Research Evidence Appraisal Tool

Evidence level and quality rating:
Article title: Morbidly obese patients’ experiences of mobility during hospitalization and rehabilitation: A qualitative descriptive study	Number:  Vol. 34 No. 1 2018
Author(s):  Caz Hales, R. N., Nicky Curran, R. N., Dip, O. S. H., & Kay de Vries, R. N.	Publication date: March 2018
Journal:  Nursing Praxis in New Zealand
Setting: Clinical	Sample (composition and size): 7 Patients with Morbid Obesity
Does this evidence address my EBP question? Yes No-Do not proceed with appraisal of this evidence
Is this study: QuaNtitative (collection, analysis, and reporting of numerical data) Measurable data (how many; how much; or how often) used to formulate facts, uncover patterns in research, and generalize results from a larger sample population; provides observed effects of a program, problem, or condition, measured precisely, rather than through researcher interpretation of data. Common methods are surveys, face-to-face structured interviews, observations, and reviews of records or documents. Statistical tests are used in data analysis. Go to Section I: QuaNtitative QuaLitative (collection, analysis, and reporting of narrative data) Rich narrative documents are used for uncovering themes; describes a problem or condition from the point of view of those experiencing it. Common methods are focus groups, individual interviews (unstructured or semi structured), and participation/observations. Sample sizes are small and are determined when data saturation is achieved. Data saturation is reached when the researcher identifies that no new themes emerge, and redundancy is occurring. Synthesis is used in data analysis. Often a starting point for studies when little research exists; may use results to design empirical studies. The researcher describes, analyzes, and interprets reports, descriptions, and observations from participants. Go to Section II: QuaLitative Mixed methods (results reported both numerically and narratively) Both quaNtitative and quaLitative methods are used in the study design. Using both approaches, in combination, provides a better understanding of research problems than using either approach alone. Sample sizes vary based on the methods used. Data collection involves collecting and analyzing both quaNtitative and quaLitative data in a single study or series of studies. Interpretation is continual and can influence stages in the research process. Go to Section III: Mixed Methods

Section I: QuaNtitative
Level of Evidence (Study Design)
Is this a report of a single research study?	Yes	No Go to B
1. Was there manipulation of an independent variable?	Yes	No
2. Was there a control group?	Yes	No
3. Were study participants randomly assigned to the intervention and control groups?	Yes	No
If Yes to questions 1, 2, and 3, this is a randomized controlled trial (RCT) or experimental study.	LEVEL I
If Yes to questions 1 and 2 and No to question 3orYes to question 1 and No to questions 2 and 3, this is quasi-experimental. (Some degree of investigator control, some manipulation of an independent variable, lacks random assignment to groups, and may have a control group).	LEVEL II
If No to questions 1, 2, and 3, this is nonexperimental. (No manipulation of independent variable; can be descriptive, comparative, or correlational; often uses secondary data).	LEVEL III
Study Findings That Help Answer the EBP Question
Skip to the Appraisal of QuaNtitative Research Studies section

Section I: QuaNtitative (continued)
Is this a summary of multiple sources of research evidence?	Yes Continue	No Use Appendix F
1. Does it employ a comprehensive search strategy and rigorous appraisal method? If this study includes research, nonresearch, and experiential evidence, it is an integrative review (see Appendix F).	Yes Continue	No Use Appendix F
B   2. For systematic reviews and systematic reviews with meta-analysis (see descriptions below):
Are all studies included RCTs?	LEVEL I
Are the studies a combination of RCTs and quasi-experimental, or quasi-experimental only?	LEVEL II
Are the studies a combination of RCTs, quasi-experimental, and nonexperimental, or non- experimental only?	LEVEL III
A systematic review employs a search strategy and a rigorous appraisal method but does not generate an effect size. A meta-analysis, or systematic review with meta-analysis, combines, and analyzes results from studies to generate a new statistic: the effect size.
Study Findings That Help Answer the EBP Question
Skip to the Appraisal of Systematic Review (With or Without a Meta-Analysis) section

