Strategies for nonrandomized clinical research in hand surgery.

Most clinical research questions in hand surgery may be effectively explored using a variety of nonrandomized study designs. The main advantage of any of these methods is that they are almost always more feasible than a prospective randomized, controlled trial. Although the level of evidence associated with nonrandomized designs is always lower than that of a randomized trial there are many instances in which the inferences based on these designs are sufficiently strong that important and meaningful conclusions can be made. The key considerations in using nonrandomized designs are to frame the research question appropriately and to recognize and anticipate the limitations and biases that are inherent to each one of these approaches.