Critical Appraisal and Its Strength and Weaknesses

CRITICAL APPRAISAL
Name of the Student:
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Author note:
2500 words

Introduction
The purpose of the critical appraisal is to lessen the burden and focus on the chosen articles
which draw relevance to the research question. It will also reliably align or refute its claims with high-
quality evidences and recognize extensive investigation to the domain of public health (Elwood 2017).
Most importantly, the purpose of the appraisal is to critically recognize the strengths as well as
weaknesses of the study articles to evaluate strengths and weaknesses of research results. It will
essentially improve the healthcare professionals’ understanding to determine if the research evidence
is completely free of bias as well as applicable to health conditions of public (Lensink et al. 2016). The
main sections of the appraisal will include purpose, methodology, sampling, results and bias if any.
Tool Selection
The Critical Appraisal Skills Programme (CASP) primarily helps in developing an evidence-based
methodology in the domain of health as well as social care, engaged with local as well as national as
well as global associations. CASP mainly intends to help scholars improve skills of identifying and
developing understanding of research evidence and enabling those to systematically put on evidence in
practice (CASP 2018). The most advantageous part of CASP tool is it comprises of seven appraisal
tools where each of the seven appraisal tool contains 10-12 questions. If the initial two questions are
screening questions and if the responses are yes to both, it can be advanced with the remaining
questions in order to evaluate the study.
However, a disadvantage of using CASP tool can be its reliance on the lack of external validation.
CASP tool might seek external use and evaluation to wholly understand ways in which it is applied by
non-specialists (Sui et al. 2017).
Critical appraisal
How and why does discretionary food consumption change when we promote fruit and
vegetables? Results from the ShopSmart randomised controlled trial
1. Yes, the trial has addressed a clearly concentrated on issue on change of discretionary food
consumption during promotion of fruit and vegetables. The article has focused on the average health
diet quality of Western population by taking into account rate of 35% of Australians consuming
energy from discretionary food consumption (Opie et al. 2019). Also, it draws data of around 86% of
the population who eats more than the suggested limit of discretionary preferences. However, Grieger
et al (2016) has conducted dietary intervention strategies on wide population range of 2-65 years old to
obtain an extensive understanding of discretionary food consumption.
2. A series of intervention have been provided to successfully promote fruit and vegetables intake.
Trials focused at adults generating low income have reported impacts starting from nearly +0·42 to

+1·1 portions of fruits and vegetables regular basis. Additionally, evaluations included 225 women
(116 interventions and 109 controls).
Meanwhile, linear regression analysis has been related to controls with intervention participants
expended less discretionary foods at intervention completion (Johnson, Hendrie and Golley 2016).
Lensink
Yes, the trial has been conducted with the use of a computer-generated block randomisation sequence,
generated as well as executed by an autonomous statistician who included blocks of 2 as well as 4 in
different permutations.
Furthermore, 248 women employed via Coles Flybuys loyalty card database has been randomly
assigned to behavioural intervention (n 124) or the control (n 124). It is clear that participant
recruitment have been incorporated in the analysis (Opie et al. 2019).
3. The 6 months intervention did not stop midway. The study included RCT design along with reduced
attrition rates. It revealed that ShopSmart intervention successfully attracted as well as retained women
of low socio-economic position.
4. Yes, health workers as well as study personnel have been ‘blind’ to the treatment applications as the
linear regression model have examined intervention results on discretionary food usage while half-
longitudinal mediator research aimed to study the probable mediating impact of individual as well as
environmental factors.
5. Yes, the article continued with similar participants from the beginning of the trail. The RCT was
conducted on 225 women categorizing 116 for intervention and 109 for control. The study aimed at
low socio-economic positioned women as they are seen as chief determinants for buying food products
or dealing with food products in households.
On the other hand, Sui et al. (2017) conducted study on Australian adults aged more than 19 years with
nearly one 24 hours dietary recall and weight along with height have been included in the study
aligning with Australian population.
6. Yes, apart from experimental intervention, the groups have treated similarly as analyses involved
225 women divided 116 for interventions and 109 controls.
7. Yes, the treatment effect was large where ranging from baseline to intervention accomplishment
within intervention group participants significant improvements have been studied for consumption of
aggregated discretionary foods and individual discretionary food items.
The result measured 95% of Confidence Interval (CI). This implies that for future studies on similar
subject there can be expected 95% of certainty containing the true mean of the population.
However, the primary outcome was not clearly specified. Study has mentioned that food behavioural
patterns showed complexity and thus cannot be taken out from other factors of structures like social
institutions with additional environment. Moreover, interventions like stealth have underlined
inducements for the development of behavioural change instead of focusing on primary outcome of
personal factors.

