Electronic Thesis and Dissertation Repository


Master of Science


Epidemiology and Biostatistics


Dr. Janet Martin


Evidence reversal occurs when new evidence contradicts established practices. The first component of this thesis is an umbrella overview of investigations – reviews and collections of studies – into evidence reversal to gather concepts and methods that we identified as useful to lay a foundation for a standardized ‘theory of reversal.’ The foundation of this review enables the construction of a framework that will provide structure to this field, as no formal organization currently exists. The next component builds upon this foundation and proposes a framework for evidence reversal and its related concepts. The second review takes this framework and applies it to Original Articles from New England Journal of Medicine to generate the groundwork for potential causes of reversal. Reversals were found in 7% of randomized trials that were original articles concerning a medical practice, including 50% of established clinical practices. The final component suggests a framework of potential reasons for reversal. Improved research in this field may help improve efficiency of knowledge translation as it applies to getting right evidence into practice.

(PROSPERO Protocol Registration Number: CRD42014013768).

Scan0158 thesis.pdf (191 kB)
Certificate of Examination