence do not need to be included at this stage. Usually they are used selectively in your critique.
Paraphrasing means putting it into your own words. Paraphrasing offers an alternative to using direct quotations in your summary (and the critique) and can be an efficient way to integrate your summary notes.
The best way to paraphrase
- Review your summary notes
- Rewrite them in your own words and in complete sentences
- Use reporting verbs and phrases, e.g. 'The author describes…', 'Smith argues that …'.
- Use quotation marks if If you include unique or specialist phrases from the text.
Next: Some general criteria for evaluating texts
Essay and assignment writing guide.
- Essay writing basics
- Essay and assignment planning
- Answering assignment questions
- Editing checklist
- Structure of a critical review
- General criteria for evaluating
- Sample extracts
- Annotated bibliography
- Reflective writing
- ^ More support
Study Hacks Workshops | All the hacks you need! 13 Feb – 13 Apr 2023
How to Critically Appraise an Article
Jane M Young; Michael J Solomon
Nat Clin Pract Gastroenterol Hepatol. 2009;6(2):82-91.
- Summary and Introduction
- Selection and Critical Appraisal of Research Literature
- Conclusions
- Sidebar: Key Points
Critical appraisal is a systematic process used to identify the strengths and weaknesses of a research article in order to assess the usefulness and validity of research findings. The most important components of a critical appraisal are an evaluation of the appropriateness of the study design for the research question and a careful assessment of the key methodological features of this design. Other factors that also should be considered include the suitability of the statistical methods used and their subsequent interpretation, potential conflicts of interest and the relevance of the research to one's own practice. This Review presents a 10-step guide to critical appraisal that aims to assist clinicians to identify the most relevant high-quality studies available to guide their clinical practice.
Introduction
To practice evidence-based medicine, clinicians need to apply the findings of scientific research to the circumstances of individual patients as part of their clinical decision-making process. Clinicians, therefore, must be able to select and appraise scientific literature that is relevant to their field, understand the implications of research findings for individual patients, elicit patients' own preferences and develop an appropriate management plan based on the combination of this information. Each of these tasks presents its own challenges, but the sheer volume of medical literature means that the first step (that of selecting and appraising scientific evidence) can be daunting. The number of new medical research articles published each year continually increases, and more than 12,000 new articles, including papers on in excess of 300 randomized controlled trials (RCTs), are added to the MEDLINE database each week. [ 1 , 2 ] One practical way that clinicians can manage this 'information overload' [ 2 ] is to develop efficient skills in critical appraisal, which enable them focus on only the highest-quality studies that will guide their clinical practice and to extrapolate information when necessary from studies of less rigorous design if high-quality trials are unavailable.
Critical appraisal has been defined as the "...application of rules of evidence to a study to assess the validity of the data, completeness of reporting, methods and procedures, conclusions, compliance with ethical standards, etc. The rules of evidence vary with circumstances." [ 3 ] Although the methodological criteria by which the validity of a study is assessed will vary according to its design, some general principles underpin the evaluation of any research study. Various guidelines and assessment tools have been developed to provide a structured approach to the process of critical appraisal for clinicians. [ 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 ]
Despite the plethora of documents available to guide the process, no 'gold-standard' instrument for critical appraisal exists. The criteria used to assess the validity and relevance of scientific literature are not static; they must evolve with improvements in understanding of the important sources of bias inherent in different study designs, and increased awareness of the potential influence of other nonmethodological factors, such as conflicts of interest. [ 15 ] A structured approach to critical appraisal could potentially improve the quality of this process, and simple checklists can be useful to screen out research that is of low quality or of little relevance. [ 16 ] This Review presents a guide to the critical-appraisal process.
Nat Clin Pract Gastroenterol Hepatol. 2009;6(2):82-91. © 2009 Nature Publishing Group
Cite this: How to Critically Appraise an Article - Medscape - Feb 01, 2009.
Authors and Disclosures
Jane M Young is an Associate Professor of Public Health and the Executive Director of the Surgical Outcomes Research Centre at the University of Sydney and Sydney South-West Area Health Service, Sydney, and Michael J Solomon is Head of the Surgical Outcomes Research Centre and Director of Colorectal Research at the University of Sydney and Sydney South-West Area Health Service, Sydney, Australia. Competing Interests: The authors declared no competing interests.