Linear regression analysis revealed comparisons with regulations where intervention participants ate
reduced level of discretionary food items during accomplishment of intervention. Additionally, four
out of the eleven possible intermediary variables have been revealed to be linked with the outcome as
well as independence of intervention group which considered food preferences and choices.
Nevertheless, no proper evidence has been found regarding outcomes mediating intervention results (P
> 0·05).
8. From Independent Variable (IV) to Mediator CI has been measured to be 95%, from Mediator to
Independent Variable CI has been measured to be 95%, while for direct effect of intervention
accomplishment Independent Variable to Direct Variable is also 95%. Lastly, same rate of CI has
measured in indirect effect from Independent Variable to Mediator and to Direct Variable or outcome.
9. Yes, the results can be functional to local population as the measures chiefly focused on
discretionary foods particularly lessening the consumption of discretionary foods. This will be
advantageous on other measures of potential mediating factors like social factors of restraining food
preferences.
10. Findings of the study clinically considered uncertain weight reductions of around 5 to 10% of body
weightiness while adding to the significance of health advantages. However, as compared to author,
the chosen article should have focused on an optimisation of a series of ecological effects will augment
the effect of prospective public fitness intermediations to recover child nutrition value.
11. Yes, the aids of the study worth the costs as it incorporated RCT design with reduced attrition rates
thus explaining that ShopSmart intervention effectively involved as well as engaged women of low
socio-economic place who are typically challenging to make participation in any study.
Lived experience of blood glucose selfmonitoring among pregnant women with gestational
diabetes mellitus: A phenomenological research
1. Yes there is a clear statement of aims of the study which intends to search as well as analyse lived
involvements of blood glucose self-monitoring amongst pregnant Thai women suffering from
gestational diabetes mellitus (GDM) (Youngwanichsetha and Phumdoung 2017).
The aim is highly investigative as diabetes is a public health issue across the world. The incidence of
gestational diabetes mellitus among pregnant women is elevating across the world fluctuating by age
as well as ethnicity. As per studies, in the United States, the pervasiveness of GDM is 8.5% where 2-
6% of women in the UK detected with GDM Thus, the subject draw great relevance as pregnant
women with GDM show high propensity of developing adverse pregnancy as well as child birth
outcomes.
2. Yes, the qualitative research for the chosen study is appropriate as the study focused on subjective
actions of showing concern regarding diabetes as well as blood testing, efforts of controlling it and
showing tolerance for the child.

