This document provides a worksheet for critically appraising a cohort study. It lists questions to consider regarding the validity of the study results, potential biases, how the study was conducted, and whether the results can be applied to patient care. Key areas examined include how the exposed and non-exposed cohorts were selected and compared, how exposures and outcomes were measured, whether important confounders were adjusted for, and the strengths and limitations of the study. The worksheet is intended to help systematically evaluate a cohort study design.
This document provides a worksheet for critically appraising a cohort study. It lists questions to consider regarding the validity of the study results, potential biases, how the study was conducted, and whether the results can be applied to patient care. Key areas examined include how the exposed and non-exposed cohorts were selected and compared, how exposures and outcomes were measured, whether important confounders were adjusted for, and the strengths and limitations of the study. The worksheet is intended to help systematically evaluate a cohort study design.
This document provides a worksheet for critically appraising a cohort study. It lists questions to consider regarding the validity of the study results, potential biases, how the study was conducted, and whether the results can be applied to patient care. Key areas examined include how the exposed and non-exposed cohorts were selected and compared, how exposures and outcomes were measured, whether important confounders were adjusted for, and the strengths and limitations of the study. The worksheet is intended to help systematically evaluate a cohort study design.
This document provides a worksheet for critically appraising a cohort study. It lists questions to consider regarding the validity of the study results, potential biases, how the study was conducted, and whether the results can be applied to patient care. Key areas examined include how the exposed and non-exposed cohorts were selected and compared, how exposures and outcomes were measured, whether important confounders were adjusted for, and the strengths and limitations of the study. The worksheet is intended to help systematically evaluate a cohort study design.
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CRITICAL APPRAISAL OF A COHORT STUDY
COHORT WORKSHEET
Citation:
Are the results valid?
1. Was there a clearly defined, focused research question? What was the study question?
2. How was the exposed cohort selected?
Was there a well defined selection procedure for inclusion into the cohort? What proportion of eligible subjects was actually included?
3. How was the non exposed cohort
selected? Was this cohort drawn from the same source population as the exposed cohort? Was there a well defined selection procedure for inclusion into the cohort? What proportion of eligible subjects was actually included?
4. How were the main exposures
ascertained? Were the exposures clear, specific and measurable? Any likelihood of exposure misclassification?
5. Was the cohort free of the disease
(outcome) at the start of follow-up? Were only people at risk of the outcome included?
6. Was duration of follow-up adequate (i.e.
long enough for main outcomes to occur)?
7. Was follow-up complete? Were efforts
made to limit the loss to follow-up? What Source: Adapted from 1) Newcastle Ottawa Scale [http://www.ohri.ca/programs/clinical_epidemiology/oxford.htm); 2) 1 Reader’s Guide to Critical Appraisal of Cohort Studies. BMJ 2005 (3 article series); 3) Grimes et al. Lancet 2002;359:341-45; and 4) Guyatt & Rennie. Users’ Guides to the Medical Literature, AMA Press, 2002. Compiled by Madhu Pai [[email protected]] CRITICAL APPRAISAL OF A COHORT STUDY COHORT WORKSHEET
was the rate of attrition and was loss to
follow-up similar in the exposed and non exposed cohorts?
8. What were the primary and secondary
outcomes of the study? How well were the outcomes measured? Was the outcome clear, specific and measurable? Were surrogate outcomes used?
9. Were outcomes measures similarly in
exposed and non exposed cohorts? Was outcome ascertainment influenced by knowledge of the exposure status (i.e. lack of blinding)?
10. How comparable were the exposed and
non-exposed cohorts? Have the authors identified all potentially important confounders? Is there information on how the potential confounders are distributed between the comparison groups? What confounders were adjusted for and was the adjustment adequate? Is residual confounding a concern?
Any other potential biases in this study?
Potential for selection bias?
Potential for information bias?
Source: Adapted from 1) Newcastle Ottawa Scale [http://www.ohri.ca/programs/clinical_epidemiology/oxford.htm); 2) 2
Reader’s Guide to Critical Appraisal of Cohort Studies. BMJ 2005 (3 article series); 3) Grimes et al. Lancet 2002;359:341-45; and 4) Guyatt & Rennie. Users’ Guides to the Medical Literature, AMA Press, 2002. Compiled by Madhu Pai [[email protected]] CRITICAL APPRAISAL OF A COHORT STUDY COHORT WORKSHEET
Potential for confounding?
Was there a clear rationale for the sample
size estimation?
Are the analytic strategies clearly
described? Were the data analytic methods appropriate for the research question and study design?
What are the results?
What are the study results?
1. How strong was the association
between exposure and outcome (e.g. rate ratio or hazard ratio or odds ratio)?
2. How precise was the estimate of the
association (i.e. confidence intervals around the point estimates or p-values)?
Can you apply the results to patient care?
1. Were the study participants similar to the
patient in your practice?
Source: Adapted from 1) Newcastle Ottawa Scale [http://www.ohri.ca/programs/clinical_epidemiology/oxford.htm); 2) 3
Reader’s Guide to Critical Appraisal of Cohort Studies. BMJ 2005 (3 article series); 3) Grimes et al. Lancet 2002;359:341-45; and 4) Guyatt & Rennie. Users’ Guides to the Medical Literature, AMA Press, 2002. Compiled by Madhu Pai [[email protected]] CRITICAL APPRAISAL OF A COHORT STUDY COHORT WORKSHEET
-Does your patient match the study
inclusion criteria?
-If not, are there compelling reasons why
the results should not apply to your patient?
2. Were all clinically important outcomes
considered?
3. Do the results of this study fit with other
available evidence?
In summary: What are the major strengths of this study?
What are the major limitations of this study?
Are there any major ethical concerns with this study?
Source: Adapted from 1) Newcastle Ottawa Scale [http://www.ohri.ca/programs/clinical_epidemiology/oxford.htm); 2) 4
Reader’s Guide to Critical Appraisal of Cohort Studies. BMJ 2005 (3 article series); 3) Grimes et al. Lancet 2002;359:341-45; and 4) Guyatt & Rennie. Users’ Guides to the Medical Literature, AMA Press, 2002. Compiled by Madhu Pai [[email protected]]