Critical Appraisal Criteria - Essay Example

? CRITICAL aPPRAISAL TOTAL NUMBER OF WORDS: 3,006 Table of Contents Introduction ............................................................................................................. 3 a. Main Purpose of the Study ....................................................................... 4 b. Research Objectives ................................................................................. 4 c. Research Questions .................................................................................. 4 2. Critical Appraisal Method ....................................................................................... 5 3. Findings .................................................................................................................. 7 4. Discussion .............................................................................................................. 11 5. Conclusion and Recommendations ........................................................................ 12 References .......................................................................................................................... 13 - 14 Appendix I – Sample Checklist Used in the Assessment of Quantitative Studies ............. 15 Appendix II – Actual Assessment of Five (5) Selected Studies - Huber et al. (2011) …... 16 Appendix III – Actual Assessment of Five (5) Selected Studies - Jelsma and Scott (2011) . 18 Appendix IV – Actual Assessment of Five (5) Selected Studies - Lohmann et al. (2011) … 20 Appendix V – Actual Assessment of Five (5) Selected Studies - Mittrach et al. (2008) ….. 22 Appendix VI – Actual Assessment of Five (5) Selected Studies - Soberg et al. (2008) …… 24 1. Introduction As a result of technology advances, a lot of studies have been successfully published in different journals all over the world. However, it is unfortunate that not all studies published in various journals are good in terms of its “validity, results, and relevance” (Hill and Spittlehourse, 2001, p. 1). To ensure that the information taken from each journal is valid and reliable, it is necessary to conduct a critical appraisal before selecting an article or a journal (Fineout-Overholt et al., 2010; Young and Solomon, 2009; Mhaskar et al., 2008). Critical appraisal is basically referring to the “process of carefully and systematically examining research to judge its trustworthiness, and its value and relevance in a particular context” (Burls, 2009). Likewise, critical appraisal is considered as a systematic process which enables the researcher to identify the strengths and weaknesses of each research article (Young and Solomon, 2009). In other words, the main purpose of conducting a critical appraisal is to be able to point out and identify all minor or major flaws which can be found in each research study that has been printed on academic or non-academic journals. As part of conducting a critical appraisal, it is necessary to look at not only the context of the research study but also the research method used, the process in which the primary or secondary research has been conducted, and the way in which the researcher(s) were able to analyze the research findings before coming up with a study conclusion (Fineout-Overholt et al., 2010; Young and Solomon, 2009; Mhaskar et al., 2008). Today, there are quite a lot of different techniques which can be used in conducting a critical appraisal (National Collaborating Centre for Methods and Tools, 2011; Kmet, Lee and Cook, 2004). For example, the Critical Appraisal Skills Programme (CASP) has been widely used as a tool when critically appraising research studies that are related to public health (National Collaborating Centre for Methods and Tools, 2011). Composed of seven (7) different checklists for systematic reviews, case control studies, randomized controlled trials (RCTs), diagnostic test studies, qualitative research, economic evaluation studies, and cohort studies, the CASP tool was purposely designed and developed in order to educate health care professionals and other researchers on how they can effectively appraise the quality and validity of the existing research studies (National Collaborating Centre for Methods and Tools, 2011). Aside from the CASP tools, HTA initiative # 13 entitled “Standard Quality Assessment Criteria for Evaluating Primary Research Papers from a Variety of Fields” was also designed and published to guide people on how to properly and effectively appraise existing research studies (Kmet, Lee and Cook, 2004). 1.1 MAIN PURPOSE OF THE STUDY The main purpose of this study is to make full use of the “Standard Quality Assessment Criteria” as written by Kmet, Lee and Cook (2004) when critically appraising a total of five (5) different articles concerning the use of International Classification of Functioning (ICF) when examining the patients’ “physical, social, and psychological environment” (Mittrach, et al., 2008, p. 151). 