Hierarchy of evidence: where observational studies fit in and why we need them.
Although randomized controlled designs are considered the so-called gold standard in medical trials and sit atop the hierarchy of evidence in evidence-based medicine, there are situations in which they are impractical or unethical to undertake, especially in surgical trials. Then, observational studies often provide the best source of information. In this paper, we use examples from the literature to explain the importance of observational studies in furthering the boundaries of orthopaedic surgery and knowledge of musculoskeletal disorders.
Division of Orthopaedic Surgery, Department of Surgery, McMaster University, 293 Wellington Street North, Suite 110, Hamilton, ON L8L 2X2, Canada.
Daniel J
DJ
Hoppe
Emil H
EH
Schemitsch
Saam
S
Morshed
Paul
P
Tornetta
Mohit
M
Bhandari
D035843:Biomedical Research / Q000379:methods*; D002986:Clinical Trials as Topic; D019317:Evidence-Based Medicine; D006801:Humans; D019370:Observation; D009985:Orthopedics; D016032:Randomized Controlled Trials as Topic; D012107:Research Design