axis tool for cross sectional studies

Published in The British Medical Journal - 8th December 2016. With the reduction in the number of questions and modification of the wording, comments in round 2 reflected the positive nature to the usability of the tool.I like the fact that it is quite simplenot too overloaded with methodological questions. The tool was developed through a rigorous process incorporating comprehensive review, testing and consultation via a Delphi panel. However, you may visit "Cookie Settings" to provide a controlled consent. Critical appraisal worksheets to help you appraise the reliability, importance and applicability of clinical evidence. The responses were compiled and analysed at the end of round 3. The process was repeated, with a new draft of the CA tool circulated each time based on the findings and consensus of the previous round, until 80% consensus on all components of the tool was achieved. In some cases, longitudinal studies can last several decades. 1. Further studies would be needed to assess how practical this tool is when used by clinicians and if the CA of studies using AXIS is repeatable. 2023 Mar 1. doi: 10.1007/s00264-023-05725-w. Online ahead of print. https://www.cebma.org/wp-content/uploads/Critical-Appraisal-Questions-for-a-Cross-Sectional-Study-july-2014.pdf, PDF: CEBM Critical Appraisal of a Cross-Sectional Study, http://www.ncceh.ca/sites/default/files/Critical_Appraisal_Cross-Sectional_Studies.pdf. PDF:A scoring system for appraising mixed methods research, and concomitantly appraising qualitative, quantitative and mixed methods primary studies in Mixed Studies Reviews. Whilst developed to be used for the development of clinical guidelines they are excellent CATs for single study appraisals, PDF: SIGN Checklist 4: Case control studies, PDF: JBI checklist for Case control studies, https://www.cebma.org/wp-content/uploads/Critical-Appraisal-Questions-for-a-Case-Control-Study.pdf. Critical appraisal is much more than a 'tick box' exercise. The analysis identified components that were to be included in a second draft of the CA tool of CSSs (see online supplementary table S3) which was used in the first round of the Delphi process. 13.5.2.3 Tools for assessing methodological quality or risk of bias in non-randomized studies. and transmitted securely. Summary: Critical Appraisal Skills Program (CASP): Qualitative Research is a methodological checklist which provides key criteria relevant to qualitative research studies. The components of the AXIS tool are based on a combination of evidence, epidemiological processes, experience of the researchers and Delphi participants. Cross-sectional studies are quick to conduct compared to longitudinal studies. We identified an appraisal tool, developed in Spanish, which specifically examined CSSs.15 Berra et al essentially converted each reporting item identified in the STROBE (STrengthening the Reporting of OBservational studies in Epidemiology) reporting guidelines and turned them into questions for their appraisal tool. 10 Highly Influential View 5 excerpts, references methods A longitudinal study requires an investigator to. Objectives: The cookies is used to store the user consent for the cookies in the category "Necessary". Careers. What is the measure? However, it has been debated that quality numerical scales can be problematic as the outputs from assessment checklists are not linear and as such are difficult to sum up or weight making them unpredictable at assessing study quality.39 ,42 ,43 The AXIS tool has the benefit of providing the user the opportunity to assess each individual aspect of study design to give an overall assessment of the quality of the study. Keywords: CA of the literature is a vital step in evidence synthesis and therefore evidence-based decision-making in a number of different disciplines. The survey examines a nationally representative sample of about 5,000 persons located across the country each year. A recent study has found that the tool takes longer to complete than other tools (the investigators took a mean of 8.8 minutes per person for a single predetermined outcome using our tool compared with 1.5 minutes for a previous rating scale for quality of reporting).22 The reliability of the tool has not been extensively studied, although the same authors observed that larger effect sizes . These cookies will be stored in your browser only with your consent. 2023 Feb 1;10(2):285. doi: 10.3390/children10020285. Bias (a systematic error, or deviation from the truth, in results or inferences5) and study design are other areas that need to be considered when assessing the quality of included studies as these can be inherent even in a well-reported study. A study that fails to address or report on more than one or two of the questions addressed below should almost certainly be rejected. Two systematic reviews failed to identify a standalone appraisal tool specifically aimed at CSSs.12 ,13 Katrak et al identified that CA tools had been formulated specifically for individual research questions but were not transferable to other CSSs. There are appraisal tools for most kinds of study designs. Summary:JBI Critical appraisal tools have been developed by the JBI and collaborators and approved by the JBI Scientific Committee following extensive peer review. 