1.2 RESEARCH OBJECTIVES The main research objective of this study is to be able to adopt and apply the “Standard Quality Assessment Criteria for Evaluating Primary Research Papers” as proposed by Kmet, Lee and Cook (2004). 1.3 RESEARCH QUESTIONS The method used in conducting a critical appraisal is an integral part of all research studies. Purposely derived from the checklist for the assessment of quantitative studies, this study will seek to address the following research questions: 1. Were the research questions and/or research objectives clearly described? 2. Did the researchers use appropriate research design? 3. Did the researchers appropriately describe the method used in group selection? 4. Did the researchers clearly describe the characteristics of each group as the subject of the study? 5. Did the researchers describe the process of random allocation? 6. Did the researchers report any blinding technique applied on the part of the researchers? 7. Did the researchers report any blinding technique applied on the part of the researcher participants? 8. Was the research findings or outcomes well defined? 9. Was the sample size sufficient to avoid sampling error? 10. Was the analytical method used in the study appropriate? 11. Did the researchers mention the estimate of variance in the report? 12. Was the study controlled for confounding? 13. Was the research findings or outcomes reported in full detail? 14. Was the conclusion of the study well supported by the research findings? 2. CRITICAL APPRAISAL METHODS Before conducting a critical appraisal, it is important to select articles that study or examine a single research topic. In this study, the five (5) selected articles talks about the application and analysis of ICF when examining the patients’ “physical, social, and psychological environment” (Mittrach, et al., 2008, p. 151). In line with this, the five (5) chosen articles are as follows: Huber, E., Tobler, A., Gloor-Juzi, T., Grill, E. and Gubler-Gut, B. (2011). The ICF as a way to specify goals and to assess the outcome of physiotherapeutic interventions in the acute hospital. Journal of Rehabilitation Medicine, 43, pp. 174-177. Jelsma, J. and Scott, D. (2011). Impact of using the ICF framework as an assessment tool for students in paediatric physiotherapy: A preliminary study. Physiotherapy, 97(2011), pp. 47-54. Lohmann, S., Decker, J., Muller, M., Strobl, R. and Grill, E. (2011). The ICF forms a useful framework for classifying individual patient goals in post-acute rehabilitation. Journal of Rehabilitation Medicine, 43, pp. 151-155. Mittrach, R., Grill, E., Walchner-Bonjean, M., Scheuringer, M., Boldt, C., Huber, E., et al. (2008). Goals of physiotherapy interventions can be described using the International Classi?cation of Functioning, Disability and Health. Physiotherapy, 94(2008), pp. 150–157. Soberg, H., Finset, A., Roise, O. and Buatz-Holter, E. (2008). Identification and comparison of rehabilitation goalsafter multiple injuries: An ICF analysis of the patients', physiotherapists' and other allied profssionals' reported goals. Journal of Rehabilitation Medicine, 40, pp. 340-346. After selecting a set of published literature, the next step is to assess the quality, validity of the research method and study results, and relevance of the study conclusion with the research findings using the quantitative checklist for critical appraisal (Kmet, Lee and Cook, 2004). Eventually, it is necessary to measure the critical appraisal results based on the scoring manual as described by Kmet, Lee and Cook (2004). In line with this, a score of ‘2’ will be allocated to each of the 14 criteria provided that the researchers were able to meet each criteria as written on the checklist whereas a score of ‘1’ and ‘0’ will be given if the researchers have partially met or failed to meet the criteria respectively. Eventually, the sum of all scores will be computed followed by dividing it by the “total possible score” (Kmet, Lee and Cook, 2004, p. 5). (See Appendix I – Sample Checklist Used in the Assessment of Quantitative Studies on page 15) 3. FINDINGS After using the checklist for the critical appraisal of the five (5) chosen articles, findings show that the article that was written by Huber et al. (2011) scored the highest (0.7692). The overall scores in the research study made by Lohmann et al. (2011), Soberg et al. (2008), Jelsma and Scott (2011), and Mittrach et al. (2008) is 0.75, 0.7272, 0.72, and 0.59 respectively. It means that the validity, reliability, and accuracy of the research findings that was presented by Lohmann et al. (2011) is much better as compared to the research findings of Huber et al. (2011), Soberg et al. (2008), Jelsma and Scott (2011), and Mittrach et al. (2008). (See Table I – Summary of Overall Scores on Five (5) Selected Studies below) Table I – Summary of Overall Scores on Five (5) Selected Studies Research Paper Overall Score Huber et al. (2011) 0.7692 Jelsma and Scott (2011) 0.72 Lohmann et al. (2011) 0.75 Mittrach et al. (2008) 0.59 Soberg et al. (2008) 0.7272 The study made by Huber et al. (2011) gained a score of ‘2’ in