A review of critical appraisal tools show they lack rigor: Alternative tool structure is proposed.

OBJECTIVES To evaluate critical appraisal tools (CATs) that have been through a peer-reviewed development process with the aim of analyzing well-designed, documented, and researched CATs that could be used to develop a comprehensive CAT. STUDY DESIGN AND SETTING A critical review of the development of CATs was undertaken. RESULTS Of the 44 CATs reviewed, 25 (57%) were applicable to more than one research design, 11 (25%) to true experimental studies, and the remaining 8 (18%) to individual research designs. Comprehensive explanation of how a CAT was developed and guidelines to use the CAT were available in five (11%) instances. There was no validation process reported in 11 CATs (25%) and 33 CATs (77%) had not been reliability tested. The questions and statements that made up each CAT were coded into 8 categories and 22 items such that each item was distinct from every other. CONCLUSIONS CATs are being developed while ignoring basic research techniques, the evidence available for design, and comprehensive validation and reliability testing. The basic structure for a comprehensive CAT is suggested that requires further study to verify its overall usefulness. Meanwhile, users of CATs should be careful about which CAT they use and how they use it.

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