Orthopaedic Surgeons Prefer to Participate in Expertise-based Randomized Trials

Empiric data and theoretical arguments suggest an alternative randomized clinical trial (RCT) design, called expertise-based RCT, has enhanced validity, applicability, and ethical integrity compared with conventional RCT. Little is known, however, about whether physicians will participate in an expe...

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Bibliographic Details
Published in:Clinical orthopaedics and related research 2008-07, Vol.466 (7), p.1734-1744
Main Authors: Bednarska, Elzbieta, Bryant, Dianne, Devereaux, P. J.
Format: Article
Language:English
Subjects:
Arthroplasty, Replacement, Knee
Biological and medical sciences
Canada
Clinical Competence
Conservative Orthopedics
Cross-Sectional Studies
Diseases of the osteoarticular system
Evidence-Based Medicine
Female
Humans
Male
Medical sciences
Medicine
Medicine & Public Health
Middle Aged
Original
Original Article
Orthopedics
Osteoarthritis, Knee - surgery
Osteotomy
Professional Practice
Randomized Controlled Trials as Topic - methods
Sports Medicine
Surgery
Surgical Orthopedics
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Summary:Empiric data and theoretical arguments suggest an alternative randomized clinical trial (RCT) design, called expertise-based RCT, has enhanced validity, applicability, and ethical integrity compared with conventional RCT. Little is known, however, about whether physicians will participate in an expertise-based RCT. In a cross-sectional survey of Canadian orthopaedic surgeons, we evaluated preference for and willingness to participate in an expertise-based versus a conventional RCT if given the opportunity to participate in a trial investigating the effectiveness of high tibial osteotomy versus unicompartmental knee arthroplasty. Using an electronic survey (©2005 SurveyMonkey.com), we invited all 767 members of the Canadian Orthopaedic Association (2005) to participate; 276 surgeons completed the questionnaire (37.5% response rate). One hundred two surgeons (53.4%) were willing to participate in an expertise-based RCT compared with 35 surgeons (18.3%) willing to participate in a conventional RCT. Ninety-seven surgeons (52.4%) strongly or moderately preferred the expertise-based design compared with 25 (13.5%) who preferred the conventional design. For the clinical example we presented, the majority of Canadian orthopaedic surgeons were willing to participate in and preferred the expertise-based design. The expertise-based randomized clinical trial design may overcome some of the barriers to conducting clinical trials in orthopaedic surgery and improve the validity of their conclusions.
ISSN:0009-921X
1528-1132
DOI:10.1007/s11999-008-0273-9