Considerations and methods for placebo controls in surgical trials (ASPIRE guidelines).

Lancet
David J BeardJonathan A Cook

Abstract

Placebo comparisons are increasingly being considered for randomised trials assessing the efficacy of surgical interventions. The aim of this Review is to provide a summary of knowledge on placebo controls in surgical trials. A placebo control is a complex type of comparison group in the surgical setting and, although powerful, presents many challenges. This Review outlines what a placebo control entails and present understanding of this tool in the context of surgery. We consider when placebo controls in surgery are acceptable (and when they are desirable) in terms of ethical arguments and regulatory requirements, how a placebo control should be designed, how to identify and mitigate risk for participants in these trials, and how such trials should be done and interpreted. Use of placebo controls is justified in randomised controlled trials of surgical interventions provided there is a strong scientific and ethical rationale. Surgical placebos might be most appropriate when there is poor evidence for the efficacy of the procedure and a justified concern that results of a trial would be associated with high risk of bias, particularly because of the placebo effect. Feasibility work is recommended to optimise the design and imple...Continue Reading

Citations

Aug 3, 2020·BJOG : an International Journal of Obstetrics and Gynaecology·Henrik MarschallLene Vase
Sep 22, 2020·PLoS Medicine·Jeremy HowickTammy Hoffmann
Jul 24, 2020·Pain·Sophie W KjærLene Vase
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Sep 22, 2021·The Journal of Hand Surgery, European Volume·Matthew D Gardiner, Pragash Kamalathevan
Oct 12, 2021·The American Journal of Sports Medicine·Kelechi C EseonuStefan Kluzek

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