Revisiting the Randomized Controlled Trial
نویسنده
چکیده
Randomized controlled trial (RCT) is generally considered to be one of the strongest study designs because the results it generates, have minimum bias and avoids confounders by virtue of the randomization and blinding technique which it employs. It has the potential to generate a Level B evidence on its own or even a Level A evidence when a pooled meta-analysis or a systematic review of several RCTs is conducted. The results a RCT generates occupy the top of hierarchy of evidence and if the trial is a large multicenter placebo controlled double blind one, people will have a hard time critically appraising it as it’s; statistically speaking, the strongest possible study design. The inception of RCT dates back to World War II when in an effort to impose an objective and scientific discipline onto the extraordinary postwar expansion of medical research, the components of the double-blind RCT were adopted and coalesced together for the first time.1 These included blind assessment (usually meaning a placebo control), random assignment to comparable groups, and inferential statistics as a surrogate for determinism.2 Back then, Placebo was not considered to offer much help in bringing a measureable change in objectively recordable outcome variables or in improving patient’s health in general. On the contrary, Physicians used it routinely in their practice as for example; in 1807, Thomas Jefferson (1743–1826) penned a description of what he called
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