process of critical appraisal requires us to review all the above aspects
of validity (internal and external) as well as the issue of reliability
steps below show an example of the critical appraisal process, which is the core part of
EBP:
1.We start with a clinical question or problem about some real clinical issue that we need to answer.
2.The question is then put into what is called a PICO format (see box below for
details).
3.The PICO helps us to clarify the issues to be reviewed and develop
the correct search strategies to find the literature by using the
relevant library databases
4.Once we have completed our literature search and found the best
study to review, we can use the steps for critical appraisal to check
its internal and external validity.
5. final step is the clinician's overview of all the evidence from
the literature search, but now includes his/her clinical
experience plus what the patient/client brings to the clinical
relationship
e.g. patient does not want to take NSAIDs for
her arthritis).
steps or questions we use for critical appraisal will differ depending
on what type of study design was used in each of the articles we
find in the literature search
I might be nursing a patient who asks me 'Is glucosamine better
that non-steroid anti-inflammatory drugs (NSAIDs) in treating
arthritis in women like me (>50 years)?'
PICO
Population
the population or patient group you are interested in.
t might be women aged 50 years and over living in rural
areas.
Intervention
relates to the treatment terms or phrases in your question
does a specific drug or type of occupational therapy intervention work?
Comparsion
relates to alternative treatment that you might want to compare
the current intervention with (if this is appropriate to your
question).
the comparison could be another drug or a placebo
Outcome
is about what you trying to accomplish, measure, improve
or affect for your clinical problem or patient.
improved mobility in women with arthritis.
E.g of PICO
P
Pregnant women with type 2 diabetes.
I
Insulin pump therapy.
C
Conventional insulin therapy.
O
Improved management of blood glucose levels.
The prob
A pregnant woman with type 2 diabetes is concerned about the
effect that her current treatment may have on her pregnancy and
unborn child. Her GP has heard that insulin pump therapy may be a
more successful treatment than conventional insulin therapy.
However, the GP wants to get his facts right, so searches the
literature.
The Question
'Are insulin pumps more effective than conventional therapies in
managing type 2 diabetes in pregnant women?'