CASP Checklist: 12 questions to help you make sense of a Cohort Study

How to use this appraisal tool: Three broad issues need to be considered when appraising a
cohort study:

Are the results of the study valid? (Section

A) What are the results? (Section
B) Will the results help locally? (Section
C)

The 12 questions on the following pages are designed to help you think about these issues
systematically. The first two questions are screening questions and can be answered quickly.
If the answer to both is “yes”, it is worth proceeding with the remaining questions. There is
some degree of overlap between the questions, you are asked to record a “yes”, “no” or
“can’t tell” to most of the questions. A number of italicised prompts are given after each
question. These are designed to remind you why the question is important. Record your
reasons for your answers in the spaces provided.

About: These checklists were designed to be used as educational pedagogic tools, as part of a
workshop setting, therefore we do not suggest a scoring system. The core CASP checklists
(randomised controlled trial & systematic review) were based on JAMA 'Users’ guides to the
medical literature 1994 (adapted from Guyatt GH, Sackett DL, and Cook DJ), and piloted
with health care practitioners.
For each new checklist, a group of experts were assembled to develop and pilot the checklist
and the workshop format with which it would be used. Over the years overall adjustments
have been made to the format, but a recent survey of checklist users reiterated that the basic
format continues to be useful and appropriate.
Referencing: we recommend using the Harvard style citation, i.e.: Critical Appraisal
Skills Programme (2018). CASP (insert name of checklist i.e. Cohort Study) Checklist.
[online] Available at: URL. Accessed: Date Accessed.

©CASP this work is licensed under the Creative Commons Attribution – Non-Commercial-
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Paper for appraisal and reference:.........................................................................................................
Section A: Are the results of the study valid?

1. Did the study address a

clearly focused issue?
Ye V HINT: A question can be ‘focused’
in terms of
s Can’t • the population studied
 the risk factors studied
Tell
• is it clear whether the study tried to
No detect a beneficial or harmful effect
• the outcomes considered

Comments: Populasi yang diteliti merupakan pasien dengan pemberian simaglutide injeksi
1xseminggu, dengan hasil yang ingin diperoleh merupakan persentase penurunan berat badan pasca
penggunaan obat tersebut.

2. Was the cohort recruited in

Ye HINT: Look for selection bias which
an acceptable way?
s Can’t
V might compromise the generalisability
of the
findings:
Tell
 was the cohort representative of a
No defined population
 was there something special about the
cohort
 was everybody included who should
have been

Comments: Populasi diambil melalui EMR (E-MedRecord) Mayo Clinic Health Centre, dan kelompok
cohort yang dianalisis mewakili populasi tersebut.

Is it worth continuing?

2
3. Was the exposure accurately
measured to minimise bias?
Ye
V HINT: Look for measurement or
classification bias:
s Can’t • did they use subjective or objective
measurements
Tell • do the measurements truly reflect what
you want them to (have they been
No validated)
 were all the subjects classified
into exposure groups using the
same procedure

Comments: Pemberian dosis pada setiap pasien dipastikan tepat dan akurat, tergantung dari dosis
masing-masing pasien.

4. Was the outcome accurately Ye HINT: Look for measurement or

measured to minimise bias?
V classification bias:
s Can’t • did they use subjective or objective
measurements
Tell • do the measurements truly reflect what
you want them to (have they been
No validated)
 has a reliable system been
established for detecting all the cases (for
measuring disease occurrence)
 were the measurement
methods similar in the different groups
 were the subjects and/or
the outcome assessor blinded to
exposure (does this matter)

Comments: Outcome yang diinginkan merupakan persentase penurunan berat badan pasca pengobatan
di bulan ke 3 dan bulan ke 6. Pasien secara seksama diukur secara tepat penurunan berat badan nya
pada waktu tersebut.

3
5. (a) Have the authors identified Yes Can’t Tell HINT:
all important confounding No
factors? • list the ones you think might
V be important, and ones the author missed

Comments:

Ye

s Can’t
5. (b) Have they taken account
HINT:
of the confounding factors in Tell • look for restriction in design,
the design and/or analysis?
and techniques e.g. modelling, stratified-,
No V regression-, or sensitivity analysis to correct,
control or adjust for confounding
factors

Comments:

Ye
6. (a) Was the follow up of
HINT: Consider
subjects complete enough?
s Can’t
V • the good or bad effects should have
had long enough to reveal
themselves
Tell
Follow up pada setiap pasien dilakukan • the persons that are lost to follow-up
secara rutin dan lengkap, untuk may have different outcomes than
mengetahui bagaimana pengaruh dari No those available for assessment
obat terhadap penurunan berat badan • in an open or dynamic cohort, was
dan juga efek samping dari obat2an there anything special about the
tersebut outcome of the people leaving, or the
exposure of the people entering the
cohort
6.(b) Was the follow up of
subjects long enough?
Ye V
Pasien paling lama di follow up
hingga 6 bulan s Can’t

Tell

No

4
7. What are the results of this study? HINT: Consider
 what are the bottom line
results
 have they reported the rate or
the proportion between the
exposed/unexposed, the
ratio/rate difference
 how strong is the association
between exposure and
outcome (RR)
 what is the absolute risk
reduction (ARR)

Comments: Hasil dari penelitian menunjukkan pasien dengan DM2 mengalami penurunan berat badan
yang lebih rendah daripada pasien tanpa DM2

8. How precise are the results? HINT:

 look for the range of the confidence
intervals, if given

Comments: Can’t tell

5
 9. Do you believe the results?
HINT: Consider
V  big effect is hard to ignore
 can it be due to bias, chance or
confounding
Yes Can’t Tell
 are the design and methods of this
study sufficiently flawed to make
No
the
results unreliable
 Bradford Hills criteria (e.g.
time sequence, dose-response
gradient, biological plausibility,
consistency)

Comments: Karena hasil dari penelitian berbanding lurus dengan alasan mengapa pengidap DM
mengalami penurunan BB lebih rendah daripada pasien tanpa DM2

Section C: Will the results help locally?

10. Can the results be applied to

Ye HINT: Consider whether
the local population?
 a cohort study was the appropriate
s Can’t
V method to answer this question
the subjects covered in this study could
Tell be sufficiently different from your
population to cause concern
No  your local setting is likely to
differ much from that of the
study
 you can quantify the local benefits and
harms

Comments: Karena masih jarang nya penggunaan obat antiobesitas di lingkungan saya, serta masih
kurangnya pengetahuan umum tentang AOM di lingkungan sekitar, sehingga belim diketahui apakah
akan berpengaruh

11. Do the results of this study

Ye
fit with other available
evidence?
s Can’t V
Tell

No

Comments: Pada jurnal ini juga disebutkan hasil dari beberapa studi lain, dengan menggunakan AOM
lain bahwa pasien dengan dm2 kesulitan untuk mengurangi BB

6
 12. What are the implications of
Ye HINT: Consider
this study for practice? V  one observational study rarely
provides sufficiently robust evidence to
s Can’t
recommend changes to clinical practice
or within health
Tell policy decision making
 for certain questions,
observational studies provide the
No
only evidence
 recommendations from
observational studies are always
stronger when supported by other
evidence

Comments: Banyak hal yang dapat diterapkan dari studi ini, terutama penggunaan AOM pada
masyarakat sekitar, dan edukasi terhadap masyarakat sekitar terhadap penggunaan AOM