Critical appraisal is a systematic process used to identify the strengths and weaknesses of a research article
Critical appraisal provides a basis for decisions on whether to use the results of a study in clinical practice
Different study designs are prone to various sources of systematic bias
Design-specific, critical-appraisal checklists are useful tools to help assess study quality
Assessments of other factors, including the importance of the research question, the appropriateness of statistical analysis, the legitimacy of conclusions and potential conflicts of interest are an important part of the critical appraisal process
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Sample Essay On Critical Appraisal Guidelines
Type of paper: Essay
Topic: Study , Information , Theory , Hypothesis , Psychology , Treatment , Therapy , Nursing
Published: 03/08/2023
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CRITICAL APPRAISAL GUIDELINES:
QUANTITATIVE STUDY Research Problem and Purpose Is the problem significant and relevant to nursing? Why? Problem Yes, the problem statement is stated clearly. It is relevant in nursing since it concerns therapy for pets.
Does the purpose narrow and clarify the focus or aim of the study?
The purpose has been narrowed. It has two key purposes; one is for the comparison concerning reaction before and after therapy and the second purpose seeks to see the experience during pet therapy.
Literature Review
Does the literature review provide a rationale and direction for the study? The study provides previous literature on how it is beneficial to intensive care patients. Further, the study has a defined direction on the preliminary support and keen research on the topic (Coakley & Mahoney, 2009, p.141). Is there a theoretical framework for the study? Is it presented with clarity and linked to study purpose, variables and findings? Yes, it focuses on the linkage between practical work and the literature. It connects the variable and the findings of the research.
Research Question or Hypothesis
Are the questions or hypotheses logically linked to study purpose? The hypothesis stated seek to proof any claim through data analysis and its interpretations. The hypothesis are either labeled valid or invalid.
Are variables clearly defined based on previous research or theories? Variables used are well defined to stay in line with the purpose of the study alongside the theories stated.
Does the design provide a means to examine all of the objectives, questions or hypotheses and study purpose? Yes, a pre-quasi experimental design was utile on a single group mixed with other methods If the study had a treatment, is it consistently implemented? No, treatment was not implemented consistently since the sample size was subjected to different conditions.
Who is blinded to the treatment, subjects, data collectors, researchers? Data collectors
If the study has treatment and comparison groups, are these groups equal? Yes, groups used are equal measurements, for example, time and set questionnaires.
Sample, Population and Setting
What are potential biases in sampling method? No, all sample sizes was devoid of any potential bias. Is sample size sufficient to avoid Type II error? Yes, it is defined to counter any error. Was sample size determined by a power analysis? No, it was determined based on eligibility. Are the rights of human subjects protected? Yes, the researches sought the patients consent and excluded those who were hemodynamically unstable.
Measurements
Are the measurement methods clearly described? Yes, all the parameters were clearly defined. Are the reliability and validity of instruments described? Yes, all were conducted on each scale and arranged from a0.70 to 0.92.
Data Collection
Is data collection process conducted in a consistent manner? Yes, it is done based on the designed made to achieve clear results. Are the data collection methods ethical? Yes, the researchers had obtained approval from Institutional review board. The methods observed all ethical measures during the collection of data.
Data Analyses
Do data analyses address each objective, question or hypothesis? Yes, based on sample characteristics the data analysis touches on each hypothesis used. Are the data analysis procedures appropriate to the type of data analyzed? Yes, the researchers followed every detail (Coakley & Mahoney, 2009, p.142).
Are tables and figures used to illustrate findings? Yes, clear tables and figures show results of the experiments.
Interpretation of Findings Are the findings significant or insignificant? The findings are significant considering the outcome in which the subjects reported an improved level of pain Did the researchers identify limitations? Yes, limitations included convenience of the sample, absence of control groups and small subject’s numbers (Coakley & Mahoney, 2009, p.145).
Are the implications for practice consistent with study conclusions? Yes, the desired outcome was achieved.
Are relevant ideas provided for future research? No, there was no suggestion for further research.
Coakley, A. B., & Mahoney, E. K. (2009). Creating a therapeutic and healing environment with a pet therapy program. Complementary therapies in clinical practice, 15, 141-146. doi:10.1016/j.ctcp.2009.05.004.
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- Joanna Smith 1 ,
- Helen Noble 2
- 1 School of Healthcare, University of Leeds , Leeds , UK
- 2 School of Nursing and Midwifery, Queens's University Belfast , Belfast , UK
- Correspondence to Dr Joanna Smith , School of Healthcare, University of Leeds, Leeds LS2 9JT, UK; j.e.smith1{at}leeds.ac.uk
http://dx.doi.org/10.1136/eb-2015-102252
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Implementing evidence into practice requires nurses to identify, critically appraise and synthesise research. This may require a comprehensive literature review: this article aims to outline the approaches and stages required and provides a working example of a published review.
Are there different approaches to undertaking a literature review?
