Development and application of the RD-10 critical appraisal checklist in a systematic review of 181 regression discontinuity studies

M. Hilton Boon, H. Thomson, M. Campbell, P. Craig, L. Moore

Research output: Contribution to journalMeeting abstractpeer-review


Background: Natural experiments are of increasing interest because of their potential to address confounding
and selection, leading to stronger evidence of causal effects. Regression discontinuity (RD) designs can be used to
evaluate an intervention or exposure in which a cut-off rule determines treatment allocation. In order to make the
best use of these studies in systematic reviews, critical appraisal tools need to reflect the strengths and
limitations specific to the design.
Objectives: We aimed to: 1) test the US Department of Education What Works Clearinghouse Standards for RD
(WWC) using a sample of public health studies; 2) develop a critical appraisal checklist for RD that is applicable to
health research; and 3) apply the checklist in a comprehensive review of RD studies.
Methods: We conducted a systematic review of RD studies of health outcomes following a protocol registered
with PROSPERO (CRD42015025117). We searched textbooks, methodological papers and the Internet for potential
quality assessment tools. We piloted the only published RD-specific assessment tool (WWC) and evaluated 17
studies of minimum legal drinking age (MLDA) legislation. We developed a 10-item checklist for RD appraisal (RD10) and assessed the quality of 181 studies included in the systematic review.
Results: Of the 17 MLDA studies, 16 failed to meet WWC standard 2 (reporting of attrition) and therefore failed the
overall quality standard. WWC produced limited description of study quality, was of little use in distinguishing
between higher and lower quality studies, and made no allowances for cross-sectional or retrospective
applications of the design. We adapted the WWC standards to produce 10 individual criteria that could be judged
as yes, no, or unclear. The majority of studies (160/181; 88.4%) provided a narrative explaining how the cut-off
rule was implemented. Just over half of the studies (93/181; 51.4%) specified whether the cut-off value was used
only to assign participants to the treatment of interest. Fewer than half the studies reported a density test or a
falsification test (74/181; 40.9%). Only 5% (9/181) of studies fully met the 10 criteria.
Conclusions: Compared to WWC, RD-10 is easier to use, produces a more detailed description of quality, and is
more applicable to the retrospective RD designs commonly seen in health research.
Original languageEnglish
JournalCochrane Database of Systematic Reviews
Issue numberSuppl.1
Publication statusPublished - 11 Sep 2018


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