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BACKGROUND AND OBJECTIVE: Randomized trials may be designed to provide evidence more strongly related to efficacy or effectiveness of an intervention. When systematic reviews are used to inform clinical or policy decisions, it is important to know the efficacy-effectiveness nature of the included trials. The objective of this study was to develop a tool to characterize randomized trials included in a systematic review on an efficacy-effectiveness continuum. METHODS: We extracted rating domains and descriptors from existing tools and used a modified Delphi procedure to condense the domains and develop a new tool. The feasibility and interrater reliability of the tool was tested on trials from four systematic reviews. RESULTS: The Rating of Included Trials on the Efficacy-Effectiveness Spectrum (RITES) tool rates clinical trials on a five-point Likert scale in four domains: (1) participant characteristics, (2) trial setting, (3) flexibility of interventions, and (4) clinical relevance of interventions. When RITES was piloted on trials from three reviews by unaffiliated raters, ratings were variable (intraclass correlation coefficient [ICC] 0.25-0.66 for the four domains); but, when RITES was used on one review by the review authors with expertise on the topic, the ratings were consistent (ICCs > 0.80. CONCLUSION: RITES may help to characterize the efficacy-effectiveness nature of trials included in systematic reviews.

Original publication




Journal article


J clin epidemiol

Publication Date





95 - 104


Applicability, Comparative effectiveness research, Effectiveness, Efficacy, Explanatory trial, Pragmatic trial, Randomized controlled trials, Systematic reviews, Comparative Effectiveness Research, Delphi Technique, Epidemiologic Research Design, Feasibility Studies, Humans, Observer Variation, Randomized Controlled Trials as Topic, Reproducibility of Results, Review Literature as Topic, Treatment Outcome