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Journal of Rehabilitation Research and Development
Vol. 39 No. 1, January/February 2002
Pages 41 - 52

Use of data from nonrandomized trial designs in evidence reports: An application to treatment of pulmonary disease following spinal cord injury


Gregory P. Samsa, PhD; Joseph Govert, MD; David B. Matchar, MD; Douglas C. McCrory, MD

Center for Clinical Health Policy Research, Duke University Medical Center, Durham, NC; Department of Medicine, Duke University Medical Center, Durham, NC; Department of Community and Family Medicine, Duke University Medical Center, Durham, NC

Abstract: Evidence reports summarize the evidence pertaining to various health-related topics. Including evidence from nonrandomized studies into such reports involves a trade-off between availability and bias. We describe a general framework by which information from nonrandomized studies might be integrated reasonably into evidence reports and illustrate its application to a recent evidence report on preventing pulmonary complications among patients with spinal cord injury. The proposed framework, which is based upon the premise that producing a fair summary of the evidence requires only a level of evidence judged by clinical experts to be sufficient to the task at hand, may help focus scarce resources, strengthen the quality and documentation of decisions including evidence from nonrandomized studies, and suggest high-priority areas for future research.

Key words: evidence reports, information synthesis, nonrandomized trials, study design.


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