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INTRODUCTION

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The link between research and clinical practice in health professions must be made by those who read reports of completed research. As consumers of research, we have a responsibility to evaluate research reports to determine whether the findings provide sufficient evidence to support the effectiveness of current practices or offer alternatives that will improve patient care. The success of evidence-based practice will depend on how well we incorporate research findings into our clinical judgments and treatment decisions.

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For most of us, it is neither practical nor possible to read the plethora of material presented each month in professional journals. Therefore, the first step in effective reading is to select publications and articles that offer the most useful information. When a particular topic is important to practice, readers should begin by searching for systematic reviews that present an analysis of current knowledge on diagnostic methods or treatment effectiveness (see Chapter 16). Readers may also consider textbooks or traditional narrative review articles that provide basic, often in-depth, information on a topic; however, we must realize that the information is second-hand, presented from the perspective of the textbook or review article author. The problem is one of interpretation; the original research may be misrepresented or inadequately described. Therefore, consumers of research must be able to access the first-hand reports of researchers to judge the merits of their work.

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Critical analysis of a research report is necessary to determine its validity and, thereby, its applicability for clinical decision making. The structure and content elements of research reports have been described in Chapter 33. The purpose of this chapter is to present a practical approach for critically reading and evaluating published literature, describing the kinds of questions readers should ask. Authors may also use this approach to appraise their own manuscripts before submitting them for publication. Although this chapter focuses on the written research report, these principles apply to the evaluation of oral and poster presentations as well. This evaluative process works for purposes of literature review, answering specific clinical questions for evidence-based practice, or just keeping up with progress in an area of interest.

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We will focus this discussion on three areas: trials that test the efficacy of interventions, studies that measure the accuracy of diagnostic/screening tests, and studies that examine the predictive validity of variables for prognosis. Guidelines for evaluating systematic reviews were presented in Chapter 16.

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Through a process of international consensus, specific guidelines have been developed to help authors assess the completeness of their reports of randomized trials and diagnostic accuracy. Known, respectively, as the CONSORT statement (Consolidated Standards of Reporting Trials)1 and the STARD statement (Standards for Reporting of Diagnostic Accuracy),2 these guidelines are composed of checklists and flow diagrams that outline a standard way for researchers to develop their reports. The intent of these statements is ...

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