Critically appraising the evidence

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Hello,

I would be very grateful if you could give me some of yours guidelines about "critically appraising the evidence " related to the literature on foot orthoses !
Generally, my base references at the moment are [without having a clear list of steps to appraise the literature established in my mind , yet] :
- DJ Pratt , A critical review of the literature on foot orthoses, Vol 90, Issue 7 339-341 related with - Juvenile HAV, http://www.podiatry-arena.com/podiatry-forum/showthread.php?p=25886
- G. Antes, What is evidence-based medicine?, Langenbecks Arch Surg. 1999
- Mr Payne's letter-to-the-editor published in 2002, JBMT , http://www.podiatry-arena.com/podiatry-forum/showthread.php?t=2013&highlight=rothbart
Which are your steps [or thinking process] when you are judging an article related to foot orthoses or foot biomechanics ?


Thank you a lot !
Daniel

 

These aren't specifically for foot orthoses, but the following are refs for critical appraisal in general -

The CASP tools can be found HERE. They have a different tool for each type of paper you might be reading.

Trisha Greenhalgh's How To Read A Paper is a great read for this type of thing too. There is a new edition coming out in May I believe.

Hope that helps.:drinks

 

Heres how I think about it all when reading a new paper.

-Keep an open mind.
-remember that every person is different so that the results will only mean that a % of those people tested have show that change in symptoms, it may be diffferent in the real world.
- When they compair one device againist another it limits the usefulness in the real world as every person is different.
-read who funded the study
- compair evidence to what you see in your practice. ie Ian put up a paper that showed that low dye strapping does not have great results in plantar fasciitis when that authors looked at a broad range of studies. In my practice daily I see great results.
- I now try and look at the theory of the mechanics of what a device maybe trying to acheive and If I don´t get it I ask on here. there was some discussion awhile back about achilles tendoniitis. a study used a medial skive device, but much of the discussion was that "best practice" would have been a heel wedge.
-remember there is no cook book to prescribing orthotics so if a study says it works for 90-100% of people with these symptoms a warning bell goes off.
-does it have a control group
- if the word custom orthotic is used look at what device it is custom is very different to individually personalised.

I think thats all Ive got.

hope it helps.

 

Thank you Michael,

For sure that it helps me ! My feeling is I have need a couple of lives to better understand statistics, methodology, biomechanics, anatomy, foot paradigms,.... And all this only for "a small [ and fascinating] piece of plastics" !

Sorry if I have some dumb questions : it is important/relevant for my practice to judge the article you have mentioned according with, for example, Sackett's levels of evidence ? Or, could be a problem with my practice if that article shows a high level of evidence ? According with "open mind" what is questionable : the article or the practice ? Which are the relations between "best practice" and evidence ?
I have to mention, unfortunately, I have no such a level of practice in order to be able to compare with an evidence !
Thank you for your kindness,
Daniel

 

Daniel you have to think both sides. I think over the last couple of years Ive probably learnt more than anyother time by looking what I thought was correct and asking is it? Its given me headaches at times and some lost sleep, but you have to consider the research side and the clinicial side sometimes they don´t work hand in hand. Ive had discussion with research people who have never treated a foot but do 1000´s of hours of research and they love to find out what a clinican would like to know from research.

I´m not sure if that helps or not ?

as for having many lives to get better knowledge would be nice, but might laed to more headaches and sleepless nights too.