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What RCT Does Best
Clinical trials are
best suited to evaluate treatment interventions. The primary advantages
of the clinical trial design are:
- It is prospective,
or longitudinal, following people over time
- The investigator
allocates, at random, the type(s) of treatment(s) to
the pool of clinical subjects (Hennekens
and Buring, 1987)
The RCT approach creates
two or more groups to be assessed with equivalent follow up measures
and who, on average, are similar on known and unknown variables
that can influence the outcome of treatment. For example, there
is evidence that resolving a current TMD condition depends upon
whether the person has ongoing psychosocial distress, such as
depression, somatization, or anxiety disorders (Ohrbach
and Dworkin, 1998). If, in a clinical trial for TMD, one treatment
group has more distressed people then the other, than any differences
in their treatment outcomes may merely reflect the maldistribution
of this prognostic factor.
Some might assume that
all aspects of TMD are best studied using RCTs. However, it is
important to recognize that many important aspects of TMD are
difficult or impossible to investigate via RCTs including frequency,
etiology, diagnosis, prognosis, pathophysiology, etc.
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