Evidence-Based Practice: Research Appraisal and Quality

Evidence-based practice (EBP) is the conscientious, explicit, and judicious integration of best research evidence with clinical expertise and patient values in making clinical decisions (Sackett, 1996). The EBP process follows five steps (the 5 A's): (1) ASK a focused clinical question (PICO format), (2) ACQUIRE the best available evidence through systematic literature searching, (3) APPRAISE the evidence critically for validity, relevance, and applicability, (4) APPLY the evidence integrated with clinical expertise and patient preferences, and (5) ASSESS the outcomes of the evidence application. CRITICAL APPRAISAL requires understanding the HIERARCHY OF EVIDENCE: Level I -- systematic reviews and meta-analyses of randomized controlled trials (RCTs); Level II -- well-designed RCTs; Level III -- controlled trials without randomization; Level IV -- cohort and case-control studies; Level V -- systematic reviews of descriptive/qualitative studies; Level VI -- single descriptive or qualitative studies; Level VII -- expert opinion. The NP must appraise research methodology: INTERNAL VALIDITY (was the study designed and conducted rigorously enough that the results are trustworthy?) assessed by evaluating randomization, blinding, sample size/power calculation, intention-to-treat analysis, attrition rates, and potential biases; EXTERNAL...