MacDermid Joy C, Walton David M, Law Mary
Hand and Upper Limb Centre Clinical Research Laboratory, St. Joseph's Health Centre, 268 Grosvenor Street, London, Ontario, Canada.
Hand Clin. 2009 Feb;25(1):29-42, v. doi: 10.1016/j.hcl.2008.11.003.
Step 3 in the evidence-based practice approach involves critical appraisal of the validity and usefulness of evidence. This process can be broken down into three sequential subcomponents having to do with validity, generalizability, and recommendation strength. Critical appraisal focuses on determining whether individual study conclusions are valid. This process can be assisted by the use of critical of appraisal forms, a wide variety of which exist. Forms vary according to structure, content, scoring, and emphasis. Recommendations to patients or within clinical practice guidelines should consider the quality of the evidence, the balance between desirable and undesirable effects, resource use, clinical experience, and patient preferences. Recently, an international collaboration (GRADE working group) has focused on defining common methods to grade recommendations clearly and consistently and has moved toward a system that integrates these factors to make either strong, weak, or no recommendation.
循证实践方法的第三步涉及对证据的有效性和实用性进行批判性评价。这个过程可以细分为与有效性、可推广性和推荐强度相关的三个连续子组件。批判性评价侧重于确定单个研究结论是否有效。使用各种各样的批判性评价表格有助于这个过程。表格在结构、内容、评分和重点方面各不相同。向患者提供的建议或临床实践指南中的建议应考虑证据的质量、有利和不利影响之间的平衡、资源使用、临床经验以及患者偏好。最近，一个国际合作组织（GRADE工作组）专注于定义清晰且一致地对推荐进行分级的通用方法，并已朝着一个整合这些因素以做出强推荐、弱推荐或不做推荐的系统发展。
