Abi Alayo, Deputy Library Services Manager, Birmingham Community Healthcare NHS Foundation Trust
Introduction
A Critically Appraised Topic (CAT) can be described as a summary of the best available evidence on a topic for the purpose of answering a focused clinical question. The library at Birmingham Community Healthcare Foundation Trust (BCHC) is actively involved in supporting Critically Appraised Topics Groups across the organisation. The aim of each established group is for a team of clinicians, supported by an academic and a library representative, to evaluate best available evidence on the chosen question and arrive at a clinical bottom line that underpins daily clinical practice.
Process
STEP 1: Identify the clinical problem or dilemma
As library representative, I join the clinical team and academic representative at the preliminary meeting of a CATs Group. The academic representative and I present the CATs process to the team, who then present issues or problems in their clinical practice before the group votes on the area to be addressed.
STEP 2: Formulate a clinical question
Once the topic to be addressed has been decided upon, it is refined into a structured question using PICO (Population, Intervention, Comparison, Outcome) or another relevant model. I conduct a scoping search to give the group a flavour of the literature on the subject – this helps in the refinement of the research question as it drives the decision on objectives, inclusion, and exclusion criteria.
Questions supported in the past include:
- Is Functional Electrical Stimulation effective in the treatment of upper limb spasticity in adults and children with neurological conditions?
- What is the optimal delivery mechanism for physiotherapy intervention for children with long term neurological metabolic or genetic conditions up to the age of 10?
- What is known about Gestalt Language Processing in autistic children between zero and 5 years of age?
STEP 3: Search for evidence
I present the range of clinical databases available, and the group decides on those for conducting the literature search; on occasion, the group requests that I deliver a literature searching session – this helps them contribute more effectively to the search strategy. Once the search is completed, it is written up and the results are shared with the group in excel and pdf formats.
STEP 4: Identify the appropriate literature
The group screens the search results, reading the titles and abstracts to identify those that meet the inclusion criteria. A record is kept of papers that are excluded and the reason for the exclusion.
STEP 5: Appraise the evidence
Once the screening has been completed, I conduct a critical appraisal session to equip the group with skills for appraising the included papers. The papers are then critically appraised by the group for quality, validity, and clinical relevance. I facilitate the critical appraisal meetings alongside the academic representative, and it usually spans several weeks depending on the number of included papers and the alignment of calendars. We choose 2-3 papers to appraise in each meeting; I then help source the full-text and advise on the appropriate critical appraisal tool.
STEP 6: Clinical Bottom Line (CBL)
Once the included evidence has been appraised, the group works with the academic representative to summarise how the findings reflect on clinical practice. An example of the impact on daily clinical practice on the Trust website is: How much physiotherapy does my child need? A research summary. A clinical bottom line is identified even if an answer to the question has not been found, as it serves as a starting point for future research or quality improvement.
An example of CBL from one of the Groups:
‘Clinicians, educators, and parents of autistic children, have shown interest in using approaches for language intervention that are based upon Gestalt Language Processing (GLP). GLP is depicted as a form of language acquisition in which early utterances are mainly represented by multi-word utterances that are memorised as whole units. This differs from the typical analytical style of language development in which children learn individual words and their meanings.
The Natural Language Acquisition (NLA) framework describes stages of language acquisition for children who use Gestalt Language Processing (GLP) instead of typical analytical language development. The highest level of evidence to support this framework is four case series studies; however, the critique of this framework indicates that there is insufficient empirical evidence to recommend the implementation of GLP-based interventions in autistic children between the ages of zero and five. Thus, there is insufficient evidence to recommend the implementation of GLP-based interventions for autistic children between the ages of zero and five.’
STEP 7: Share your Clinical Bottom Line
It is important for the identified clinical bottom line to be shared to ensure that learning is publicised. The most common avenues the CATs Groups have employed within BCHC are Trust bulletins, meetings, the Quality Improvement Forum – external avenues include presenting at conferences.
Conclusion
Supporting CATs alongside the academic representative has become an integral part of my role, and I believe my involvement adds significant value to the output of the group. My experience has helped me realise how the right guidance can alter perceptions of research. I have found that people are usually keen to be research active at the start, but quite uncertain about their capabilities, and through the CATs process, they gain skills and confidence, with some feedback describing it as having ‘taken away some of the fear of engaging in research.’
References
- Centre for Evidence-Based Medicine. Glossary. Available from https://www.cebm.ox.ac.uk/resources/ebm-tools/glossary [Accessed 29 January 2026].
- Physiopedia. Critically Appraised Topics. Available from https://www.physio-pedia.com/Critically_Appraised_Topics?utm_source=copilot.com#cite_note-1 [Accessed 26 March 2026].
- Foster, N., Barlas, P., Chesterton, L., & Wong, J. (2001). Critically appraised topics (CATs): One method of facilitating evidence-based practice in physiotherapy. Physiotherapy, 87(4), 179-190.
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