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Evaluation of systematic reviews of treatment or prevention interventions
  1. Donna Ciliska, RN,Phd1,
  2. Nicky Cullum, RN,Phd2,
  3. Susan Marks, BA,BEd3
  1. 1School of Nursing Faculty of Health Sciences McMaster University Hamilton, Ontario, Canada
  2. 2Centre for Evidence Based Nursing Department of Health Studies University of York York, UK
  3. 3Health Information Research Unit McMaster University, Hamilton, Ontario, Canada

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In a previous article in this series we explained how the critical appraisal of research is an essential step in evidence-based health care because most published research is too poor in quality to be applied to clinical practice.1 Critical appraisal is made easier through the use of quality checklists that can help you to appraise research studies systematically and efficiently. The 3 basic appraisal questions are the same whether the clinical question is about treatment, diagnosis, prognosis, or causation:

  • Are the results of the study valid?

  • What were the results?

  • Will the results help me in caring for my patients?1–,3

The first 2 articles in the EBN users' guide series focused on critical appraisal of primary studies of treatment or prevention.1,2 This guide will deal with critical appraisal of systematic reviews, beginning with a clinical scenario and applying the appraisal questions to the review by Glazener and Evans on the effectiveness of alarm interventions for nocturnal enuresis in children.4

How to critically appraise review articles

Are the results of this systematic review valid?
  • Is this a systematic review of randomised trials?

  • Does the systematic review include a description of the strategies used to find all relevant trials?

  • Does the systematic review include a description of how the validity of individual studies was assessed?

  • Were the results consistent from study to study?

  • Were individual patient data or aggregate data used in the analysis?

What were the results?
  • How large was the treatment effect?

  • How precise is the estimate of treatment effect?

Will the results help me in caring for my patients?
  • Are my patients so different from those in the study that the results don't apply?

  • Is the treatment feasible in our setting?

  • Were all clinically important outcomes (harms as well as benefits considered? …

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