0000121095 00000 n , Were subjects randomly allocated? Out of these, the cookies that are categorized as necessary are stored on your browser as they are essential for the working of basic functionalities of the website. Critical appraisal (CA) is a skill central to undertaking evidence-based practice which is concerned with integrating the best external evidence with clinical care. PDF:Individually-randomized, parallel-group trials - CAT Guidance sheet, Cluster-randomized, parallel-group trials - CAT Guidance Sheet, Individually-randomized, cross-over trials - CAT Guidance Sheet, Summary: This CAT is based on a combination of other CATs. Depending on the types of studies you are analyzing, the questionnaire will be tailored to ask specific questions about the methodology of the study. Authors: The University of Auckland, New Zealand Delphi methods and use of expert groups are increasingly being implemented to develop tools for reporting guidelines and appraisal tools.18 ,19. Personal contacts of the authors and well-known academics in the EBM/EVM fields were used as the initial contacts and potential members of the panel. Appraising qualitative, quantitative and mixed methods studies included in mixed studies reviews: The MMAT. 0000104858 00000 n Were the risk factor and outcome variables measured appropriate to the aims of the study? What is the difference between 'Blended', 'Fully Online' and 'By Attendance' delivery modes? List is too long at present and contains too many things that are general to all scientific studies. Whilst developed to be used for the development of clinical guidelines they are excellent CATs for single study appraisals, PDF: SIGN Checklist 5: Diagnostic studies, PDF: JBI checklist for Diagnostic studies, https://www.gla.ac.uk/media/media_64046_en.pdf. 0000118716 00000 n to even a few decades. Risk of Bias Tool. Steps you through the process of asking, accessing, appraising (using the RAMboMAN tool), applying and auditing. The use of a multidisciplinary panel with experience in epidemiology and EBM limits the effect of using a non-representative sample, and the use of the Delphi tool is well recognised for developing consensus in healthcare science.38 The selection of a Delphi group is very important as it effects the results of the process.31 As CSSs are used extensively in human and veterinary research, it was appropriate to use expertise from both of these fields. 0000043010 00000 n 0000118834 00000 n The Centre for Evidence-based Veterinary Medicine is supported by an unrestrictive grant from Elanco Animal Health and The University of Nottingham. Critical appraisal can occur through a non-structured approach where you critically read the study as you read it, or through a structured approach through the use of a Critical Appraisal Tool (CAT). (b) the bending stress at point H. Participants were qualified a mean of 17.6years (SD: 7.9) and the panel was made up of participants from varying disciplines (table 1). But opting out of some of these cookies may affect your browsing experience. Cross sectional studies are carried out at one point in time, or over a short period of time. The https:// ensures that you are connecting to the While numerous tools exist for CA, we found a lack of tools for general use in CSSs and this was consistent with what others have found previously.12 ,13 In order to ensure quality and completeness of the tool, we utilised recognised reporting guidelines, other appraisal tools and epidemiology design text in the development of the initial tool which is similar to the development of appraisal tools of other types of studies.12. The second draft (developed in phase I described above) of the CA tool (see online supplementary table S3) was circulated in the first round of the Delphi process to the panel using an online questionnaire (SurveyGizmo). A detailed explanatory document was also developed with the tool, giving expanded explanation of each question and providing simple interpretations and examples of the epidemiological concepts being examined in each question to aid non-expert users. The Appraisal tool for Cross-Sectional Studies (AXIS) was developed - 20 point questionnaire that addressed study quality and reporting. Required fields. A CA tool to assess the quality and risk of bias in CSSs (AXIS), along with supporting help text, was successfully developed by an expert panel using Delphi methodology. Valid methods and reporting Clear question addressed Value. In each round, if a component had 80% consensus, it remained in the tool. paired institutional or society access and free tools such as email alerts and saved searches. But the results can be less useful. Was the sample frame taken from an appropriate population base so that it closely represented the target/reference population under investigation? Two ROB tools were selected for cross-sectional studies as there was no single most recommended tool. Following round 3 (undertaken in July 2013) of the Delphi process, there was consensus (81%) that all components of the tool were appropriate for use by non-expert users, so no further rounds were necessary. In case of disagreement, another author was consulted, and discussions were held until a consensus was reached. Delphi study Rome did not create a great empire by having meetings, they did it by killing all those who opposed them, Methods The contents were agreed on based on 80% consensus, Results Started with > 30 areas of interest 18 recruited for Delphi panel 3 rounds of consensus were carried Ended with a 20 item questionaire. Are Award, Course and Dissertation fees the same every year? , Is the effect size practically relevant? Tested and further developed before Delphi Examined and further developed using a Delphi process. 