criteria numbers 3, 4, 8, 10, 12, 13, and 14. Aside from providing a detailed results and conclusion, Huber et al. (2011) gathered a total of 425 participants came from different hospital departments which allowed them to have five (5) different sets of comparison group. On top of being able to fully describe the research method used in selecting qualified research participants as well as the research outcome, Huber et al. (2011) also adopted the use of appropriate research analysis method. Other criterion such as those related to the research questions and objectives, study design, random allocation of research participants, blinding of investigators and subjects, and sample size were all given a score of ‘1’. This explains why the overall score of this article reached a total of 0.7692. (See Appendix II – Actual Assessment of Five (5) Selected Studies - Huber et al. (2011) on page 16) Specifically the research study made by Lohmann et al. (2011) was given the score of ‘2’ in criteria 2, 3, 4, 8, 10, 12, 13, and 14. For criteria 2, the study of Lohmann et al. (2011) was given a score of ‘2’ for the reason that the use of semi-structured questionnaire when conducting a multi-centre cohort study enabled the researcher to capture subjective response from the research participants. With regards to examining improvements in the overall functioning of each participant, more subjective information was gathered in this study. Criteria number 3 is all about the method used in subject or group selection. With regards to this matter, Lohmann et al. (2011) made a comparison based on the condition group, age, and gender. In fact, the researchers mentioned that 35% or 52 out of 116 patients had musculoskeletal problem, 50% or 58 out of 116 patients had neurological problems, and 5% or 6 out of 116 patients had cardiopulmonary problems, etc. (Lohmann et al., 2011). Aside from describing the characteristics of the subjects, the researchers also clearly presented the results of the statistical computation. On top of reporting a detailed results and conclusion, Lohmann et al. (2011) mentioned that even though patients were categorized under two groups (no goals attained vs. at least one goal attained). In general, failure to differentiate the differentiate patients who were able to attain major goals from those who attained minor goals could blur the connection between goal attainments and improved functioning. Therefore, the researchers strongly suggest the need to encourage the patients to identify 1 or 2 goals that are important for them. (See Appendix IV – Actual Assessment of Five (5) Selected Studies - Lohmann et al. (2011) on page 20) The study of Soberg et al. (2008) gained a total score of 0.7272. In line with this, the study that was completed by Soberg et al. (2008) was given a score of ‘2’ for criteria numbers 1, 2, 3, 4, 8, 10, 13, and 14. It means that Soberg et al. (2008) was able to fully described its research objectives and questions, appropriate analysis method, sufficient data to justify the study results, the use of robust measurement strategies and provided a detailed outcome. Soberg et al. (2008) also adopted the use of appropriate research study design. It means that the research method used by Soberg et al. (2008) when it comes to group selection was appropriate. In line with this, Soberg et al. (2008) mentioned that out of the 66 patients, 24 have head injuries, 17 have face injuries, 37 have chest injuries, 21 have abdomen or pelvic injuries, 37 have spine injuries, 31 have upper extremities injuries, and 48 have lower extremities injuries. (See Appendix VI – Actual Assessment of Five (5) Selected Studies - Soberg et al. (2008) on page 24) The study of Jelsma and Scott (2011) was given the overall score of 0.72. In line with this, Jelsma and Scott (2011) was given a score of ‘2’ for criteris number 3, 5, 6, 7, 10, 13, and 14. It means that Jelsma and Scott (2011) was able to use appropriate research method particularly when it comes to group selection, fully described the interventional and random allocation, blinding for investigators and subjects. In line with this, Jelsma and Scott (2011) mentioned that the 23 assessments used in the study were purposely shuffled to ensure that the gathered assessment forms are in random order. Likewise, the researchers shuffled the assessment results of each patient in order to keep their personal identity anonymous on the part of the investigators. In fact, the researchers also mentioned that the students who participated in the study were not informed about the main purpose of the study including the use of the ICF framework (Jelsma and Scott, 2011). Similar to other research studies that were assessed in this report, Jelsma and Scott (2011) was also successful in terms of being able to fully describe the study results. The authors also came up with a highly reliable study conclusion based on the study results (Jelsma & Scott, 2011). For criteria number 1, 2, 4, and 8, the research study of Jelsma and Scott (2011) was given a score of ‘1’. For instance, even though Jelsma and Scott (2011) clearly stated the research objective, the authors failed to provided a set of research questions which could somehow guide them during the process of completing the research study. (See Appendix III – Actual Assessment of Five (5) Selected Studies - Jelsma and Scott (2011) on page 18) The research study of Mittrach et al. (2008) had the lowest score of 0.59. Specficially the study of Mittrach et al. (2008) was given a score of ‘2’ for criteria numbers 2, 3, 4, 10, 13, and 14. Just like any other studies that were assessed in this report, Mittrach et al. (2008) also managed to come up with a detailed results. Likewise, Mittrach et al. (2008) also based the study conclusion from the study results. Mittrach et al. (2008) gained a score of ‘1’ due to the fact that the authors were able to clearly state the study objectives but not the research questions. Other reasons why Mittrach et al. (2008) got the lowest score in the critical assessment process is because of the fact that the authors did not use appropriate sample size in the actual study. Even though the researchers gathered a total of 100 participants, they were divided into three groups based on their health condition (i.e. neurological = 50, cardiopulmonary = 20, and musculoskeletal = 30). This makes the sample size too small to give more reliable research findings. Aside from not providing data concerning the estimated variance or issues related to confounding, Mittrach et al. (2008) did not mention any forms of random allocation or intervention as well as the blinding effects on the part of the investigators and the research participants. (See Appendix V – Actual Assessment of Five (5) Selected Studies - Mittrach et al. (2008) on page 22) 4. DISCUSSION Evidence-based practice (EBP) is defined as “making decisions about behavioural health by integrating the best available research evidence with practitioner expertise and the characteristics of those who will be affected” (Council for Training in Evidence-Based Practice, 2007, p. 1). As a common knowledge, critical appraisal is a significant part of the “evidence-based practice” (Fineout-Overholt et al., 2010, p. 47). Unfortunately, not all health care professionals are knowledgeable when it comes to conducting a critical appraisal. As a result, health care professionals who seek to conduct their own primary research studies are at risks of coming up with a less reliable or misleading research findings. The critical appraisal checklist as suggested by Kmet, Lee and Cook (2004) is useful in terms of enabling the researcher identify the strength and weaknesses of each previous studies. Using the critical appraisal checklist, the researcher will be able to tell whether or not a given study has a well-defined research objectives and research questions, whether or not the selecting research method is appropriate with the main purpose of the research study, whether or not the researchers were able to gather enough research participants which could minimize the risks of getting a misleading statistical research findings, whether ornot the analysis method used is well justified, and whether or not the research study conclusion has been aligned with the main purpose of the study, the research objectives, research method, the gathered secondary data, and the research findings. The use of a small sample size increases the risk of generating bias or misleading statistical data (Carlberg, 2011, p. 74). With this in mind, the use of the checklist as proposed by Kmet, Lee and Cook (2004) will help the researchers take note or avoid quantitative research studies that use a relatively small sample size such as the study that was conducted by Jelsma and Scott (2011). In other words, making it a practice to conduct critical appraisal when conducting a research study will help minimize the risks of inaccurate and unreliable research study result. 5. CONCLUSION AND RECOMMENDATIONS Aside from the CASP tools, it is possible to appraise primary research studies using the Standard Quality Assessment Criteria. Depending on the type of study the researcher would want to appraise, this report highly recommends that each and every researcher should make it a habit to select from either the quantitative or qualitatve checklist as proposed by Kmet, Lee and Cook (2004). Ever since the Internet technology has improved, people all over the world can submit their studies for publication. Unfortunately, not all of the existing studies that are published worldwide contains valid, accurate, and reliable research findings. To reduce the risks of using unreliable research data, each person who wish to make a research study should learn how to conduct critical appraisal. Using either the quantative or qualitative checklist for critical assessment, the researcher will be able to empower themselves in terms of being able to identify a good research study from those that are not highly reliable. In other words, the process of applying the critical appraisal strategy will effectively increase the validity, reliability, and accuracy of their primary and secondary research findings. REFERENCES Burls, A. (2009). What is critical appraisal? In UCL - Critical appraisal of a journal article. [Online] Available at: http://www.ucl.ac.uk/ich/services/library/training_material/critical-appraisal [Accessed 4 October 2013]. Carlberg, C. (2011). Statistical Analysis: Microsoft Excel 2010. US: Pearson Education Inc. Council for Training in Evidence-Based Practice. (2007). In Glicken, M.D. (ed) "Evidence-Based Practice with Emotionally Troubled Children and Adolescents". 