Date of Award


Degree Type


Degree Name

Master of Science


Epidemiology and Biostatistics


Dr. Mark Speechley

Second Advisor

Dr. Robert Teasell


Differentiating between efficacy and effectiveness research approaches has become increasingly recognized as a critical step in the evidence-based decision-making process. A critical review of these archetypal approaches, as well as an evaluation of a new tool that purports to distinguish between them, was undertaken. Three raters independently applied the tool to 151 randomized controlled trials that evaluated either a pharmacological or non-pharmacological intervention in stroke rehabilitation. Inter-rater reliability was assessed both for individual items and total scores. Validity was assessed by examining associations between the total scale score and key study characteristics consistent with the effectiveness design. Inter-rater reliability values were sub-optimal for most items; however, there was support for basic scale validity. Further item standardization is required before the scale can be incorporated into the critical appraisal process; however, the tool provides a solid foundation upon which to base further discussion of the differential criteria of efficacy-effectiveness trial design.



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