I love them because:
- The outcomes are measured on a continuous functional scale, so that one-third of a standard deviation can be detected with a trial of about 500 patients, rather than the 5,000 needed for many mortality trials.
- Outcomes are usually short-term; we do not need to wait for recurrence or death, for example.
- It is possible to rapidly determine the effect of trial results on clinical practice through hospital databases, and confirm through orthopaedic registries.
CLAHRC WM is collaborating with CLAHRC East Midlands in evaluating all outputs from the NIHR HTA programme, and orthopaedic trials are proving particularly informative. We give three examples in the table below:
|Clark , et al. Outpatient versus inpatient polyp treatment for abnormal uterine bleeding. 2015.||Outpatient polyp treatment is effective, acceptable and cost-effective. The current situation is unsustainable – the majority of NHS providers cannot offer choice routinely.|
|Rangan, et al. Surgical versus non-surgical treatment for proximal fracture of the humerus. 2015.||Robust, clinically relevant evidence shows that surgical intervention does not result in a better outcome for patients with a displaced fracture of the proximal humerus involving the surgical neck than non-surgical treatment. Surgery is currently the most widely used treatment. It is neither effective nor cost-effective.|
|Costa, et al. RCT Kirschner wires versus plate fixation for displaced distal radius fractures. 2015.||Trial contradicts both the increasing trend towards the use of locking plates in the treatment of distal radius fractures, and the findings of previous trials, which indicated that locking plates provide improved functional outcomes compared with K-wire fixation.|
— Richard Lilford, CLAHRC WM Director