LEVEL I: Evidence from an integrated literature review, systematic review or meta-analysis of all relevant randomized controlled trails (RCTs), or evidence-based clinical practice guidelines based on systematic reviews of RCTs.

· Review of research evidence related to a specific clinical question.

· Critically analyzes and synthesizes findings from multiple random control trials.

· Aim is to interpret and translate findings.

LEVEL II: Evidence obtained from at least one well-designated RCT. (experimental)

· Study subjects are randomly assigned to either a treatment or control group.

· May be:

· Blind: neither subject nor investigator knows which treatment the subject is receiving.

· Double-blind: neither subject nor investigator knows which treatment the subject is receiving.

· Non-blind: both subject and investigator know which treatment subject is receiving; used when it is felt that the knowledge of treatment is unimportant.

LEVEL III: Evidence obtained from well-designed controlled trials without randomization. (quasi-experimental)

· Always includes manipulation of an independent variable

· Lacks either random assignment or control group

· Findings must be considered in light of threats to validity (particularly selection)

LEVEL IV: Evidence from well-designed case-control and cohort studies.

· No manipulation of the independent variable.

LEVEL V: Evidence from systematic reviews of descriptive and qualitative studies, correlational studies.

LEVEL VI: Evidence from a single descriptive or qualitative study.

· Explorative in nature, such as interviews, observations, or focus groups.

· Starting point for studies of questions for which little research currently exists.

· Sample sizes are usually small and study results are used to design stronger studies that are more objective and quantifiable.

· Describing differences in variables between or among groups.

· Describing relationships among variables. No attempt to understand causal relationship.

LEVEL VII: Evidence from the opinion of authorities and/or reports of expert committees.

QUALITY DEFINITIONS

(Quality is based on Critical Appraisal)

GOOD: A study meets all research design-specific criteria well

FAIR: A study does not meet (or it is not clear that it meets) at least one design-specific criterion but has no known “fatal flaws”

POOR: A study that has at least one design specific “fatal flaw: or an accumulation of lesser flaws.

References

Dearholt, S.L.; & Dang, D. (2012). John Hopkins nursing-evidence based practice: model and guidelines (2nd ed.). John Hopkins University, School of Nursing: Sigma Theta Tau

Fineout-Overholt, E and Melnyk, B.M. (2005). Evidence-based practice in nursing and healthcare: a guide to best practice. Philadephia:Lippincott Williams and Wilkins.

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