Qualitative research has been conducted through in-depth interview which primarily focused on the
lived experiences which have broaden the understanding of the complex understanding in
understanding behavioural pattern of the participants.
3. Yes, the research design is suitable in addressing the objectives of the investigation. This study has
been directed in the settings of antenatal care units with diabetes hospitals and obstetric sections of two
government health organization located in Southern Thailand. Additionally, data collection methods
have been sanctioned by the Institutional Review Boards in addition to ethics boards of the Faculty of
Nursing and Faculty of Medicine, Prince of Songkla University in addition to particular hospices
located in southern Thailand. It clearly mentioned to evaluate qualitative data with Colaizzi method.
4. Cannot tell whether the recruitment strategy of the study is appropriate to purpose of the research.
While, 30 women participants have been approached with GDM during 24 -30 week gestation as well
as interviewed through semi-structured interview guides with extensive effort of establishing rapport
before conducting the interview. Participants were initially approached by staff nursing professionals
with informed consent gathered by research teams.
However, Youngwanichsetha and Phumdoung (2017) have failed to provide detailed explanation of
essential aspects of participants’ relevance to offer understanding of GDM within pregnant women.
There cannot be found any discussion around recruitment in the chosen study.
5. Yes, the information of data collection clearly addressed the research issue. The setting included
antenatal care units, diabetes health center in addition to obstetric divisions of two government health
organizations located in southern Thailand known as the appointment centres delivering
unconventional administration of pregnancy problematical with GDM. Additionally, the setting can be
considered appropriate as it can gather best subjective experiences of pregnant women in blood
glucose self-monitoring as well as utilization of blood glucose levels.
Data has been mainly collected through in-depth interviews with semi-structured interview monitors
interval of 30-45 minutes of each interview.
Youngwanichsetha and Phumdoung (2017) have been successful in providing explanation of selection
of phenomenology study to gather understanding of lived experiences of regnant Thai women
suffering from gestational diabetes mellitus. It has been selected to gain comprehensive understanding
of target population in self-monitoring of blood glucose (Neubauer, Witkop and Varpio 2019).
Furthermore, reliability of the study is improved using operational methods of continued commitment,
triangulation of data as well as field minutes.
The research method is explicit with triangulation of data collection with interview data as well as
evaluation of records in BGSM log book. On the other hand, Cosson et al. (2017) extracted data from
the electronic medical records declared to the French-dedicated committee.
There were no modifications found in methodology during the research study.
The form of data of the chosen article includes prolonged participation, triangulation of data and field
notes. On the other hand, Zhang et al. (2016) impact of various dosage of Vitamin D supplements on

pregnant women with GDM have been analysed through Randomized Control Trial on 133 pregnant
women suffering from GDM during 24th-29th week of pregnancy.
Youngwanichsetha and Phumdoung (2017) mentioned about team of researchers who participated in
the research for period of 6 months until attainment of data saturation.
6. Cannot tell if the author critically analysed own role and there cannot be found any factor of
potential bias. It has mentioned recruitment of 30 pregnant women suffering with gestational diabetes
in Thailand.
No indications of changes have been seen in the research design.
7. Yes, Youngwanichsetha and Phumdoung (2017) have emphasized on ethical considerations with
informed consent taken by researcher teams. Twedt et al. (2015) have also considered similar ethical
issues by registering pregnant women in Magee Women’s Hospital after attaining documented
informed approval.
Also, the study has been sanctioned by Institutional Review Boards besides ethics groups of the
Faculty of Nursing as well as Faculty of Medicine, Prince of Songkla University as well as nominated
hospitals in southern Thailand.
Similar to Zhang et al. (2016), the chosen research has been accepted by Institutional Review Boards
as well as ethics groups of the Faculty of Nursing and Faculty of Medicine.
8. Cannot tell whether authors have provided rigorous data analysis with in-depth explanation of the
analysis development. However, research contains developed themes related to awareness as well as
implication of self-monitoring of blood glucose amongst pregnant women with GDM
However, at antenatal clinics as well as obstetric regions, registered nurses or diabetes nurse mentors
must evaluate the view of BGSM in pregnant women suffering from GDM.
There is an absence of contradictory data in the study. The study should have also drawn relevance of
effects of exercise in comparison to insulin therapy Harrison et al. (2016).
9. Cannot tell if there are adequate findings on evidence due to lack of arguments. However, the
themes as well as sub -themes have been legalized by peer questioning and member inspection with
five participants.
While, there is a link with original research question which purposed to investigate lived experiences
of target population with findings categorized in themes and sub-themes.
10. Cannot tell if the research is valuable as combination of qualitative studies must be directed to
support the findings for further study.
However, on the other hand, new areas have been identified as it emphasizes on attaining good
glycaemic control for preventing diabetes issues during pregnancy and newborns.
Since the study focuses on only 30 pregnant women suffering from gestational diabetes in Thailand, it
will not align with other target populations.

