Understanding and evaluating clinical trials

In this review, we attempt to provide the basic knowledge necessary to understand and evaluate clinical trials because properly conducted, randomized clinical trials are the best sources for determining the best available treatment. Other commonly used sources rarely provide sufficient detail necessary to determine the efficacy and safety of any treatment, and they often contain biases or pitfalls that make them unacceptable or unreliable. Our method for reviewing clinical trials allows a busy clinician to use his or her time most efficiently by deciding not to read the majority of poorly conceived, designed, executed, or reported trials and those trials with insignificant results. It provides a means to determine the quality of the trials that one does decide to read and to retain and retrieve the information when it is needed. The method involves recognizing and evaluating the features that strengthen clinical trials and help validate their conclusions. These features include proper selection and allocation of patients, inclusion of an appropriate control group, randomization, prior selection of clinically and biologically important outcome variables, blinding of assessment, consideration of patient compliance and drop out, and proper presentation and statistical analysis of results.