Appraisal of QuaNtitative Research Studies
Does the researcher identify what is known and not known about the problem and how the study will address any gaps in knowledge?	Yes	No
Was the purpose of the study clearly presented?	Yes	No
Was the literature review current (most sources within the past five years or a seminal study)?	Yes	No
Was sample size sufficient based on study design and rationale?	Yes	No
If there is a control group: Were the characteristics and/or demographics similar in both the control and intervention groups?	Yes	No	N/A
If multiple settings were used, were the settings similar?	Yes	No	N/A
Were all groups equally treated except for the intervention group(s)?	Yes	No	N/A
Are data collection methods described clearly?	Yes	No
Were the instruments reliable (Cronbach’sa[alpha] > 0.70)?	Yes	No	N/A
Was instrument validity discussed?	Yes	No	N/A
If surveys or questionnaires were used, was the response rate > 25%?	Yes	No	N/A
Were the results presented clearly?	Yes	No
If tables were presented, was the narrative consistent with the table content?	Yes	No	N/A
Were study limitations identified and addressed?	Yes	No
Were conclusions based on results?	Yes	No
Complete theQuality Rating for QuaNtitative Studiessection

Appraisal of Systematic Review (With or Without Meta-Analysis)
Were the variables of interest clearly identified?	Yes	No
Was the search comprehensive and reproducible? Key search terms stated	Yes	No
Multiple databases searched and identified	Yes	No
Inclusion and exclusion criteria stated	Yes	No
Was there a flow diagram that included the number of studies eliminated at each level of review?	Yes	No
Were details of included studies presented (design, sample, methods, results, outcomes, strengths, and limitations)?	Yes	No
Were methods for appraising the strength of evidence (level and quality) described?	Yes	No
Were conclusions based on results?	Yes	No
Results were interpreted	Yes	No
Conclusions flowed logically from the interpretation and systematic review question	Yes	No
Did the systematic review include a section addressing limitations andhow they were addressed?	Yes	No
Complete theQuality Rating for QuaNtitative Studies section (below)

Quality Rating for QuaNtitative Studies

Circle the appropriate quality rating below: A High quality: Consistent, generalizable results; sufficient sample size for the study design; adequate control; definitive conclusions; consistent recommendations based on comprehensive literature review that includes thorough reference to scientific evidence. B Good quality: Reasonably consistent results; sufficient sample size for the study design; some control, and fairly definitive conclusions; reasonably consistent recommendations based on fairly comprehensive literature review that includes some reference to scientific evidence. C Low quality or major flaws: Little evidence with inconsistent results; insufficient sample size for the study design; conclusions cannot be drawn.

Section II: QuaLitative
Level of Evidence (Study Design)
A   Is this a report of a single research study?	Yes this is Level III	No go to II B
Study Findings That Help Answer the EBP Question There is relationship between Morbid Obesity and limited mobility.
Complete theAppraisal of Single QuaLitative Research Studysection(below)

Appraisal of a Single QuaLitative Research Study
Was there a clearly identifiable and articulated: Purpose?	Yes	No
Researchquestion?	Yes	No
Justificationformethod(s)used?	Yes	No
Phenomenonthatisthefocusoftheresearch?	Yes	No
Were study sample participants representative?	Yes	No
Did they have knowledge of or experience with the research area?	Yes	No
Were participant characteristics described?	Yes	No
Was sampling adequate, as evidenced by achieving saturation of data?	Yes	No
Data analysis: Was a verification process used in every step by checking and confirming with participants the trustworthiness of analysis and interpretation?	Yes	No
Was there a description of how data were analyzed (i.e., method), by computer or manually?	Yes	No
Do findings support the narrative data (quotes)?	Yes	No
Do findings flow from research question to data collected to analysis undertaken?	Yes	No
Are conclusions clearly explained?	Yes	No
Skip to theQuality Rating for QuaLitative Studiessection

B   ForsummariesofmultiplequaLitativeresearchstudies(meta-synthesis), wasacomprehensivesearchstrategyandrigorousappraisalmethodused?	Yes Level III	No go to Appendix F
Study Findings That Help Answer the EBP Question
Complete the Appraisal of Meta-Synthesis Studies section (below)

Appraisal of Meta-Synthesis Studies
Were the search strategy and criteria for selecting primary studies clearly defined?	Yes	No
Were findings appropriate and convincing?	Yes	No
Was a description of methods used to:   Compare findings from each study?	Yes	No
Interpret data?	Yes	No
Did synthesis reflect:	Yes	No
New insights?	Yes	No
Discovery of essential features of phenomena?	Yes	No
A fuller understanding of the phenomena?	Yes	No
Was sufficient data presented to support the interpretations?	Yes	No
Complete the Quality Rating for QuaLititative Studies section (below)