Ethical issues
An important ethical issue concerns with the suitable length of follow-up for the gathering of protected
data subsequent to the research. Another ethical issue takes place when researchers decide to stop
midway as favourable efficacy tends to reduce potential safety information. On the other hand, clinical
investigators face ethical challenges while adhering to the protocol study design and conducting
ethically suitable informed consent methods. Furthermore, transparency of trial conduct is also
challenging in clinical study. Use of placebo and deception worries the issue of deception. Meanwhile,
there is a major gap between participants who are visible to the risk of a clinical intervention the trial
participants and those who are identified as the planned beneficiaries of the trial results. In addition to
this, avoidance of bias in any aspect of the study together with design, data analysis, interpretation as
well as peer review is important to avoid ethical challenges.
At this juncture, it is imperative to note that research conducted by Sununta Youngwanichsetha and
Phumdoung (2017) has been sanctioned by Institutional Review Boards as well as ethics committees
of the Faculty of Nursing and Faculty of Medicine.
The study by Opie et al. (2019) is conducted as per regulations set by Declaration of Helsinki besides
all measures concerning human subjects have been sanctioned by the Deakin University Faculty of
Health Human Ethics Advisory Group. Additionally, written informed consensus has been gathered
from all participants which included 225 women categorized 116 women for intervention and 109 for
control. In addition to this, the trail conducted by Opie et al. (2019) contained a 3 month retrospective
baseline data collection period which involved reclamation of information for a 3-month retrospective
period. This period is evaluated after the participants have been listed and gave approval to the
research with a subsequent 6-month intervention period as well as an extra 6-month no-intervention
development period.
Similar consent has been taken by Youngwanichsetha and Phumdoung (2017) who initially
approached the participants and sought for their participation which has been performed by staff
nurses. After receiving informed consent from the participants, 30 pregnant women with GDM in their
24th to 30th week gestation have been registered for the research.
Summary of the appraised papers
Research of Youngwanichsetha and Phumdoung (2017) fundamentally purposed to investigate and
analyse the survived experiences of using blood glucose self-monitoring by pregnant Thai women
diagnosed with GDM. Since majority of women in their pregnancy are diagnosed with GDM, this
study has drawn great relevance to the importance of using blood glucose self-monitoring method. The
research provided thematic analysis which included information on experiences of pregnant women
doing blood testing, showing resistance towards monitoring diabetes level and showing patience for
delivery. Target population of 30 Thai pregnant women learnt methods of finger pricking to test their
blood and glucometer testing. The study explored elevating concerns of pregnant women regarding

their own health. The article has made good use of former studies which have revealed major
reduction in glycosylated haemoglobin (HbA 1c) as well as development of glycaemic control
amongst type 1 as well as type 2 diabetic persons using BGSM. The article is appropriate as it can be
used to provide pathways in nursing field for evaluating perception as well as responses in using
glucose self-monitoring to recover attainment of good glycaemic control amongst pregnant women
with gestational diabetes mellitus.
Opie et al. (2018) primarily aimed to distinguish if discretionary food ingesting dropped in an
intervention concentrated on endorsing fruit as well as vegetable ingestion. It also draws emphasis on
identifying possible mediators describing intervention impacts on discretionary food intake. The
research has focused on RCT by data gathered from ShopSmart which comprised of 6 months
intervention supporting intake of fruit and vegetables. While, Opie et al. (2018) failed to identify
certain mediators, the study has been successful in explicitly illustrating behavioural intervention
amongst socio-economically underprivileged participants in decreasing discretionary food eating and
has drawn great effectiveness. Thus, to attain further study continual investigation on factors behind
discretionary food consumption changes with consumption of fruits and vegetables.

