At its heart, critical appraisal is the ability to review articles on evidence based medicine & evaluate their internal validity and then external validity.
There is no absolute in critical appraisal and different people will hold valid different opinions on research, the importance though is that sound critical thinking and application of critical appraisal concepts have been applied.
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PICO is the format that an abstract for a paper is written?
Internal validity relates to how well the population of the study reflects that of the general population?
External validity reflects how well the results of a trial can be extrapolated into the wider population?
Clinical significance reflects how easy it is to measure the outcome of interest in a clinical setting?