FIGURE 8-1 Hierarchy of evidence.

NOTE: The following acronyms are used for spacing purposes: SR is systematic review, MA is meta-analysis, BE is best evidence, EG is evidence guidelines, and ES is evidence summaries.

SOURCE: Reprinted with permission, Elizabeth Krupinski (2012).

part of the study design, which is why some people consider observational studies to be a little less reliable than experimental studies, but that is not necessarily the case. RCTs and observational studies (with a control or comparison group) both have advantages and disadvantages, and in the long run, both are valid and have been used in many telemedicine studies. Observational studies without a control or comparison group are generally considered less rigorous.

Each of these types of studies serves a different purpose. Although the RCT is the gold standard and there should be more of these, other viable alternatives are being used in traditional medicine as well, so there is no reason why these other study designs should not be used and have the same impact in telemedicine as occurs in the rest of medical care.

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