References
CASP, U., 2018. CASP checklists. Critical Appraisal Skills Programme (CASP) Oxford: CASP UK.
Cosson, E., Baz, B., Gary, F., Pharisien, I., Nguyen, M.T., Sandre-Banon, D., Jaber, Y., Cussac-
Pillegand, C., Banu, I., Carbillon, L. and Valensi, P., 2017. Poor reliability and poor adherence to self-
monitoring of blood glucose are common in women with gestational diabetes mellitus and may be
associated with poor pregnancy outcomes. Diabetes care, 40(9), pp.1181-1186.
Elwood, M., 2017. Critical appraisal of epidemiological studies and clinical trials. Oxford University
Press.
Grieger, J.A., Wycherley, T.P., Johnson, B.J. and Golley, R.K., 2016. Discrete strategies to reduce
intake of discretionary food choices: a scoping review. International Journal of Behavioral Nutrition
and Physical Activity, 13(1), p.57.
Harrison, A.L., Shields, N., Taylor, N.F. and Frawley, H.C., 2016. Exercise improves glycaemic
control in women diagnosed with gestational diabetes mellitus: a systematic review. Journal of
physiotherapy, 62(4), pp.188-196.
Johnson, B.J., Hendrie, G.A. and Golley, R.K., 2016. Reducing discretionary food and beverage intake
in early childhood: a systematic review within an ecological framework. Public health nutrition, 19(9),
pp.1684-1695.
Lensink, M.F., Velankar, S., Kryshtafovych, A., Huang, S.Y., Schneidman‐Duhovny, D., Sali, A.,
Segura, J., Fernandez‐Fuentes, N., Viswanath, S., Elber, R. and Grudinin, S., 2016. Prediction of
homoprotein and heteroprotein complexes by protein docking and template‐based modeling: A CASP‐
CAPRI experiment. Proteins: Structure, Function, and Bioinformatics, 84, pp.323-348.
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Y., Levy, J.C., Loerup, L. and Rivero-Arias, O., 2018. Comparing the efficacy of a mobile phone-
based blood glucose management system with standard clinic care in women with gestational diabetes:
randomized controlled trial. JMIR mHealth and uHealth, 6(3), p.e71.
Marcus, G., 2018. Deep learning: A critical appraisal. arXiv preprint arXiv:1801.00631.
Neubauer, B.E., Witkop, C.T. and Varpio, L., 2019. How phenomenology can help us learn from the
experiences of others. Perspectives on Medical Education, 8(2), pp.90-97.
Opie, R.S., McNaughton, S.A., Crawford, D., Abbott, G. and Ball, K., 2019. How and why does
discretionary food consumption change when we promote fruit and vegetables? Results from the
ShopSmart randomised controlled trial. Public Health Nutrition, pp.1-10.
Sui, Z., Wong, W.K., Louie, J.C.Y. and Rangan, A., 2017. Discretionary food and beverage
consumption and its association with demographic characteristics, weight status, and fruit and
vegetable intakes in Australian adults. Public health nutrition, 20(2), pp.274-281.

Twedt, R., Bradley, M., Deiseroth, M.D., Althouse, A. and Facco, F., 2015. Sleep duration and blood
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p.326.
Youngwanichsetha, S. and Phumdoung, S., 2017. Lived experience of blood glucose self‐monitoring
among pregnant women with gestational diabetes mellitus: a phenomenological research. Journal of
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Appendix
CASP Checklist: 10 questions to help you make sense of a Qualitative research
How to use this appraisal tool: Three broad issues need to be considered when appraising a
qualitative study:
Are the results of the study valid? (Section
A) What are the results? (Section
B) Will the results help locally? (Section
C)
The 10 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. Qualitative) Checklist. [online]
Available at: URL. Accessed: Date Accessed.
©CASP this work is licensed under the Creative Commons Attribution – Non-Commercial-
Share A like. To view a copy of this license, visit http://creativecommons.org/licenses/by-
nc- sa/3.0/ www.casp-uk.net
Critical Appraisal Skills Programme (CASP) part of Oxford Centre for Triple Value Healthcare Ltd www.casp-uk.net

