Discussion

20. Interpretation A useful structure has been proposed comprising the following elements: a brief synopsis of the key findings; possible explanations and mechanisms; comparison with other relevant results; limitations of the present study and any attempts made to address these; and a summary of the clinical and/or research implications of the results. The trial discussion should include a critical review not just of its strengths but also of its limitations, particularly those that may be apparent only to those who conducted the trial.

21. Generalizability Indicate, but only if there is good justification, if the trial results can be extrapolated to groups not involved in the trial, for example different ages or genders, or to different classes of the intervention studied.

22. Overall evidence This aspect requires comparison or integration with other relevant results, some of which may support the results and some of which may not. It may be impractical to conduct a full systematic review, but an attempt should be made to identify relevant sources of information so that the trial results can be placed in the context of other relevant results; does it confirm or contradict them? What are the possible reasons for contradiction, and do they cast any shadow on the trial? How does it add to the totality of evidence - what proportion of the total information does your trial represent? It is not necessarily essential to conduct a formal systematic review and meta-analysis to quantify the contribution and impact of the trial, but it is worth considering if this is feasible or at least highlighting what such an approach may bring to the debate.

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