ARTICLE
Study and citation : ........................................................................................................................
Section A : Is the basic study design valid for a randomised controlled trial ?
A number of quality appraisal checklists have been developed to help readers decide if the paper is worth reading . There are different checklists for each study design . For example , the Critical Appraisal Skills Program ( CASP ) ( https :// www . casp-uk . net / casptools-checklists /) contains checklists for a number of study designs , including the CASP checklist for randomised controlled trials . It contains 11 questions in four sections : Is the basic study design valid for a randomised controlled trial ? ( Section A ); Was the study methodologically sound ? ( Section B ); What are the results ? ( Section C ); Will the results help locally ? ( Section D ) ( Figure 4 shows section A and B ).
Is the paper worth reading ?
• What ’ s the source of the article ( peer-reviewed journal , reputable website , scientific conference )?
• Consider the evidence hierarchy – systematic reviews likely to be higher quality than surveys and opinion pieces
• Is a conflict of interest declared ( even if there is no conflict )?
• Note that critical appraisal checklists ( e . g . CASP checklists ) are available for each study design
1 . Did the study address a clearly focused research question ? CONSIDER :
• Was the study designed to assess the outcomes of an intervention ?
• Is the research question ‘ focused ’ in terms of :
• Population studied
• Intervention given
• Comparator chosen
• Outcomes measured ?
2 . Was the assignment of participants to interventions randomised ? CONSIDER :
• How was randomisation carried out ? Was the method appropriate ?
• Was randomisation sufficient to eliminate systematic bias ?
• Was the allocation sequence concealed from investigators and participants ?
3 . Were all participants who entered the study accounted for at its conclusion ? CONSIDER :
• Were losses to follow-up and exclusions after randomisation accounted for ?
• Were participants analysed in the study groups to which they were randomised ( intention-to-treat analysis )?
• Was the study stopped early ? If so , what was the reason ?
4 .
• Were the participants ‘ blind ’ to intervention they were given ?
• Were the investigators ‘ blind ’ to the intervention they were giving to participants ?
• Were the people assessing / analysing outcome / s ‘ blinded ’?
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Section B : Was the study methodologically sound ?
5 . Were the study groups similar at the start of the randomised controlled trial ? CONSIDER :
• Were the baseline characteristics of each study group ( e . g . age , sex , socio-economic group ) clearly set out ?
• Were there any differences between the study groups that could affect the outcome / s ?
Figure 4 . Sections A and B of the CASP checklist for Randomised Controlled Trials
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4 . Easy ways to keep up to date
In this last section strategies for keeping up to date are presented . It is unrealistic for any health practitioner to stay abreast of all relevant research , much less be able to recall accurately the relevant information on demand . However , all practitioners have a responsibility to try if they are to provide optimal care for clients . The General Medical Council 9 guidance for medical practitioners on keeping up to date states that :
• You must keep your professional knowledge and skills up to date .
• You must regularly take part in activities that maintain and develop your competence and performance .
• You must be familiar with guidelines and developments that affect your work .
• You must keep up to date with , and follow , the law , our guidance and other regulations relevant to your work .
• You must take steps to monitor and improve the quality of your work .
This guidance applies equally to all health practitioners and it is why continuing professional education has been mandated by AHPRA for registered professions and by professional associations for nonregistered ones . Members of ATMS are required to complete 20 points of CPE each year to ensure the ongoing development of skills among natural medicine practitioners .
138 | vol27 | no3 | JATMS