2009. London. Academic Press. Fineout-Overholt, E., Melnyk, B., Stillwell, S. and Williamson, K. (2010). Critical Appraisal of the Evidence: Part I. An introduction to gathering, evaluating, and recording the evidence. AJN, 110(7), pp. 47-52. Hill, A. and Spittlehourse, C. (2001, February). What is critical appraisal? Vol. 3, No. 2. [Online] Available at: http://meds.queensu.ca/medicine/obgyn/pdf/what_is/WhatisCriticalAppraisal.pdf [Accessed 4 October 2013]. Huber, E., Tobler, A., Gloor-Juzi, T., Grill, E. and Gubler-Gut, B. (2011). The ICF as a way to specify goals and to assess the outcome of physiotherapeutic interventions in the acute hospital. Journal of Rehabilitation Medicine, 43, pp. 174-177. Jelsma, J. and Scott, D. (2011). Impact of using the ICF framework as an assessment tool for students in paediatric physiotherapy: A preliminary study. Physiotherapy, 97(2011), pp. 47-54. Kmet, L., Lee, R. and Cook, L. (2004). HTA Initiative # 13. Standard Quality Assessment Criteria for Evaluating Primary Research Papers from a Variety of Fields. Alberta: AHFMR. Lohmann, S., Decker, J., Muller, M., Strobl, R. and Grill, E. (2011). The ICF forms a useful framework for classifying individual patient goals in post-acute rehabilitation. Journal of Rehabilitation Medicine, 43, pp. 151-155. Mhaskar, R., Emmanuel, P., Mishra, S., Patel, S., Naik, E. and Kumar, A. (2008). Critical appraisal skills are essential to informed decision-making. Indian Journal of Sexually Transmitted Diseases, 30(2), pp. 112-119. Mittrach, R., Grill, E., Walchner-Bonjean, M., Scheuringer, M., Boldt, C., Huber, E., et al. (2008). Goals of physiotherapy interventions can be described using the International Classi?cation of Functioning, Disability and Health. Physiotherapy, 94(2008), pp. 150–157. National Collaborating Centre for Methods and Tools (2011). Critical appraisal tools to make sense of evidence. Hamilton, ON: McMaster University. [Online] Available at: http://www.nccmt.ca/registry/view/eng/87.html [Accessed 4 October 2013]. Soberg, H., Finset, A., Roise, O. and Buatz-Holter, E. (2008). Identification and comparison of rehabilitation goalsafter multiple injuries: An ICF analysis of the patients', physiotherapists' and other allied profssionals' reported goals. Journal of Rehabilitation Medicine, 40, pp. 340-346. Young, J. and Solomon, M. (2009). How to critically appraise an article. Nature Clinical Practice, 6(2), pp. 82-91. Appendix I – Sample Checklist Used in the Assessment of Quantitative Studies Criteria Yes (2) Partial (1) No (0) N/A 1 Question / objective sufficiently described? 2 Study design evident and appropriate? 3 Method of subject/comparison group selection or source of information/input variables described and appropriate? 4 Subject (and comparison group, if applicable) characteristics sufficiently described? 5 If interventional and random allocation was possible, was it described? 6 If interventional and blinding of investigators was possible, was it reported? 7 If interventional and blinding of subjects was possible, was it reported? 8 Outcome and (if applicable) exposure measure(s) well defined and robust to measurement / misclassification bias? Means of assessment reported? 9 Sample size appropriate? 10 Analytic methods described/justified and appropriate? 11 Some estimate of variance is reported for the main results? 12 Controlled for confounding? 13 Results reported in sufficient detail? 14 Conclusions supported by the results? Source: Kmet, Lee and Cook, 2004, p. 4 Appendix II – Actual Assessment of Five (5) Selected Studies - Huber et al. (2011) Criteria Yes (2) Partial (1) No (0) N/A 1 Question / objective sufficiently described? 11 2 Study design evident and appropriate? 12 3 Method of subject/comparison group selection or source of information/input variables described and appropriate? 23 4 Subject (and comparison group, if applicable) characteristics sufficiently described? 24 5 If interventional and random allocation was possible, was it described? 15 6 If interventional and blinding of investigators was possible, was it reported? 16 7 If interventional and blinding of subjects was possible, was it reported? 17 8 Outcome and (if applicable) exposure measure(s) well defined and robust to measurement / misclassification bias? Means of assessment reported? 2 9 Sample size appropriate? 18 10 Analytic methods described/justified and appropriate? 2 11 Some estimate of variance is reported for the main results? 