BackgroundYou are to find minimum of five (5) high-quality peer-reviewed studies related to the
background of your critical appraisal of topic. Please submit them in either APA or AMA format as
well as a screenshot of the first page.
Study #1
Study #2
Study #3
Study #4
Study #5
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Instructions for Critically Appraised Topics (CATs)
A CAT is a standardized, brief summary of research evidence organized around a clinical
question. CATs are intended to provide both a critical summary of primary knowledge sources
(i.e., journal articles) as well as statements regarding the clinical relevance of the results. As such,
they represent a translation of primary knowledge sources into more accessible secondary
knowledge sources, with the ultimate objective of facilitating the transfer of knowledge derived
from published evidence into clinical practice. CATs will represent collaboration between clinicians
and researchers.
Establish a clinical question
The first step of writing a CAT is to formulate a well-developed, clinically-relevant question. The
PICO method is encouraged. Each question should identify the patient population (P), intervention
(I), comparison (C), and outcome assessment (O). For example, the topic being The Longitudinal
Metabolic and Cardiovascular Effects of Weighted Vest Training in Females might include a PICO
question, “Does weighted vest endurance training over six weeks, improve cardiovascular and
metabolic markers in females?” A breakdown of this question might resemble the following:
P: endurance trained females, aged 18-45 years
I: six week endurance training program
C: Either wearing weighted vests or not wearing weighted vests
O: metabolic (blood lactate) and cardiovascular (VO2max and non-invasive estimated
cardiac output) markers
Identify the most current and relevant literature
For most topics, three to five peer-reviewed journal articles should be used for primary knowledge
sources. Additional references may be necessary for the background session. A CAT-specific
literature review should be performed using at least two databases such as PubMed or Google
Scholar. Authors must describe their search terms and inclusion/exclusion criteria in the “search
strategy” section. It is the authors’ responsibility to identify the most current and relevant literature.
CAT consumers are encouraged to identify any pertinent literature that meets this description but
has been overlooked by the original authors or has been published after the CAT.
A forum for this feedback will be part of future plans and will include two mechanisms: 1) CAT
revisions and 2) consumer feedback. CATs are intended to be frequently updated and revised.
Appraise the validity of these articles and identify potential limitations
Recognizing that the consumers of CATs will be predominantly clinicians, authors should identify
those areas where bias may have affected the reported outcomes. In addition, the authors should
address the following:
•
•
•
If similar bias is present in other articles on the same subject
If the outcomes assessed are affected by issues with internal validity
If the results can be generalized to clinical populations
Provide actionable clinical findings
The primary objective of a CAT lies in the synthesis and interpretation of research findings that
can inform daily clinical practice. However, the goal is to summarize what can be learned from the
literature while acknowledging its limits.
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Definitions
Primary knowledge sources: typically, new findings and information are discovered and
communicated in peer-reviewed manuscripts. Therefore, peer-reviewed research articles are
commonly referred to as primary knowledge sources.
Secondary knowledge sources: these are commonly shorter summaries of primary knowledge
sources. An example of a secondary knowledge source is a Critically Appraised Topic (CAT).
Study limitations: all research findings have limitations associated with study design. Limitations
are often considered threats to study validity:
•
Validity refers to a measure’s ability to describe or measure the actual phenomenon of
study. Commonly, three types of validity are described: internal, external, and ecologic
validity.
•
Internal validity deals with the rigor of the study design and assures that the study
measured and captured accurate data about the phenomenon of interest.
•
External validity of a study enables consumers of literature to be confident that a
study’s findings may be generalized and applied to subjects beyond the study sample,
such as clinical populations.
•
Ecologic validity is often confused with external validity. To improve ecologic validity,
attempts are made to make the study measures and environment as similar as possible
to the natural setting (e.g., patient’s home, clinic). The challenge for researchers is in
controlling for extraneous variables that can threaten internal validity.
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Critical Appraisal of Topic Template
CRITICALLY APPRAISED TOPIC TITLE
Author Name(s); Author Affiliation; Corresponding author email(s); Creation Date
Clinical Question: Develop a clinical question that is focused, answerable, and complete. Be
sure to include elements that describe the patient (P), intervention (I), comparison (C), and
outcome (O).
Background: Provide a brief background on the topic related to the clinical question using
citations as appropriate. These citations will often be in addition to the 3-5 studies used to answer
the clinical question.
Search Strategy:
Databases Searched: A minimum of three databases should be searched, one of which
must be either PubMed or Google Scholar.
Search Terms: The search terms should be clear enough to enable reviewers and readers
to replicate your search.
Inclusion/Exclusion Criteria: For example, date range, language, or topic specific
eligibility criteria.
Synthesis of Results: Summarize your review and appraisal of the evidence. Cleary and
succinctly describe key findings and limitations. Details will be included in the evidence table.
Clinical Message: Develop an answer to the focused clinical question based on your review of
the evidence. The clinical message should be stated in a way to encourage clinical
implementation. Acknowledge key limitations of the evidence that may affect use of these findings.
References: For most topics, 3-5 studies should be referenced that address the clinical question.
Additional articles may be cited that support information provided in the background. Citation
format should follow either APA or AMA guidelines.
Evidence Table
Create an evidence table using information from each article you have appraised. You may
add/remove rows and columns (or indicate as “not applicable”). Use Calibri or Times New Roman,
12–‐pt. font in the evidence table.
You can set the orientation to “landscape” for the evidence table if that would assist the visual
presentation of information. The evidence table can extend to multiple pages if needed, use the
“repeat headers” feature to repeat header rows on each page.
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Evidence Table Example
Explanation: 1st
author and year,
reference number
(superscript)
Weinstein, 20131
Population
Describe relevant
characteristics of the
subject population
(e.g., sample size,
age, sex, clinical
characteristics)
242 skeletally
immature patients
with AIS, age 10–‐ 15,
Cobb angle 20–‐ 40
degrees
Study Design
e.g., case report,
crossover,
prospective
randomized
Prospective multi–‐
site trial with
randomized and
preference arms
Intervention
Main clinical strategy
or technique (often an
orthotic or prosthetic
approach) of interest
TLSO with
prescribed wear
time 18 hours per
day
Comparison
The alternative or
Observation
control clinical
without orthotic
strategy or technique
intervention
being compared to the
intervention
Methodology
Brief description of
the research
approach
Author, Year
Author, Year
Author, Year
Curve assessed via
standing x–‐ray
every 6 months
until skeletal
maturity
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Outcomes
Outcomes measures
assessed
Cobb Angle
Key Findings
Summary of results
Bracing group had
72% treatment
success compared
to 48% in
observation.
Subjects who wore
their brace >12.9
hours per day had
90% success
Study Limitations Potential threats to
Did not control for
validity or other
brace design
methodological
decisions that may limit
use of findings in a
clinical setting
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