10.1136/bmj.323.7317.833 Participants were asked to add any additional comments they had regarding each component. However, if consensus was lower than 80% but >50%, the help text was considered for modification. Email was used to contact potential participants for enrolment in the Delphi study. Evidence based medicine: an approach to clinical problem-solving. 0000001173 00000 n Demographic information such as age, height, weight of patients . Authors:Dept. This cookie is set by GDPR Cookie Consent plugin. If you click 'Reject all non-essential cookies' only necessary cookies providing core functionality such as security, network management, and accessibility will be enabled. 2. Review authors should specify important confounding domains and co-interventions of concern in their protocol. How to choose an appropriate quality assessment tool A number of publications were identified in the review and a number of key epidemiological texts were also identified to assist in the development of the new tool.1 ,11 ,12 ,15 ,17 ,2029 MJD and MLB used these resources to subjectively identify areas that were to be included in the CA tool. Epub 2022 Mar 20. Covidence includes the Cochrane Risk of Bias 2.0 quality assessment template, but you can also create your own custom quality assessment template. across the clinical question domains of intervention, diagnosis & assessment, prognosis, etiology & risk factors, incidence, prevalence, and meaning. In addition, the aim was to produce a help document to guide the non-expert user through the tool. 2001 Relative Risk (RR) = risk of the outcome in the treatment group / risk of the outcome in the con-trol group. However, presently, validated instruments to evaluate healthcare professionals' attitude and practices toward implementing EBM are not widely available. This is the first CA tool made available for assessing this type of evidence that can be incorporated in systematic reviews, guidelines and clinical decision-making. Keywords: CAT-CSS, Appraisal- tool, Cross Sectional Studies INTRODUCTION methodological features of the study design, the appropriateness of the used statistical analysis and relevance Utilization of research findings is a crucial health of the results to the clinical situation of the professional's related issue in the provision of health care . The Delphi panel was based on convenience and may not encompass all eventual users of the tool. Eighteen experts (67%) agreed to participate in the Delphi panel. Critical appraisal is the systematic evaluation of clinical research papers in order to establish: If the answer to any of these questions is no, you can save yourself the trouble of reading the rest of it. Design Cross sectional study. Join Cochrane. Performance cookies are used to understand and analyze the key performance indexes of the website which helps in delivering a better user experience for the visitors. This cookie is set by GDPR Cookie Consent plugin. We considered it reasonable to initially restrict the recommendations to the three main analytical designs that are used in observational research: cohort, case-control, and cross-sectional studies. A CSS has been defined as: An observational study whose outcome frequency measure is prevalence. Data were collected from 51 483 participants in Jiangxi province using the multistage stratified random cluster sampling method. The AXIS tool focuses mainly on the presented methods and results. Study sample 163 trials in children . The methodological quality assessment tools for preclinical and clinical studies, systematic review and meta-analysis, and clinical practice guideline: a systematic review. . , Can the results be applied to my organization and my patient? You also have the option to opt-out of these cookies. This is the first CA tool made available for assessing this type of evidence that can be incorporated in systematic reviews, guidelines and clinical decision-making. A secondary aim was to produce a document to aid the use of the CA tool where appropriate. http://www.bristol.ac.uk/population-health-sciences/centres/cresyda/barr/riskofbias/rob2-0/. 