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What Is the Hierarchy of Clinical Evidence?

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Basic Methods Handbook for Clinical Orthopaedic Research

Abstract

Any clinical question can be investigated in more than one way. The method by which a hypothesis is tested not only affects the results and format of presentation, but it also serves to provide varying degrees of evidence in support of (or against) the examiner’s question. In addition, based on how they were obtained, study results may be more equipped to imply causation (over simple correlation) and be more (or less) vulnerable to error. In order to clearly stratify results based on the strength of evidence they provide, a hierarchy of clinical evidence has been developed. A robust explanation of this hierarchy is essential to any discussion of evidence-based medicine and clinical research design. Using an example-based analysis of a clinically relevant orthopedic medicine topic, this chapter will serve to elucidate how the scientific question and goals of the investigator are used to select the appropriate study design. Furthermore, it will highlight the principles, benefits, and limitations of these various study designs. And finally, this chapter will introduce how to hierarchically organize the relative strength of results to ensure that scientific evidence is presented and interpreted in a clinically relevant manner.

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Author information

Authors and Affiliations

  1. Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, MN, USA

    Vishal S. Desai, Christopher L. Camp & Aaron J. Krych

Authors
  1. Vishal S. Desai
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  2. Christopher L. Camp
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  3. Aaron J. Krych
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Corresponding author

Correspondence to Aaron J. Krych .

Editor information

Editors and Affiliations

  1. UPMC Rooney Sports Complex, University of Pittsburgh, Pittsburgh, PA, USA

    Volker Musahl

  2. Department of Orthopaedics, Sahlgrenska Academy, Gothenburg University, Sahlgrenska University Hospital, Gothenburg, Sweden

    Jón Karlsson

  3. Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (Bruderholz, Laufen und Liestal), Bruderholz, Switzerland

    Michael T. Hirschmann

  4. McMaster University, Hamilton, ON, Canada

    Olufemi R. Ayeni

  5. Hospital for Special Surgery, New York, NY, USA

    Robert G. Marx

  6. Department of Orthopaedic Surgery, NorthShore University HealthSystem, Evanston, IL, USA

    Jason L. Koh

  7. Institute for Medical Science in Sports, Osaka Health Science University, Osaka, Japan

    Norimasa Nakamura

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Desai, V.S., Camp, C.L., Krych, A.J. (2019). What Is the Hierarchy of Clinical Evidence?. In: Musahl, V., et al. Basic Methods Handbook for Clinical Orthopaedic Research. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-58254-1_2

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  • DOI: https://doi.org/10.1007/978-3-662-58254-1_2

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  • Print ISBN: 978-3-662-58253-4

  • Online ISBN: 978-3-662-58254-1

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