What stages are required to undertake a literature review.
The rationale for the review should be established; consider why the review is important and relevant to patient care/safety or service delivery. For example, Noble et al 's 4 review sought to understand and make recommendations for practice and research in relation to dialysis refusal and withdrawal in patients with end-stage renal disease, an area of care previously poorly described. If appropriate, highlight relevant policies and theoretical perspectives that might guide the review. Once the key issues related to the topic, including the challenges encountered in clinical practice, have been identified formulate a clear question, and/or develop an aim and specific objectives. The type of review undertaken is influenced by the purpose of the review and resources available. However, the stages or methods used to undertake a review are similar across approaches and include:
Formulating clear inclusion and exclusion criteria, for example, patient groups, ages, conditions/treatments, sources of evidence/research designs;
Justifying data bases and years searched, and whether strategies including hand searching of journals, conference proceedings and research not indexed in data bases (grey literature) will be undertaken;
Developing search terms, the PICU (P: patient, problem or population; I: intervention; C: comparison; O: outcome) framework is a useful guide when developing search terms;
Developing search skills (eg, understanding Boolean Operators, in particular the use of AND/OR) and knowledge of how data bases index topics (eg, MeSH headings). Working with a librarian experienced in undertaking health searches is invaluable when developing a search.
Once studies are selected, the quality of the research/evidence requires evaluation. Using a quality appraisal tool, such as the Critical Appraisal Skills Programme (CASP) tools, 5 results in a structured approach to assessing the rigour of studies being reviewed. 3 Approaches to data synthesis for quantitative studies may include a meta-analysis (statistical analysis of data from multiple studies of similar designs that have addressed the same question), or findings can be reported descriptively. 6 Methods applicable for synthesising qualitative studies include meta-ethnography (themes and concepts from different studies are explored and brought together using approaches similar to qualitative data analysis methods), narrative summary, thematic analysis and content analysis. 7 Table 1 outlines the stages undertaken for a published review that summarised research about parents’ experiences of living with a child with a long-term condition. 8
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An example of rapid evidence assessment review
In summary, the type of literature review depends on the review purpose. For the novice reviewer undertaking a review can be a daunting and complex process; by following the stages outlined and being systematic a robust review is achievable. The importance of literature reviews should not be underestimated—they help summarise and make sense of an increasingly vast body of research promoting best evidence-based practice.
- ↵ Centre for Reviews and Dissemination . Guidance for undertaking reviews in health care . 3rd edn . York : CRD, York University , 2009 .
- ↵ Canadian Best Practices Portal. http://cbpp-pcpe.phac-aspc.gc.ca/interventions/selected-systematic-review-sites / ( accessed 7.8.2015 ).
- Bridges J , et al
- ↵ Critical Appraisal Skills Programme (CASP). http://www.casp-uk.net / ( accessed 7.8.2015 ).
- Dixon-Woods M ,
- Shaw R , et al
- Agarwal S ,
- Jones D , et al
- Cheater F ,
Twitter Follow Joanna Smith at @josmith175
Competing interests None declared.
Read the full text or download the PDF:
IMAGES
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COMMENTS
Tools for Critical Appraisal Now, that you have found articles based on your research question you can appraise the quality of those articles. These are resources you can use to appraise different study designs. Critical Appraisal Tools Centre for Evidence Based Medicine (Oxford) Evidence-Based Practice (EBP) checklists University of Glasgow
Critical appraisal—the heart of evidence-based practice—involves four phases: rapid critical appraisal, evaluation, synthesis, and recommendation. This article reviews each phase and provides examples, tips, and caveats to help evidence appraisers successfully determine what is known about a clinical issue.
Critical Appraisal Checklists by specific Study Design type Randomized Controlled Trials ROB 2.0 Risk Of Bias Tool There are 3 variations of the tool based on trial design. Choose the appropriate version. 1. Individually randomized, parallel group trials (traditional RCT) 2.
Most importantly: Read your article / book as many times as possible, as this will make the critical review much easier. Contents 1. Read and take notes 2. Organising your writing 3. Summary 4. Evaluation 5. Linguistic features of a critical review 6. Summary language 7. Evaluation language 8. Conclusion language 9.
This example shows how a literature review from a PhD thesis can be analysed for its structure, purpose and content. Three sections of the thesis are analysed to show the: relationship between the introduction and the literature review structure and purpose of dedicated literature review chapters
What is critical appraisal? "A process of carefully and systematically examining research to judge its trustworthiness, value, and relevance in a particular context" [1] . Just because a study is the 'best' type of study for the clinical question, you cannot necessarily be confident of the study conclusions.
