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Trial quality - Part I

Every time that I am teaching evidence-based practice to my students on how to conduct randomised controlled trials, I heard questions like: Why trial quality is not getting better over time?

Don’t get me (or my students) wrong here: trial quality IS improving over time, but in a very (veeeeeeeery) slow pace. Although we can observe a slow improvement over time, it is hard to understand why initiatives like the CONSORT Statement, Cochrane Reviews or PEDro database did not push this improvement further (or faster). There is a lot of data showing that this slow improvement is happening in all fields of health-related research, so there is no winner here. Incidentally, what trial quality is, and how we go about measuring it is another beast all together, and the topic for next week’s post.

My concern is that clinicians don’t have to fully understand research methods in such depth, and dodgy trials make their lives much more complicated. Maybe that is the reason that clinicians sometimes just ignore evidence! I don’t expect a perfect world on this issue, but I think that is unacceptable to see so many biased trials been published these days.

Rob Herbert’s excellent book1 gives us some insights on what would be the reasons that bad trials are still being published:

  1. Research is not always carried out by experts in the field, actually much of the clinical research is conducted by people with little or no training in research.

  2. The peer review process is not always performed by good researchers/editors.

  3. Some journals are desperate to publish something, in this case poorly design studies are used to fill the pages of their journals.

  4. Sometimes authors want to make their point rather than test a specific hypothesis.

  5. Finally some good researchers can have practical problems in conducting their trials (for example, to recruit a reasonable number of patients for a specific trial).

I was wondering if the ICECREAMers have more ideas on this issue, I would love to hear your opinions on it.


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