We (ThinkWell and PLOT ) are set up to use both side by side and test the value and sturdiness of the design by using treatments people can do for themselves without medical supervision. In the Polio trials 1954 they used RCT and observational. There is literature on this that shows situations in much more depth than STAR D. There is a need to test the value in the space between real and what works! Real can not be at the expense of valid evidence and RCT can't assume they are the only effective path to truth without adequately testing the hypothesis.
Best
Amy
Amy Price
Empower 2 Go
Building Brain Potential
Http://empower2go.org
Sent from my iPad
On 16 Aug 2013, at 05:03 PM, "Laura Cousineau" <[log in to unmask]> wrote:
> A student presented the STAR*D study on depression today in journal club. These types of studies are referred to as “practical trials” or “effectiveness trials.”
>
> I confess that this is the first time that I have come across this study design. I asked questions about how they would compare this type of study to a prospective cohort, what they thought about the lack of control groups, what they thought about the randomization - or lack there of - etc. Mostly I heard that they loved this study design because it is "real." They seemed to value this design over an RCT because it draws from patients with comorbidities and who self-select a treatment arm, as opposed to RCTs that are careful to eliminate comorbidities and use proper randomization.
>
> Are there any guidelines for evaluating these "effectiveness" trials? What are your thoughts about them?
>
> Thanks!
> Laura
>
> --
> Laura K. Cousineau, MLS
> Director, Biomedical Libraries at Dartmouth
> Instructor, Department of Medicine
> Dana Biomedical Library / HB 6168
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