1. Methods: Was the study designed and conducted in a way that limits bias?
2. Results: What was found, and how large and precise are the estimates?
3. Interpretation: Do the data support the authors' conclusions? What limitations matter?
4. Application: Are the findings relevant to the patient, population, or practice setting?

Does a treatment or intervention improve outcomes compared with an alternative?

• Were participants assigned to groups appropriately, and were the groups comparable?
• Were outcomes measured consistently, and was follow-up adequate?
• How large and precise were the benefits and harms?
• Are the outcomes important to patients, and do the results apply to your setting?

How accurately does a test identify or exclude a condition?

• Was the test compared with an appropriate reference standard?
• Were test and reference-standard results interpreted independently?
• Were participants representative of patients in whom the test would be used?
• What do sensitivity, specificity, and likelihood ratios indicate about clinical usefulness?

What conditions may explain a presenting sign or symptom, and how frequently do they occur?

• Was the patient sample representative of the clinical presentation?
• Was the diagnostic evaluation appropriate and sufficiently complete?
• How common were the diagnoses, and how precise were the estimates?
• Are the findings relevant to the population and setting in which you practice?

Is an exposure associated with an adverse outcome?

• Were exposed and unexposed groups comparable, and were confounding factors addressed?
• Were exposures and outcomes measured reliably?
• What is the magnitude and precision of the association?
• Does the study support a causal interpretation, or only an association?

What outcomes are likely over time for people with a particular condition?

• Was the study population clearly defined and representative?
• Was follow-up long and complete enough to observe the outcomes?
• Were outcomes measured consistently and relevant prognostic factors considered?
• How precise are the estimates, and do they apply to your patient?

A systematic review uses explicit methods to identify and synthesize studies addressing a question; a meta-analysis statistically combines compatible results when appropriate.

• Was the question clearly defined and the search sufficiently comprehensive?
• Were study selection and risk-of-bias assessments appropriate?
• Were differences among studies and uncertainty considered in the synthesis?
• Do the conclusions reflect the certainty and applicability of the evidence?

Guidelines synthesize evidence to inform clinical recommendations.

• Were the evidence review and recommendation-development methods transparent?
• Are recommendations linked to evidence and its certainty?
• Were benefits, harms, patient values, and relevant conflicts of interest considered?
• Are the recommendations current and applicable to your setting?

Qualitative studies explore experiences, perspectives, and processes.

• Does the chosen qualitative approach fit the research question?
• Were participants selected and data collected appropriately?
• Is the analysis transparent and supported by the data?
• How might the context shape the relevance of the findings elsewhere?

Economic evaluations compare the costs and outcomes of healthcare options.

• Were the alternatives and analytic perspective clearly specified?
• Were relevant costs and health outcomes measured appropriately?
• Were uncertainty and important assumptions tested?
• Are the results transferable to your patient population and healthcare setting?

Critical appraisal is one part of evidence-based practice. Consider the quality and relevance of the research alongside clinical expertise, patient preferences and circumstances, and available resources. A statistically significant finding does not necessarily represent a clinically meaningful benefit.