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PT 741 Principles of Evidence Based Practice

Format for creating CATS (Critically Appraised Topic Sheets) OUTLINE TO CRITICALLY APPRAISE AN INTERVENTION STUDY
Title of the CAT: A concise statement (similar to the clinical bottom line or clinical question) that will be used to catalogue the CAT. Clinical Bottom Line: Provide a concise summary of how the results can be applied, a description of how results will affect clinical decisions or actions. Clinical Scenario: Provide a concise description of the patient case. Include the patients age, gender, and information that is relevant to the clinical question. Clinical Question: This is the question that was developed from the patient case. It includes the elements of PICO: The patient/population, the intervention that is being considered, a comparison (if relevant), and the outcome of interest (generally a change in performance or condition). Search Terms: Describe the search strategy used to obtain the study or studies that are being appraised. Include the search engine and database that was used, and the terms that were entered to locate the articles. Indicate steps and numbers of useful references obtained at each step. Include how you searched using individual terms and then combinations of terms. If you used mapping in OVID, indicate the additional terms that were used for your search. DO NOT only look for full text articles, as the best article to answer your question may not be available. Summary of the Study: Is the evidence about intervention in this study valid? Provide explanations of Yes/No answers as appropriate in three sections: Are the results of the study valid? Are the results meaningful? Will these results help me in caring for my patient? A few questions require a descriptive answer. Is the evidence important? Summarize the results of the study that provide evidence for the effectiveness of the intervention. Provide specific data as appropriate, including means and mean differences, outcomes of statistical tests (t and F ratios are not important, but you may include p values and confidence intervals or other measures of effect size). Odds ratios or other estimates of follow-up may be included. Put data in tabular form to summarize if appropriate. DO NOT just copy tables from the article. Summarize the data that will be important to take away from the study for clinical decision making. Additional Comments: Provide critical comments on the study, including issues related to the sampling, methods, data analysis, quality of discussion and interpretation of results. This is where you should comment on the internal, external, conclusion and statistical validity of the study, possibly referring to some of the Yes/No questions in the summary section. Comment on positive and negative aspects of the study. Include comments on the introduction, discussion and conclusions if relevant. How will these findings influence management of my patient? Indicate how the findings will change your strategies for treating your patient, if at all, and why. SEE SAMPLE:

http://www.med.unc.edu/medicine/edursrc/021198.htm

Critically Appraised Topic (CAT) for an Intervention Study Title: Clinical Bottom Line: Clinical Scenario: Clinical Question: Search History: Summary of Study Are the results of the study valid? Is the study a randomized controlled trial? Yes No If not, what is the design, and how were comparison groups assigned?

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How were the patients selected for the trial? Does this process impact interpretation of results? Were specific inclusion and exclusion criteria provided? Were the intervention and control groups similar at the start of the trial? If there were initial differences, were these adjusted for? Were patients evaluated at more than one point in time? Were data standardized and collected at specific intervals according to a preplanned protocol? Were measurements taken at reasonable time intervals, and were subjects followed for a sufficient time period? Were operational definitions provided for independent and dependent variables, such that they could be replicated? Did the authors provide a rationale for the interventions and measurements used? Were all measures reliable and valid? Are all participants who entered the trial properly accounted for at its conclusion? Were patients analyzed in the groups to which they were initially assigned (intention-to-treat analysis)? Were the groups treated equally (aside from the experimental intervention)? Was everyone involved in the study (subjects, investigators and testers) blind to treatment? Were other factors present that could have affected the outcome? (Was the study internally valid?) Are the results meaningful? Are the results clinically as well as statistically significant? Were appropriate statistical analyses performed? Were the outcomes measured clinically important? Were outcomes addressed in terms of a minimally important clinical change? Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No No No No No No No No No No No No No No No No No Cant tell Cant tell Cant tell Cant tell Cant tell Cant tell Cant tell Cant tell Cant tell Cant tell Cant tell Cant tell Cant tell Cant tell Cant tell Cant tell Cant tell

If a negative outcome, was a power analysis done? Will these results help in caring for my patient? Are the subjects similar to mine? Are the treatment benefits worth the potential harm or cost? Are the authors conclusions valid based on findings? The Evidence

Yes Yes Yes Yes

No No No No

Cant tell Cant tell Cant tell Cant tell

Comments How will these findings influence management of my patient? Citation Appraiser(s): Date of Appraisal:

Townsend,E. (2014,January). Evidence Based Practice for Physical Therapists [Course material]. MGH IHP PT 741.