Quality Rating for QuaLitative Studies

Circle the appropriate quality rating below: No commonly agreed-on principles exist for judging the quality of quaLitative studies. It is a subjective process based on the extent to which study data contributes to synthesis and how much information is known about the researchers’ efforts to meet the appraisal criteria. For meta-synthesis, there is preliminary agreement that quality assessments should be made before synthesis to screen out poor-quality studies1. A/B High/Good quality is used for single studies and meta-syntheses2. The report discusses efforts to enhance or evaluate the quality of the data and the overall inquiry in sufficient detail; and it describes the specific techniques used to enhance the quality of the inquiry. Evidence of some or all of the following is found in the report: Transparency: Describes how information was documented to justify decisions, how data were reviewed by others, and how themes and categories were formulated.Diligence: Reads and rereads data to check interpretations; seeks opportunity to find multiple sources to corroborate evidence.Verification: The process of checking, confirming, and ensuring methodologic coherence.Self-reflection and self-scrutiny: Being continuously aware of how a researcher’s experiences, background, or prejudices might shape and bias analysis and interpretations.Participant-driven inquiry: Participants shape the scope and breadth of questions; analysis and interpretation give voice to those who participated.Insightful interpretation: Data and knowledge are linked in meaningful ways to relevant literature. CLower-quality studies contribute little to the overall review of findings and have few, if any, of the features listed for High/Good quality.

1 https://www.york.ac.uk/crd/SysRev/!SSL!/WebHelp/6_4_ASSESSMENT_OF_QUALITATIVE_RESEARCH.htm
2 Adapted from Polit & Beck (2017).

Section III: Mixed Methods
Level of Evidence (Study Design)
You will need to appraise both the quaNtitative and quaLitative parts of the study independently, before appraising the study in its entirety.
Evaluate the quaNitative part of the study using Section I.	Level	Quality
Insert here the level of evidence and overall quality for this part:
Evaluate the quaLitative part of the study using Section II.	Level	Quality
Insert here the level of evidence and overall quality for this part:
To determine the level of evidence, circle the appropriate study design:
Explanatory sequential designs collect quaNtitative data first, followed by the quaLitative data; and their purpose is to explain quaNtitative results using quaLitative findings. The level is determined based on the level of the quaNtitative part.Exploratory sequential designs collect quaLitative data first, followed by the quaNtitative data; and their purpose is to explain quaLitative findings using the quaNtitative results. The level is determined based on the level of the quaLitative part, and it is always Level III.Convergent parallel designs collect the quaLitative and quaNtitative data concurrently for the purpose of providing a more complete understanding of a phenomenon by merging both datasets. These designs are Level III.Multiphasic designs collect quaLitative and quaNtitative data over more than one phase, with each phase informing the next phase. These designs are Level III.
Study Findings That Help Answer the EBP Question
Complete the Appraisal of Mixed Methods Studiessection (below)

Appraisal of Mixed Methods Studies3
Wasthemixed-methodsresearchdesignrelevanttoaddressthe quaNtitative and quaLitative research questions (orobjectives)?	Yes	No	N/A
WastheresearchdesignrelevanttoaddressthequaNtitativeand quaLitative aspects of the mixed-methods question (orobjective)?	Yes	No	N/A
Forconvergentparalleldesigns,wastheintegrationofquaNtitative andquaLitativedata(orresults)relevanttoaddresstheresearch question orobjective?	Yes	No	N/A
For convergent parallel designs, were the limitations associated withtheintegration(forexample,thedivergenceofquaLitativeand quaNtitative data or results) sufficientlyaddressed?	Yes	No	N/A
Complete theQuality Rating for Mixed-Method Studies section (below)

3 National Collaborating Centre for Methods and Tools. (2015). Appraising Qualitative, Quantitative, and Mixed Methods Studies included in Mixed Studies Reviews: The MMAT. Hamilton, ON: McMaster University. (Updated 20 July, 2015) Retrieved from http://www.nccmt.ca/resources/search/232

Quality Rating for Mixed-Methods Studies

Circle the appropriate quality rating below A Highquality:Containshigh-qualityquaNtitativeandquaLitativestudycomponents;highlyrelevant studydesign;relevant integration  of data or results;and careful considerationofthelimitationsof the chosen approach. B Goodquality:Containsgood-qualityquaNtitativeandquaLitativestudycomponents;relevantstudy design;moderatelyrelevantintegrationofdataorresults;andsomediscussionoflimitationsof integration. CLow quality or major flaws: Contains low quality quaNtitative and quaLitative study components; studydesignnotrelevanttoresearchquestionsorobjectives;poorlyintegrateddataorresults;and noconsiderationoflimitsofintegration.

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