Is it worth continuing?
Section A: Are the results valid?
2
Paper for appraisal and reference: ...............................................................................................................
1. Was there a clear
statement of the
aims of the
research?
2. Is a
qualitative
methodolo
gy
appropriat
e?
Yes
Can’t
Tell
No
Yes
Can’t
Tell
No
HINT: Consider
• what was the goal of the
research
• why it was thought important
• its relevance
HINT: Consider
 If the research seeks to
interpret or illuminate the actions
and/or subjective experiences of
research participants
Is qualitative research
the right methodology for
addressing the
research goal
Comments:
Comments:

3
3. Was the research
design
appropriate to
address the aims
of the research?
Ye
s
Can’t
Tell
No
HINT: Consider
• if the researcher has
justified the research design
(e.g. have they discussed how
they decided which
method to use)
Comments:

4
4. Was the
recruitment
strategy
appropriate to the
aims of the
research?
Ye
s
Can’t
Tell
No
HINT: Consider
 If the researcher has explained how
the
participants were selected
 If they explained why the
participants they selected
were the most appropriate to
provide access to the type of
knowledge sought by the
study
 If there are any discussions
around recruitment (e.g.
why some people
chose not to take part)
5. Was the data
collected in a way
that addressed the
research issue?
Ye
s
Can’t
Tell
No
HINT: Consider
• If the setting for the data collection
was
justified
• If it is clear how data were
collected (e.g. focus group,
semi-structured interview
etc.)
• If the researcher has justified the
methods
chosen
• If the researcher has made the
methods explicit (e.g. for
interview method, is there an
Comments:

5
indication of how
interviews are
conducted, or did
they use a topic
guide)
 If methods
were
m
o
di
fi
e
d
d
ur
ing the study. If so, has
the researcher
explained how and why
 If the form of data is clear
(e.g. tape recordings, video
material, notes etc.)
 If the researcher has discussed
saturation of data
Comments:

Section B: What are the results?
6
6. Has the
relationship
between
researcher and
participants been
adequately
considered?
Ye
s
Can’t
Tell
No
HINT: Consider
 If the researcher
critically examined their own role,
potential bias and influence
during (a) formulation of the
research questions (b) data
collection, including sample
recruitment and choice of
location
 How the researcher
responded to events
during the study and
whether they considered
the implications of any
changes in the
research design
7. Have ethical issues
been taken into
consideration?
Ye
s
Can’t
Tell
No
Comments:

7
H
I
N
T
:
C
o
n
s
i
d
e
r
 If
there
are
sufficien
t details
of how
the
research
was
explaine
d to
participa
nts for
the reader to assess whether ethical
standards were maintained
 If the researcher has
discussed issues raised by the
study (e.g. issues around
informed consent or
confidentiality or how they have
handled the effects of the study
on the participants during and
after the
study)
 If approval has been sought from
the ethics committee
Comments:

8
8. Was the data
analysis
sufficiently
rigorous?
Ye
s
Can’t
Tell
No
HINT: Consider
 If there is an in-depth description of
the
analysis process
 If thematic analysis is used. If so,
is it clear how the
categories/themes were derived
from the data
 Whether the researcher explains
how the data presented were
selected from the original sample
to demonstrate the analysis
process
 If sufficient data are presented to
support
the findings
 To what extent contradictory data are
taken into account
 Whether the researcher critically
examined their own role, potential
bias and influence during analysis
and selection of data for
presentation
9. Is there a clear
statement of
findings?
Ye
s
Can’t
Tell
No
Comments:

