CASP Checklist: 12 questions to help you make sense of a Cohort Study

How to use this appraisal tool: Three broad issues need to be considered when appraising a
cohort study:

Are the results of the study valid? (Section A)

What are the results? (Section B)
Will the results help locally? (Section C)

The 12 questions on the following pages are designed to help you think about these issues
systematically. The first two questions are screening questions and can be answered quickly.
If the answer to both is “yes”, it is worth proceeding with the remaining questions. There is
some degree of overlap between the questions, you are asked to record a “yes”, “no” or
“can’t tell” to most of the questions. A number of italicised prompts are given after each
question. These are designed to remind you why the question is important. Record your
reasons for your answers in the spaces provided.

About: These checklists were designed to be used as educational pedagogic tools, as part of a
workshop setting, therefore we do not suggest a scoring system. The core CASP checklists
(randomised controlled trial & systematic review) were based on JAMA 'Users’ guides to the
medical literature 1994 (adapted from Guyatt GH, Sackett DL, and Cook DJ), and piloted with
health care practitioners.
For each new checklist, a group of experts were assembled to develop and pilot the checklist
and the workshop format with which it would be used. Over the years overall adjustments
have been made to the format, but a recent survey of checklist users reiterated that the basic
format continues to be useful and appropriate.
Referencing: we recommend using the Harvard style citation, i.e.: Critical Appraisal Skills
Programme (2018). CASP (insert name of checklist i.e. Cohort Study) Checklist. [online]
Available at: URL. Accessed: Date Accessed.

©CASP this work is licensed under the Creative Commons Attribution – Non-Commercial-
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Paper for appraisal and reference:.........................................................................................................
Section A: Are the results of the study valid?

1. Did the study address a clearly Yes √ HINT: A question can be ‘focused’
focused issue? in terms of
Can’t Tell • the population studied
 the risk factors studied
No
• is it clear whether the study tried to
detect a beneficial or harmful effect
• the outcomes considered

Comments:
Penulisan telah menjelaskan sampel dari populasi, jumlah sampel, cara pengumpulan data, alat ukur
uang digunkan, dan alur proses penelitian. Penelitian menuliskan tujuan dan keuntungan yang
diharapkan, faktor risiko dijelaskan pada bagian pembahasan.

2. Was the cohort recruited in Yes √ HINT: Look for selection bias which
an acceptable way? might compromise the generalisability
Can’t Tell of the
findings:
No  was the cohort representative of a
defined population
 was there something special about the
cohort
 was everybody included who should
have been

Comments:
Penelitian menggunakan sample yang sesuai dengan tujuan penelitian, namun tidak dijelaskna group
size dengan individu atau berkelompok. Sample yang dimasukkan adalah pasien kanker dengan
kempoterapi 6 siklus selama 18 minggu

Is it worth continuing?

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3. Was the exposure accurately Yes HINT: Look for measurement or
measured to minimise bias? classification bias:
Can’t Tell √ • did they use subjective or objective
measurements
No • do the measurements truly reflect what
you want them to (have they been
validated)
 were all the subjects classified
into exposure groups using the
same procedure

Comments:
Tidak disebutkan dengan jelas faktor inklusi dan eksklusi yang di gunakan, validitas variable juga tidak
disebutkan. Penggunaan alat ukur kualitas hidup menggunakan FACT-G yang sudah baku diberikan pre
dan post intervensi. Setiap individu atau grup diberikan intervensi yang sama, yaitu; bridge drawing,
“your door” collage, “feelings” printmaking, mandala dan final session sesuai siklus kemoterapi lama
sesi pertemuan 45 menit sampai 2,5 jam

4. Was the outcome accurately Yes HINT: Look for measurement or

measured to minimise bias? classification bias:
Can’t Tell √ • did they use subjective or objective
measurements
No • do the measurements truly reflect what
you want them to (have they been
validated)
 has a reliable system been
established for detecting all the cases (for
measuring disease occurrence)
 were the measurement
methods similar in the different groups
 were the subjects and/or
the outcome assessor blinded to
exposure (does this matter)

Comments:
Sampel yang digunakan adalah 16 dengan karakteristik yang sama, namun criteria inklusi tidak
disebutkan. Alat ukur yang digunakan telas sesuai dengan tujuan penelitian.
Hasil penelitian menunjukan non signifikan, faktor yang memengaruhi salah satunya sample yang kecil.
Penelitian tidak menyebutkan dengan jelas faktpr apa saja yang dapat mempengaruhi hasil untuk
meminimalkan bias.

