Back in 1982, when some of the readers of this journal were being tucked up in bed, others were doing the tucking-up and yet more had already fallen asleep in their armchairs, Sylvester Stallone wandered half-naked around the outskirts of a fictional US town in the film “First Blood”. However, this memorable character (John Rambo) has nothing to do with EBM.
RAMbo is another EBM mnemonic. This one deals with step 3 – critical appraisal – of the process. (To recap, EBM is to Ask, Acquire, Appraise, Apply and Assess.) R – is the population representative? Were treatments randomly allocated in a concealed manner? A – how complete was the ascertainment? Did they get everyone they could have? Remember 5 & 20 (less than 5% loss – no problems, more than 20% loss – big problems). M b o – Were the measurements the same in all groups? What did they measure? Were they blinded or objective (or both)? This set of reminder questions can serve as an excellent memory jogger to rapidly appraise the most important points of a primary study, and forms the basis of what you should be asking of every article that’s asking you to change you practice.