Chad Cook RCT Commentary

[Aaron Hartstein]

Chad’s perspectives are always worth a read. Here is a new one about RCTs. See what you think.

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[Erik Kreil]

Love this! It all has individual value, and it’s important to not overestimate an RCT just because of where it falls on the evidence pyramid.

[Jon Lester]

I find that quite a few people don’t take these “reasons” as to why a RCT is not gospel into consideration for their clinical decision making. Most readers will look into the conclusions of the study (maybe the methods if they feel ambitious) and extrapolate the findings to use on their next patient. Like the authors were stating, this is not always the best way of thinking and further investigation into the rationale behind said conclusions is needed. It’s challenging to look into new research this way because we all want the newest, most interesting way of treating our patients. However, I agree that not every RCT should be so heavily relied upon without delving deeper into the clinical reasoning side of our brain and questioning the results and their application to the patient in front of us.

[Cameron Holshouser]

This article was helpful to highlight the limitations of RCT’s. My biggest takeaway was that RCT’s demonstrate the efficacy and effectiveness between interventions, but do not tell you why there was a difference. This article also highlights how difficult it is to make a good RCT. There are so many biases that go into any study, but it is important to understand these biases and take them into consideration when reading the conclusions of a study.

[jeffpeckins]

Good points everyone. My biggest takeaway was that in an effort to meet internal validity, the external validity may be sacrificed, and therefore the treatment parameters in an RTC may not always reflect how an intervention is usually carried out in clinical practice. This is another reason why looking at just the abstract and conclusion of an RTC may not give you all the info that you need to make a clinically sound choice.

Overall, the article reminded me of the importance of using my own clinical reasoning when using the conclusions of an RTC (or any other form of research) when applying them to my patient. Does my patient match the inclusion criteria? Do the methods match how I would use that intervention in the clinic? Does my patient have yellow flags or other traits/presentation that make them a “marginal patient”? What intervention-bias do I have and what intervention-bias does my patient have?

[Erik Kreil]

Absolutely, Jeff. That’s why I’ve appreciated journal club — it’s helped me consider the applicability of the article to the patient.

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