3

5. (a) Have the authors identified
all important confounding
factors?
Yes
√ HINT:
• list the ones you think might be
Cant tell
important, and ones the author missed
No

Comments:
Perlu ditambahkan faktor inklusi yang jelas untuk menentukan sample, dijelaskan pelaksaan intervensi
dengan grup beserta jumlahnya, diberikan kesimpulan pada paper penelitian

Yes
5. (b) Have they taken account of HINT:
the confounding factors in the • look for restriction in design, and
Can’t Tell
design and/or analysis? √ techniques e.g. modelling, stratified-,
regression-, or sensitivity analysis to
No correct, control or adjust for confounding
factors

Comments:
Design dengan prospektif, non-randomised, Intervensi penelitian diberikan dalam satu kali pertemuan,
alat ukur dilakukan pre dan post intervensi, dalam pengukuran kualitas hidup terdapat empat domain
yang dinilai, yaitu; kesehatan fisik, dukungn keluarga/social, kesehatan emosional, dan functional well-
being. Analisis statistic menggunakan IBM SPSS Statistic version 19.0

Yes HINT: Consider

6. (a) Was the follow up of
subjects complete enough? • the good or bad effects should have
Can’t Tell had long enough to reveal
√ themselves
• the persons that are lost to follow-up
No may have different outcomes than
those available for assessment
• in an open or dynamic cohort, was
there anything special about the
outcome of the people leaving, or the
exposure of the people entering the
cohort
Yes
6. (b) Was the follow up of √
subjects long enough?
Can’t Tell

No

4
Comments:
Intervensi penelitian diberikan selama 40-50 menit sesuai sesi bridge drawing, “your door” collage,
“feelings” printmaking, mandala dan final. Pengukuran kualitas hidup menggunkaan kuesioner
diberikan sebelum dan setelah intervensi dalam satu kali pertemuan. Hasil penelitian memberikan
pengaruh non signifikan. Terdapat 8 sample yang tidak dapat menyelesaikan penelitian, namun tidak
dijelaskan alasanya.

Section B: What are the results?

7. What are the results of this study? HINT: Consider

 what are the bottom line
results
 have they reported the rate or
the proportion between the
exposed/unexposed, the
ratio/rate difference
 how strong is the association
between exposure and
outcome (RR)
 what is the absolute risk
reduction (ARR)

Comments:
Hasil dari penelitian dijelaskan dengan pernyataan dan table sehingga mudah untuk dipahami, hasil
menunjukan pengaruh non tidak signifikan. Penelitian menjelaskan intervensi yang digunakan sampel
yang kurang, tingkat kanker dan jenis kanker yang berbeda diasumsikan sebagai salah satu faktor hasil
penelitian.

8. How precise are the results? HINT:

 look for the range of the confidence
intervals, if given

Comments:
Hasil penelitian menjelaskan bahwa terapi seni pada kualitas hidup pengaruh non signifikan. Skore pre
intervensi 82,3 (95% CI: 75.5, 89.2) dan post intervensi 78.6 (95% CI: 71.1, 85.5) yang artinya
perubahan kualitas hidup -3.7 point (95% CI: -10.7, 3.2, p= 0.27). penelitian menjelaskan bahwa
alternative intervensi dapat menurunkan laporan setiap kemoterapi seperti perubahan mood, nyeri,
dan ansietas selama kemoterapi

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9. Do you believe the results?
Yes Can’t √ HINT: Consider
 big effect is hard to ignore
Tell  can it be due to bias, chance or
confounding
No  are the design and methods of this
study sufficiently flawed to make the
results unreliable
 Bradford Hills criteria (e.g. time
sequence, dose-response gradient,
biological plausibility, consistency)

Comments:
Walaupun hasil penelitian non signifikan, namun telah dijelaskan bagaimana intervensi yang diberikan,
alat ukur yang digunakan telah baku, alur proses penelitian dijelaskan di setiap tahapan, pemilihan
sample dengan 6 siklus kemoterapi, analisis statistik telah dijelaskan dan mudah dipahami

Section C: Will the results help locally?

10. Can the results be applied to Yes √ HINT: Consider whether

the local population?  a cohort study was the appropriate
Can’t Tell method to answer this question
 the subjects covered in this study could
No be sufficiently different from your
population to cause concern
 your local setting is likely to differ
much from that of the study
 you can quantify the local benefits and
harms

Comments:
Penelitian sejenis dengan intervensi yang sama dapat diterapkan di tempat yang berbeda, karena
penderita kanker dengan kemoterapi setiap tahun meningkat, hal ini dapat memperngaruhi kualitas
hidup sehingga intervensi terapi seni dapat dijadikan salah satu pilihan terpai komplementer untuk
mempermudah komunikasi dan penyembuhan kanker

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 11. Do the results of this study fit Yes
with other available √
evidence? Can’t Tell

No

Comments:
Diagnose kanker dan pengobatan kemoterapi dapat mempengaruhi kualitas hidup seseorang. Diberikannya
intervensi terapi seni bertujuan untuk meningkatkan kualitas, penelitian menyebutkan bahwa intervensi ini dapat
mempengaruhi mood, nyeri dan ansietas akibat kemoterapi.

7
 12. What are the implications of
this study for practice?
Can’t Tell
Yes √ HINT: Consider
 one observational study rarely
provides sufficiently robust
evidence to recommend changes
to clinical practice or within health
policy decision making
No
 for certain questions,
observational studies provide the
only evidence
 recommendations from
observational studies are always
stronger when supported by other
evidence

Comments:
Penelitian menjelaskan bahwa intervensi yang digunakan dapat untuk membantu penurunan laporan saat
kemoterapi seperti perubahan mood, nyeri, dan ansietas selama kemoterapi. Asumsi pada penelitian
hasildipengaruhi oleh jumpal sampel yang kecil. Paraktik terapi seni terlah diterapkan dibeberapa
pelaynaan kesehatan dan memberikan dampak positif, sehingga intervensi tersebut dapat
diaplikasikan di tempat lain sesuai dengan kebijakan yang ada.