1996 Bajoria et al. 1st edn Oxford, UK: Blackwell Publishing Ltd, 2003. What does it mean? What date do short-course applications close? Available from www.cochrane-handbook.org. If you reach the quality assessment step and choose to exclude articles for any reason, update the number of included and excluded studies in your PRISMA flow diagram. Best practices for reporting quality assessment results in your review. An initial scoping review of the published literature and key epidemiological texts was undertaken prior to the formation of a Delphi panel to establish key components for a CA tool for CSSs. 0000107800 00000 n This website uses cookies to improve your experience while you navigate through the website. Thirty-two pregnant women, whose gestational age was 20 weeks or more, were considered as the case group after evaluating blood pressure and confirming proteinuria and pre-eclampsia. RoB 2. This view is also seen in other appraisal tools, is shared by other researchers and can be seen by the absence of questions relating to the discussion sections in CA tools for other types of studies.12 ,16 ,20 ,28 ,36. Specialist Unit for Review Evidence. If consensus was 50%, components were removed from the tool. It is therefore the responsibility of the appraiser of the study to recognise omissions in reporting and consider how this affects the reliability of the results. Subsequently, parametric studies were conducted using the validated FE models to generate extensive numerical data . Int J Environ Res Public Health. Cross sectional studies are quicker and cheaper to do. It was an international panel, including 10 participants from the UK, 3 from Australia, 2 from the USA, 2 from Canada and 1 from Egypt. Summary: PEDro (Physiotherapy Evidence Database) Scale is an excellent webpage which provides access to a range of appraisal resources including a tutorial and appraisal tool. These potential participants were also asked to provide additional recommendations for other potential participants. Tool to Assess Risk of Bias in Cohort Studies Tool to Assess Risk of Bias in Case Control Studies Tool to Assess Risk of Bias in Randomized Controlled Trials Tool to Assess Risk of Bias in Longitudinal Symptom Research Studies Aimed at the General Population Risk of bias instrument for cross-sectional surveys of attitudes and practices. If you would like more information on cohort studies, their characteristics and weaknesses then please refer to Greenhalgh T. How to read a paper: the basics of evidence-based medicine. A hyperlink to the online questionnaire with the tool was distributed to the panel using email. Cochrane Handbook. 0000005423 00000 n These cookies ensure basic functionalities and security features of the website, anonymously. of General Practice, University of Glasgow, UK, http://cobe.paginas.ufsc.br/files/2014/10/MINORS.pdf. Authors Summary: National Collaborating Centre for Methods and Tools (2015). Feedback from the different groups was assessed and any changes to the CA tool were made accordingly. The purpose of this appraisal is to assess the methodological quality of a study and to determine the extent to which a study has addressed the possibility of bias in its design, conduct and analysis. 0000121318 00000 n Analytical cookies are used to understand how visitors interact with the website. Traditionally, evidence-based practice has been about using systematic reviews of randomised controlled trials (RCTs) to inform the use of interventions.10 However, other types/designs of research studies are becoming increasingly important in evidence-based practice, such as diagnostic testing, risk factors for disease and prevalence studies,10 hence systematic reviews in this area have become necessary. Fundamentally, the tool developed by Berra et al15 only appraises the quality of reporting of CSSs and does not address risk of bias or other aspects of study quality.16 Good quality of reporting of a study means that all aspects of the methods and the results are presented well and in line with international standards such as STROBE;17 however, this is only one aspect of appraisal as a well-reported study does not necessarily mean that the study is of high quality. By providing this subjectivity, AXIS gives the user more flexibility in incorporating quality of reporting and risk of bias when making judgements on the quality of a paper. Can the programme be completed entirely online without attending Oxford? Quality Assessment tools are questionnaires created to help you assess the quality of a variety of study designs. Summary: This CAT for Case control Studies has been developed by the Centre for Evidence Based Medicine, Oxford University, and has been adapted from Crombie, The Pocket Guide to Critical Appraisal; the critical appraisal approach used by the Oxford Centre for Evidence Medicine, checklists of the Dutch Cochrane Centre, BMJ editors checklists and the checklists of the EPPI Centre. General comments mostly related to the tool having too many components.The tool needs to be succinct and easy and quick to use if possibletoo many questions could have an impact. Epub 2007 Aug 27. Objectives To evaluate the risk of bias tool, introduced by the Cochrane Collaboration for assessing the internal validity of randomised trials, for inter-rater agreement, concurrent validity compared with the Jadad scale and Schulz approach to allocation concealment, and the relation between risk of bias and effect estimates. The .gov means its official. sure@cardiff.ac.uk. PLoS One. A longitudinal study is a type of correlational research study that involves looking at variables over an extended period of time. Phone: +61 8 8302 2376 PDF: JBI Checklist for Systematic Reviews, Summary:This CAT presented by the CEBM, scores the SR over 5 questions. case-control, cohort, cross-sectional). McColl A, Smith H, White P et al. The aim of this study was to develop a CA tool that was simple to use, that addressed study design quality (design and reporting) and risk of bias in CSSs. Present key elements of study design early in the paper. Two contacts felt they were not suitably qualified for the Delphi panel (n=2); one was retired and the other was a lecturer with research and clinical duties. These items were discussed with RSD and a first draft of the tool (see online supplementary table S2) and accompanying help text was created using previously published CA tools for observational and other types of study designs, and other reference documents.1 ,11 ,12 ,15 ,17 ,2029 The help text was directed at general users and was developed in order to make the tool easy to use and understandable. 