Critical appraisal is an important element of evidence-based medicine. The five steps of evidence-based medicine are: 1. asking answerable questions, i.e. formulating questions into a format whereby you can interrogate the medical literature and hopefully find an answer - to do this, you may use the PICO tool, which helps to
The critical appraisal of the research studies facilitates in distinguishing between the useful and flawed studies. 5 The online databases contain substantial resources of peer-reviewed...
Critical appraisal - Best Practice for Literature Searching - LibGuides at IFIS Best Practice for Literature Searching For the sciences of food and health Deciding what to include in your review through critical appraisal Once you have narrowed down your pool of results, it's time to begin critically appraising your articles.
example) depends upon the intended use of the review. In the context of field studies, remember that an overreliance on the literature can stifle creativity and may produce an overly deductive approach. Let the literature guide you, not rule you. Tips on doing a critical literature review Finding usable literature:
Critical appraisal allows us to: reduce information overload by eliminating irrelevant or weak studies identify the most relevant papers distinguish evidence from opinion, assumptions, misreporting, and belief assess the validity of the study assess the usefulness and clinical applicability of the study recognise any potential for bias.
Critical appraisal methods address both the credibility (quality of conduct) and rate the confidence in the quality of summarized evidence from a systematic review. The A Measurement Tool to Assess Systematic Reviews-2 tool is a widely used practical tool to appraise the conduct of a systematic review.
Examples of literature reviews Step 1 - Search for relevant literature Step 2 - Evaluate and select sources Step 3 - Identify themes, debates, and gaps Step 4 - Outline your literature review's structure Step 5 - Write your literature review Free lecture slides Frequently asked questions Introduction Quick Run-through Step 1 & 2 Step 3 Step 4
Section 1 covers an introduction to critical appraisal. Section 3 covers appraising difference types of papers including qualitative papers and observational studies. Casey D, Clark L and Hayes S (2017) Study skills for master's level students: a reflective approach for health and social care. 2nd edn.
Home; Steps for Conducting a Lit Review; Finding "The Literature" Organizing/Writing; APA Style; Chicago (Author-Date) Toggle Dropdown Turabian ; MLA Style; Sample Literature Reviews
Critically Appraise - Literature Reviewing - LibGuides at Edinburgh Napier University Literature Reviewing Getting Started Search Write This page is not currently available due to visibility settings. Last Updated: Nov 14, 2022 12:01 PM URL: https://libguides.napier.ac.uk/litrev Login to LibApps Subjects:
Example: Covidence is a web-based tool that enables you to work with a team to screen titles/abstracts and full text for inclusion in your review, as well as extract data from the included studies. Tools & Additional Resources: Covidence. Covidence Support; Critical Appraisal Tools; Data Extraction Tools
Present a summary of the key points along with a limited number of examples. You can also briefly explain the author's purpose/intentions throughout the text and you may briefly describe how the text is organised. ... The length of your summary for a critical review should only be about one quarter to one third of the whole critical review ...
This review article presents a 10-step guide to the critical appraisal of research literature to assist clinicians in identifying relevant, high-quality studies to guide their clinical practice.
Good Essay About Critical Literature Review Type of paper: Essay Topic: Nursing, Aliens, Study, Surgery, Medicine, Stay, Disaster, Recovery Pages: 11 Words: 3250 Published: 01/29/2021 ORDER PAPER LIKE THIS Abstract Early ambulation is now recognised as an intervention that confers many positive benefits to patients following cardiac surgery.
Literature Review. Does the literature review provide a rationale and direction for the study? The study provides previous literature on how it is beneficial to intensive care patients. Further, the study has a defined direction on the preliminary support and keen research on the topic (Coakley & Mahoney, 2009, p.141).
Example: Critical Review of a Journal Article Article: Carroll, J. (2002). Play Therapy: the children's views, Child and Family Social Work, 7, pg 177-187 ... Carroll's literature review highlights how children's experiences of play therapy remained largely unexamined. Referring to previous research, Carroll highlights methodological ...
A literature review is a . overview of a particular topic. It generally follows a discussion of the . paper's thesis statement or the study's goals or purpose. look at what has been said on the topic and by whom. *This sample paper was adapted by the UAGC Writing Center from Key, K. L., Rich, C., DeCristofaro, C., & Collins, S. (2010).
Implementing evidence into practice requires nurses to identify, critically appraise and synthesise research. This may require a comprehensive literature review: this article aims to outline the approaches and stages required and provides a working example of a published review. Literature reviews aim to answer focused questions to: inform professionals and patients of the best available ...