Hierarchy of Evidence: Where Observational Studies Fit in and Why We Need Them

• DOI: 10.2106/jbjs.h.01571
• Publication Date: 2009-05-01T17:30:06Z
• Authors: Daniel J. Hoppe; Emil H. Schemitsch; Saam Morshed; Paul Tornetta; Mohit Bhandari
• Keywords: Evidence-Based Medicine; Gold standard (test)

Although randomized controlled designs are considered the so-called gold standard in medical trials and sit atop hierarchy of evidence evidence-based medicine, there situations which they impractical or unethical to undertake, especially surgical trials. Then, observational studies often provide best source information. In this paper, we use examples from literature explain importance furthering boundaries orthopaedic surgery knowledge musculoskeletal disorders.