0 12 Controlled for confounding? 2 13 Results reported in sufficient detail? 2 14 Conclusions supported by the results? 29 Score 14 6 Total Sum 20 Total Possible Sum 26 Summary Score (Total Sum / Total Possible Sum) 0.7692 Appendix III – Actual Assessment of Five (5) Selected Studies - Jelsma and Scott (2011) Criteria Yes (2) Partial (1) No (0) N/A 1 Question / objective sufficiently described? 110 2 Study design evident and appropriate? 111 3 Method of subject/comparison group selection or source of information/input variables described and appropriate? 212 4 Subject (and comparison group, if applicable) characteristics sufficiently described? 113 5 If interventional and random allocation was possible, was it described? 214 6 If interventional and blinding of investigators was possible, was it reported? 215 7 If interventional and blinding of subjects was possible, was it reported? 216 8 Outcome and (if applicable) exposure measure(s) well defined and robust to measurement / misclassification bias? Means of assessment reported? 117 9 Sample size appropriate? 018 10 Analytic methods described/justified and appropriate? 219 11 Some estimate of variance is reported for the main results? 020 12 Controlled for confounding? O21 13 Results reported in sufficient detail? 222 14 Conclusions supported by the results? 223 Score 14 4 Total Sum 18 Total Possible Sum 25 Summary Score (Total Sum / Total Possible Sum) 0.72 Appendix IV – Actual Assessment of Five (5) Selected Studies - Lohmann et al. (2011) Criteria Yes (2) Partial (1) No (0) N/A 1 Question / objective sufficiently described? 124 2 Study design evident and appropriate? 225 3 Method of subject/comparison group selection or source of information/input variables described and appropriate? 226 4 Subject (and comparison group, if applicable) characteristics sufficiently described? 227 5 If interventional and random allocation was possible, was it described? 128 6 If interventional and blinding of investigators was possible, was it reported? 029 7 If interventional and blinding of subjects was possible, was it reported? 030 8 Outcome and (if applicable) exposure measure(s) well defined and robust to measurement / misclassification bias? Means of assessment reported? 231 9 Sample size appropriate? 032 10 Analytic methods described/justified and appropriate? 233 11 Some estimate of variance is reported for the main results? 034 12 Controlled for confounding? 235 13 Results reported in sufficient detail? 236 14 Conclusions supported by the results? 237 Score 16 2 Total Sum 18 Total Possible Sum 24 Summary Score (Total Sum / Total Possible Sum) 0.75 Appendix V – Actual Assessment of Five (5) Selected Studies - Mittrach et al. (2008) Criteria Yes (2) Partial (1) No (0) N/A 1 Question / objective sufficiently described? 138 2 Study design evident and appropriate? 239 3 Method of subject/comparison group selection or source of information/input variables described and appropriate? 240 4 Subject (and comparison group, if applicable) characteristics sufficiently described? 241 5 If interventional and random allocation was possible, was it described? 042 6 If interventional and blinding of investigators was possible, was it reported? 043 7 If interventional and blinding of subjects was possible, was it reported? 044 8 Outcome and (if applicable) exposure measure(s) well defined and robust to measurement / misclassification bias? Means of assessment reported? 9 Sample size appropriate? 045 10 Analytic methods described/justified and appropriate? 246 11 Some estimate of variance is reported for the main results? 047 12 Controlled for confounding? 048 13 Results reported in sufficient detail? 249 14 Conclusions supported by the results? 250 Total Score 12 1 Total Sum 13 Total Possible Sum 22 Summary Score (Total Sum / Total Possible Sum) 0.59 Appendix VI – Actual Assessment of Five (5) Selected Studies - Soberg et al. (2008) Criteria Yes (2) Partial (1) No (0) N/A 1 Question / objective sufficiently described? 251 2 Study design evident and appropriate? 252 3 Method of subject/comparison group selection or source of information/input variables described and appropriate? 253 4 Subject (and comparison group, if applicable) characteristics sufficiently described? 254 5 If interventional and random allocation was possible, was it described? 055 6 If interventional and blinding of investigators was possible, was it reported? 056 7 If interventional and blinding of subjects was possible, was it reported? 057 8 Outcome and (if applicable) exposure measure(s) well defined and robust to measurement / misclassification bias? Means of assessment reported? 258 9 Sample size appropriate? 059 10 Analytic methods described/justified and appropriate? 260 11 Some estimate of variance is reported for the main results? 061 12 Controlled for confounding? 062 13 Results reported in sufficient detail? 263 14 Conclusions supported by the results? 264 Total Score 16 0 Total Sum 16 Total Possible Sum 22 Summary Score (Total Sum / Total Possible Sum) 0.7272 Read More