Critical Appraisal Tools

Does it say that blinding of the patients also essential?

 

Interesting reading this as it makes it clear where EBM falls apart, and starts short in the firs place. Comparing to the link at the bottom on formulation of research quesions it also shows why it has led to iterative stuck in rut because it doesn't answer a hypothesis or move anything forward literatures too?

And yes, sadly even within this cropped framework BPSm don't even tick the boxes of the compulsory stuff (one of the biggies in their research being rated very low quality was they didn't even get the patient population right to make sure everyone they sampled had the condition they were generalising the results for)

I read the top page which listst the following,which aren't too wrong in being twisted from the core principles of good research design (but really it should be 'what is your question, then how does that translate to what is my Research Question' and does that research question actually answer the question ie is it valid/internally consistent etc):

Where the switch and bait issue occurs is when what they term in point 1. as 'clearly focused question' then becomes translated in the page underneath: https://www.cebm.ox.ac.uk/resources/ebm-tools/asking-focused-questions

It doesn't seem to really care what the question is trying to achieve, whether it is valid. And as for pretending it is precise - it doesn't even metnion dose and whether that might vary. Or linking it back to the patient population in point 4. by noting whether the methods need controls from other patient populations, checking their population is representative etc.

So it at that point seems to be a lesson in making research more ambiguous, shady and less smart whilst labelling all of these changes with terms that infer you've done the opposite and made it more forensic.

And in fact then their list seems back to front, where instead of prompting thinking to make sure that the design is correct to be valid it seems like it is a case of pick your question then how do you sell it as 'being valid' or 'important' or 'applicable'.

This all seems a far cry from the main principle of research design of 'is what you are actually asking [what are people really thinking they are being asked with the questions you've put down, what informaion and combo of information is influencing the objective measurement etc] what you think you are asking [the Research Question]?'

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6322175/

 

Yes, I had look at the document.

This is just no good. It does mention the need for blinding being less for objective outcomes but if they are not then blinding of patients is at least as important as assessors. And it is not a question of what is ideal. It is a matter of the minimum requirement to produce a meaningful result.

The style writing 'we the experts are giving you this good advice' is the worst part of it. These are exactly the people who produce poor quality stuff when it is their turn.

 

From @MSEsperanza:

Yes. At least according to the Cochrane Handbook, as pointed out in one of the published responses to the Anomalies paper:

"NICE did downgrade quality of evidence when subjective outcomes (not just fatigue, but also pain, sleep, quality of life, etc.) were used in trials where participants and therapists were not blinded as this combination creates a high risk of bias. This grading is in accordance with the Cochrane Handbook which states that “the potential for bias cannot be ignored even if the outcome assessor cannot be blinded." (2) In the case of patient-reported outcome measures such as fatigue, the Cochrane Handbook considers patients to be the outcome assessor."

https://jnnp.bmj.com/content/early/...shortcomings-in-the-commentary-by-white-et-al

Just wonder why Cochrane & co can't use clearer wording, e.g. just say 'patients/ participants' or add that participants are their own outcome assessors in this case (and maybe in addition to study staff that is involved both as therapists giving feedback to the participants and as study nurses asking and sometimes actually filling the participants' answers in the questionnaires).

See also: Basic questions on terms and methodology used in clinical trials

https://www.s4me.info/threads/basic...gy-used-in-clinical-trials.30316/#post-445244

 

It is a bit like a critical appraisal tool designed for students judging the quality of course-setting programmes for spaceships to Mars.

'As experts we are here to advise students that it is ideal to assume the three angles of a triangle add up to 180 degrees, because it tends to work out better if you do.'

If the students have not as schoolchildren proven to their own satisfaction that the three angles of a triangle must obviously add up to 180 degrees they are not suitable candidates for the programme. Clinical science requires the same level of understanding.

 

I guess in this situation from common sense and understanding of body language when sitting in on clinical sessions as a student. If one gets to medical qualification (and I assume these Tools are intended for people who have at least a first degree in a health profession) without having a good idea of how open to manipulation the interaction between healthcare worker and patient is and how often that is exploited then one isn't awake enough to be much good as a potential clinical academic. You can see the reason why you need patient blinding by looking at the patronising smile on the surgeon's face as easily as you can see that the angles of a triangle must add up to 150 degrees.