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The Intention-to-Treat Principle: A Primer for the Orthopaedic Surgeon
Vikrant K. Bubbar, BScH, BEd, MD, FRCSC1; Hans J. Kreder, MD, MPH, FRCSC2
1 305-1120 Yates Street, Victoria, BC V8V 3M9, Canada. E-mail address: vic.bubbar@gmail.com
2 Division of Orthopaedic Surgery, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON M4N 3M5, Canada. E-mail address: hans.kreder@sw.ca
The Journal of Bone & Joint Surgery.  2006; 88:2097-2099  doi:10.2106/JBJS.F.00240.top
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Randomization in clinical trials reduces bias. Its intent is to generate groups of patients that are comparable with each other before starting a study. As a result, both known and unknown patient factors that may affect the outcome under investigation are balanced between the treatment groups, minimizing the risk of differences between the two groups at the onset of the trial. This helps to ensure that differences in outcomes observed between the groups are the result of the intervention. Anything that compromises the balance of these factors may introduce bias into the results1,2. If an imbalance between the groups skews the results in favor of one intervention over the other, this can lead to a biased study. Therefore, a randomized, double-blinded, placebo-controlled (when appropriate) trial with intention-to-treat analysis is considered to be the highest level of evidence in clinical research. This provides the clearest insight into the effect of the intervention being studied by controlling for as many factors as possible.
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    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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