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  • Evidence based Medical (& Surgical) Practice

    Clinicians all over the world are becoming increasingly aware of the need for a more rational approach to medical treatment. Many new treatment modalities that have been reported in the literature are not based on sound scientific evidence.

    Sackett1 suggested that the scientific "weight" of different types of studies performed for deciding treatment options are in the following order of descending value :

    • 1. Randomised controlled trials
    • 2. Non-randomised cohort comparisons of contemporaneous patients
    • 3. Non-randomised historical cohort comparisons
    • 4. Case series without controls.

    While assessing therapeutic effectiveness of a surgical procedure the preferred study design is a randomised controlled trial (RCT). The Cochrane Collaboration has been preparing a database of all published RCTs. The Musculo-Skeletal Section of the Cochrane Collaboration had requested the Editor to scrutinise the literature published in India and identify all RCTs. Not a single study which fulfilled the criteria of a RCT could be located in Orthopaedic literature in India !

    It is certainly incumbent on us to improve the quality of surgical care in the field of Paediatric Orthopaedics in India. This will only be possible if we make a concerted effort to base our treatment protocols on scientific evidence. The article of Harrison & Bassett abstracted in this issue clearly demonstrates how a RCT failed to show any therapeutic value of a treatment method which, initially, was thought to be beneficial.

    It is our hope that POSI would lead the way among our Orthopaedic colleagues in improving the quality of clinical research with the aim of practising evidence based medicine.

    1. Sackett DL. Rules of evidence and clinical recommendations on the use of antithrombotic agents. Chest 1986; 89: 2-35.