Cluster randomised trials with repeated cross sections: alternatives to parallel group designs.
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In 1948 the UK Medical Research Council’s streptomycin trial established the principles of the modern clinical trial,1 and for longer still the idea of a comparison group recruited concurrently to the intervention group has been recognised as essential to obtaining sound evidence for clinical effectiveness.2 But must a trial proceed by running an intervention and comparator in parallel? In this article we focus on trials where participants are randomised in clusters such as general practices or schools. This is common when evaluating interventions applied at cluster level.3 We look at trials where the comparator is routine care, which effectively ask how individuals’ outcomes would compare before and after introducing the intervention in a cluster. We discuss efficient alternatives to parallel group trial designs in this case – made possible by delaying introduction of the intervention in some clusters after randomisation, with these clusters continuing in the meantime to receive routine care.
AuthorsHooper, R; Bourke, L
- College Publications