9
HINT: Consider whether
 If the findings are
explici
t
 If there is adequate
discussion of the
evidence both for
and against the
researcher’s
arg
um
ent
s
 If
the
rese
arch
er
has discussed the credibility of
their findings (e.g. triangulation,
respondent validation, more
than one analyst)
 If the findings are discussed in
relation to
the original research question
Comments:

1
0
r e g y t
-
e
h
y
r
o
r
d
Section C: Will the results help
locally?
10. How valuable
is the research?
HINT: Conside
 If the researcher
discusses th contribution the
study makes to existin
knowledge or understanding
(e.g. do the consider the findings
in relation to curren practice or
policy, or relevant research
based literatur
 If they identify new areas where researc
is necessar
 If the researchers have
discussed whethe or how the
findings can be transferred t
other populations or considered
othe ways the research may be
use
Comments:

1
1
CASP Checklist: 11 questions to help you make sense of a Randomised Controlled
Trial
How to use this appraisal tool: Three broad issues need to be considered when appraising a
trial:
Are the results of the study valid? (Section
A) What are the results? (Section
B) Will the results help locally? (Section
C)
The 11 questions on the following pages are designed to help you think about these issues
systematically. The first three 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.

1
2
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. Randomised Controlled Trial) Checklist.
[online] Available at: URL. Accessed: Date Accessed.
©CASP this work is licensed under the Creative Commons Attribution – Non-Commercial-
Share A like. To view a copy of this license, visit http://creativecommons.org/licenses/by-
nc- sa/3.0/ www.casp-uk.net
Critical Appraisal Skills Programme (CASP) part of Oxford Centre for Triple Value Healthcare Ltd www.casp-uk.net

Section A: Are the results of the trial valid?
2
Paper for appraisal and reference:............................................................................................................
1. Did the trial address a
clearly focused issue?
2. Was the
assignment of
patients to
treatments
randomised?
3. Were all of the
patients who
entered the trial
pr
op
erl
y
ac
co
un
te
d
for
at
its
co
nc
lu
si
on
?
Yes
Can’t Tell
No
Yes
Can’t Tell
No
Yes
Can’t Tell
No
Comments:
Comments:

3
Is it worth continuing?
HINT: An issue can be
‘focused’ In terms of
• the population studied
• the intervention given
 the comparator given
• the outcomes considered
HINT: Consider
how this
was
carried
out
 was the
alloc
ation
sequ
ence
conc
eale
d
from
rese
archers and patients
HINT: Consider
• was the trial stopped early
• were patients analysed in the groups
to
which they were randomised
Comments:

4
4. Were patients, health
workers and study
personnel ‘blind’ to
treatment?
Yes
Can’t Tell
No
5. Were the groups
similar at the start of
the trial
6. Aside from the
experimental
intervention, were the
groups treated equally?
Yes
Can’t
Tell
No
Yes
Can’t Tell
No
Comments:
Comments:

Section B: What are the results?
5
HINT:
Consider
• ot
her factors
that might affect the outcome,
such as; age, sex, social class
Comments:

Comments:
Section C: Will the results help locally?
6
7. How large was the treatment effect? HINT: Consider
 what outcomes were
measured
 Is the primary outcome clearly
specified
 what results were found for
each outcome
8. How precise was the estimate of the
treatment effect?
HINT:
Consider
 what are the confidence
limits
9. Can the results be
applied to the local
population, or in your
context? 10.Wer
e all
clinic
ally
impo
rtant
outc
ome
s considered?
Comments:
Comments:

7
Yes
Can’t Tell
No
Yes
Can’t Tell
No
HINT:
Consider
whether
 th
e patients
covered
by the
trial are
similar
enough to
the
patients
to whom
you will
apply this
how they
differ
HINT: Consider whether
 there is other information you
would
like to have seen
 if not, does this affect the
decision
Comments:

8
11.Are the benefits
worth the harms and
costs?
Ye
s
Can’t
Tell
No
HINT:
Consider
 even if this is not addressed by
the
trial, what do you think?

Running head: CRITICAL APPRAISAL
Comments: