Fillable 12!questions!to!help!you!make!sense!of!a! Three!broad!issues!need!to!be!considered!when!appraising!a! !!Are!the!results!of!the!study!valid?!(Section!A )! !!What!are!the!results?! (Section!B)! Cohort!S

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12!questions!to!help!you!make!sense!of!a! Three!broad!issues!need!to!be!considered!when!appraising!a! !!Are!the!results!of!the!study!valid?!(Section!A )! !!What!are!the!results?! (Section!B)! Cohort!Study How!to!use!this!appraisal!tool:! (Critical Appraisal Skills Programme)

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The 12!questions!to!help!you!make!sense!of!a! Three!broad!issues!need!to!be!considered!when!appraising!a! !!Are!the!results!of!the!study!valid?!(Section!A )! !!What!are!the!results?! (Section!B)! Cohort!S form is 7 pages long and contains:

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CASP!Checklist:
!
12!questions!to!help!you!make!sense!of!a!
Cohort!Study
!
How!to!use!this!appraisal!tool:!
Three!broad!issues!need!to!be!considered!when!appraising!a!
cohort!study:
!
!!Are!the!results!of!the!study!valid?!(Section!A )!
!!What!are!the!results?! (Section!B)!
!!Will!the!results!help!locally?! (Section!C)!
The!12!questions!on!the!following!pages!are!designed!to!help!you!think!about!these!issues!
systematically.!The!first!two!questions!are!screening!questions!and!can!be!answered!quickly.!
If!the!answer!to!both!is!“yes”,!it!is!worth!proceeding!with!the!remaining!questions.!There!is!
some!degree!of!overlap!between!the!questions,!you!are!asked!to!record!a!“yes”,!“no”!or!
“can’t!tell”!to!most!of!the!questions.!A!number!of!italicised!prompts!are!given!after!each!
question.!These!are!designed!to!remind!you!why!the!question!is!important.!Record!your!
reasons!for!your!answers!in!the!spaces!provided.!
About:
!These!checklists!were!designed!to!be!used!as!educational!pedagogic!tools,!as!part!of!a!
workshop!setting,!therefore!we!do!not!suggest!a!scoring!system.!The!core!CASP!checklists!
(randomised!controlled!trial!&!systematic!review)!were!based!on!JAMA!'Users’!guides!to!the!
medical!literature!1994!(adapted!from!Guyatt!GH,!Sackett!DL,!and!Cook!DJ),!and!piloted!with!
health!care!practitioners.!
For!each!new!checklist,!a!group!of!experts!were!assembled!to!develop!and!pilot!the!checklist!
and!the!workshop!format!with!which!it!would!be!used.!Over!the!years!overall!adjustments!
have!been!made!to!the!format,!but!a!recent!survey!of!checklist!users!reiterated!that!the!basic!
format!continues!to!be!useful!and!appropriate.!
Referencing:
!we!recommend!using!the!Harvard!style!citation,!i.e.:!Critical!Appraisal!Skills!
Programme!(2018).!CASP!(insert!name!of!checklist!i.e.!Cohort!Study)!Checklist.![online]!
Available!at:!!URL.!Accessed:!Date!Accessed.!
©CASP!this!work!is!licensed!under!the!Creative!Commons!Attribution!–!Non-Commercial-
Share!A!like.!To!view!a!copy!of!this!license,!visit!http://creativecommons.org/licenses/by-nc-
sa/3.0/!www.casp-uk.net!!
Critical Appraisal Skills Programme (CASP) part of Oxford Centre for Triple Value Healthcare Ltd www.casp-uk.net
2!
Section!A:!Are!the!results!of!the!study!valid?!
1. Did!the!study!address!a!clearl y
focused!issue?
Yes!
HINT:!A!question!can!be!‘focused’ !
in!terms!of!
•
the !population!s tudied
• the!risk!factors!studie d
•
is!it!clear !whether!t h e !s tu d y !t rie d ! to
detect!a!beneficial!or!harmful!effect
•
the !outcomes!considered
Can’t!Tell!
No!
Comments:!
2. Was!the!coho rt!recruite d!in
an!acceptable!way?
Yes!
HINT:!Look!for!selection!bias!which!might!
compromise!the!generalisability!of!the!
findings:!
• was!the!cohort!representative!of!a
defined!population!
• was!there!something!special!about!the
cohort!
• was!everybody!include d !w ho !sh ou ld
have!been!
Can’t!Tell!
No!
Comments:!
Is!it!worth!c o ntin u ing ? !
Paper for appraisal and reference:.........................................................................................................
3!
3. Was!the!exposure!accurately
measured!to!minimise!bias?
Yes!
HINT:!Look!for!measurement!or!
classification!bias:!
•
!did!they!use!subjective!or!objective
measurements!
•
!do!the!measurements!truly!reflect!what
you!want!them!to!(have!they!been!
validated)!
• were!all!the!subjects!classified
into!ex p o s u re ! g ro u p s !u s in g !t h e
same!procedure!
Can’t!Tell!
No!
Comments:!
4. Was!the!outcome!accurately
measured!to!minimise!bias?
Yes!
HINT:!Look!for!measurement!or!
classification!bias:!
•
!did!they!use!subjective!or!objective
measurements!
•
!do!the!measurements!truly!reflect!what
you!want!them!to!(have!they!been!
validated)!
• has!a!reliable!system!been
established!for!detecting!all!the!cases!(for!
me
asuring!disease!occurrence)!
• were!the!measurement
methods!similar!in!the!different!groups!
• were!the!subjects!and/or
the!outcom e !asse sso r!blind ed !to!
exposure!(does!this!matter)!
Can’t!Tell!
No!
Comments:!
4!
5. (a)!Have!the!authors!identified
all!important!confounding
factors?
Yes!
HINT:!
•
!list!the!ones!you!think!might!be
important,!and!ones!the!author!missed!
Can’t!Tell!
No!
Comments:!
5. (b)!Have!they!taken!accou nt!o f
the!confoun ding !facto rs!in!the
des
ign!and/or!analysis?
Yes!
HINT:!
•
look!fo r! re s tr ict io n !in ! d e s ig n ,!a n d
techniques!e .g.!m od elling,!stratified -,!
regression-,!o r !se n s itiv ity !a n a lys is!t o !
correct,!control!or!adju st!for!confounding!
factors!
Can’t!Tell!
No!
Comments:!
6. (a)!Was!the!follow!up!of
subjects!complete!enough ?
Yes!
HINT:!Consider!
•
the!good!or!b ad !effe cts!sh ou ld!ha ve
had!long!enough!to!reveal!
themselve s!
•
the!persons!th at!are !lost!to !follow -up
may!have!different!outcomes!th
an!
those!available!fo r!ass essment!
•
in!an!open!or!dy n a mic!cohor t,!was
there!anything !spe cial!ab ou t!the
outcome!of!the!people!leaving,!or!the!
exposure!of!the!people!entering!the!
cohort!
Can’t!Tell!
No!
6. (b)!Was!the!follow!up!of
subjects!long!enough?
Yes!
Can’t!Tell!
No!
!!
!
!
5!
!
!
!
Comments:!
!
!
!
!
!
Section!B:!What!are!the!results?!
!
!
!
7.!What!are!the!results!of!this!study?!
!
!
!
!
HINT:!Consider! !
• what!are!the!bottom!line!
results!
• have!they!reported!the!rate!o r!
the!proportion !be tw ee n!th e !
exposed/unexposed,!the!
ratio/rate!difference!
• how!strong!is!the!association!
between!exposure!and!
outcome!(RR)!
• what!is!the!absolute!risk!
reduction!(ARR )!
!
Comments:!
!
!
!
!
!
!
8.!How!precise!are!the!results?!
!
HINT:!!!
• look!fo r! th e !r a n g e !of!the!con f id e n c e !
interva ls,! if!g iv e n !
!
Comments:!
!
!
!
!
!
!
!
!
!
!!
!
!
6!
!
9.!Do!you!believe!the!results?!
Yes!
!
!
HINT:!Consider!
• big!effect!is!hard!to!ignore!
• can!it!be!due!to!bias,!chance!or!
confounding!
• are!the!design!and!methods!of!this!
study!sufficiently!flawed!to!make!the!
results!unreliable!
• Bradford!Hills!criteria!(e.g.!time!
sequence,!dose- re spo ns e!grad ient,!
biological!plausibility,!consistency)!
Can’t!Tell!
!
!
No!
!
!
!
!
!
Comments:!
!
Section!C:!Will!the!re sults!help!locally?!
!
10.!Can!the!results!be!applied!to!
the!local!population?!
Yes!
!
!
HINT:!Consider!whether!
• a!cohort!study!was!the!appropriate!
method!to!answer!this!question!
• the!subjects!cov ere d!in!th is!study !co uld!
be!sufficiently!different!from!your!
population!to!cause!concern!
• your!local!setting!is!likely!to!differ!
much!from!that!of!the!study!!
• you!can!quantify!the!local!benefits!and!
harms!
Can’t!Tell!
!
!
No!
!
!
!
!
!
Comments:!
!
!
!
!
11.!Do!the!results!of!this!study!fit!
with!other!available!
evidence?!
Yes!
!
!
!
Can’t!Tell!
!
!
No!
!
!
!
Comments:!
!
!!
!
!
7!
!
12.!What!are!the!implications!of!
this!study!for!practice ? !
Yes!
!
!
HINT:!Consider!
• one!observational!study!rarely!
provides!sufficiently!robust!
evidence!to!recommend!changes!
to!clinical!practice!or!w ithin!he alth !
policy!decision!making!
• for!certain!qu es tion s,!
observational!studies!provide!the!
only!evidence!
• recomm en da tions!fro m !
observational!studies!are!always!
stronger!when!supported!by!oth er!
evidence!
Can’t!Tell!
!
!
No!
!
!
!
!
!
Comments:!!
!
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12questionstohelpyoumakesenseofa Threebroadissuesneedtobeconsideredwhenappraisinga Aretheresultsofthestudyvalid(SectionA ) Whataretheresults (SectionB) CohortStudy Howtousethisappraisaltool: (Critical Appraisal Skills Programme)

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