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Introduction
  • A method utilized in evidenced based medicine to determine the clinical value of a study
  • See details of Clinical Design Trials 
Different Levels of Evidence
 
Level 1
  1. Randomized controlled trial (RCT)
    • a study in which patients are randomly assigned to the treatment or control group and are followed prospectively
  2. Meta-analysis of randomized trials with homogeneous results
Level 2  
  1. Poorly designed RCT
    • follow up less than 80%
  2. Prospective cohort study (therapeutic) 
    • a study in which patient groups are separated non-randomly by exposure or treatment, with exposure occurring after the initiation of the study
  3. Meta-analysis of Level 2 studies
Level 3
  1. Retrospective cohort study
    • a study in which patient groups are separated non-randomly by exposure or treatment, with exposure occurring before the initiation of the study
  2. Case-control study
    • a study in which patient groups are separated by the current presence or absence of disease and examined for the prior exposure of interest
  3. Meta-analysis of Level 3 studies 
Level 4
  1. Case series
    • a report of multiple patients with the same treatment, but no control group or comparison group
Level 5
  1. Case report (a report of a single case)
  2. Expert opinion
  3. Personal observation
 
 JBJS LOE
AAOS Recommendations
 

AAOS Evidence-Based Practice Committee

  Recommendations in Clinical Practice Guidelines

Strong • Two or more HIGH quality studies
Moderate  • One HIGH or 2 MODERATE quality studies
Weak 

• One MODERATE or 1 or more LOW quality studies

Consensus
• Expert opinion (no studies)* Only used in one circumstance: It pertains to medical interventions that potentially prevent loss of life or limb (catastrophic consequences).

 
 
 

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