0000118977 00000 n Design: AXIS critical Appraisal of cross sectional Studies Dr. Martin Downes @mjdepi. Critical appraisal tools for cross-sectional studies are the AXIS tool [4] and JBI tools; [5] for randomised controlled trials are Cochrane Risk of Bias Tool, [6] [7] JBI tool [8] and CASP tools. Two authors independently assessed the quality of the studies. Results The Appraisal tool for Cross-Sectional Studies (AXIS) was developed 20 point questionnaire that addressed study quality and reporting. For round 2 (undertaken in May 2013), 11 components remained the same and did not require testing for consensus as this was established in round 1; 9 components that had previously reached consensus were incorporated with the 13 components that required modification to create 10 new components (see online supplementary table S4). Postfeedback modification after the pilot study identified 37 components to be included in the second draft of the CA tool (see online supplementary table S3). Materials and Methods: We analyzed the 2014-2015 Korea Institute . Some information may be lacking due to poor reporting in studies, making it difficult to assess the risk of biases and the quality of the study design. Results The Appraisal tool for Cross-Sectional Studies (AXIS) was developed - 20 point questionnaire that addressed study quality and reporting. 3 TOOLS AND DEVICES. Ball & Giles 1964 Scott & Sommerville Reddy et al. A detailed explanatory document was also developed with the tool, giving expanded explanation of each question and providing simple interpretations and examples of the epidemiological concepts being examined . During round 1 (undertaken in February 2013) of the Delphi process, 20 components reached consensus, 13 components were assessed to require modification and it was deemed appropriate to remove 4 components from the tool. We also use third-party cookies that help us analyze and understand how you use this website. 0000004930 00000 n Accessibility Summary: A CAT for evaluation of reporting quality from cross-sectional epidemiological studies employing biomarker data. Evidence-based medicine (EBM) is a widely accepted scientific advancement in clinical settings that helps achieve better, safer, and more cost-effective healthcare. The number of participants from each discipline enrolled in the Delphi panel for the development of the AXIS tool. A relatively high prevalence of CKD, especially in older patients and those with diabetic complications-related to poor glycaemic control, was encountered in this primary care practice, which may help to target optimise care and prevention programs for CKD among T2DM patients. https://www.fmhs.auckland.ac.nz/assets/fmhs/soph/epi/epiq/docs/GATE%20CAT%20Case%20Control%20Studies%20May%202014%20V3.docx, Summary: This CAT developed by the Scottish Intercollegiate Guidelines Network (SIGN), scores the case control study over 10 questions and provides an overall assessment of the studies effort to reduce bias. We use cookies to ensure that we give you the best experience on our website. This scoring system assesses Qualitative, Quantitative experimental, Quantitative observational and Mixed Methods at the one time. The aim of this study was to develop a critical appraisal (CA) tool that addressed study design and reporting quality as well as the risk of bias in cross-sectional studies (CSSs). Is it clear what was used to determined statistical significance and/or precision estimates? Other 19 Were there any funding sources or conflicts of interest that may affect the authors interpretation of the results? https://www.fmhs.auckland.ac.nz/assets/fmhs/soph/epi/epiq/docs/GATE%20CAT%20Intervention%20Studies%20May%202014%20V8.docx. When piloted, there was an overall per cent agreement of 88.9%; however, 32.9% of the questions were unanswered. 4. 0000001705 00000 n Measure the prevalence of disease and thus . Psychiatric Disorders and Obesity in Childhood and Adolescence-A Systematic Review of Cross-Sectional Studies. Key areas addressed in the AXIS include Study Design, Sample Size Justification, Target Population, Sampling Frame, Sample Selection, Measurement Validity & Reliability, and Overall Methods. How this tool is structured: Study Type Abbreviations: 11 Risk-of-bias questions or domains Each question is applicable to 1 to 6 study design types Questions are rated by selecting among 4 possible answers . Soliman ABE, Pawluk SA, Wilby KJ, Rachid O. Int J Clin Pharm. If not, could this have introduced bias? reliability testing, the Appraisal tool for Cross-Sectional Studies (AXIS)25 was used.

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