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Review Article Randomization, What is the Proper Method? Jin Ho Hong, M.D., Jae Chul Yoo, M.D. Shoulder & Sports medicine, Department of Orthopedic Surgery, Samsung Medical Center Purpose: Among the numerous clinical researches and following articles, there are few cases that apply proper methodology, which guarantees high reliability. By understanding the right concept and randomization of proper methods, research bias could be minimized. Materials and Methods: By reviewing the recently published articles about randomization, the basic concept and the necessity of applying the technique was described. Then proper methodologies for good randomization such as simple randomization, permuted-block randomization, and stratification were briefly introduced with examples. Results and Conclusion: Randomization lowers the possibility of bias and leads to higher reliability in clinical research. To obtain more reliable research results, understanding the right concept and proposition of proper methodologies of randomization is essential for researchers. Key Words: Randomization, Random number, Selection bias, Stratification

Fig. 1. Coin flipper from Random.org.

Fig. 2. SNOSE method, Doig 2). Fig. 3. Imbalance of simple randomization, Kang 3). Fig. 4. Example of permuted block randomization, Doig 2).

Fig. 5. Example of Stratification procedure, Randelli 1). REFERENCES 01) Randelli P, Arrigoni P, Lubowitz JH, Cabitza P, Denti M. Randomization procedures in orthopaedic trials. Arthroscopy. 2008;24:834-8. 02) Doig GS, Simpson F. Randomization and allocation concealment: a practical guide for researchers. J Crit Care. 2005;20:187-91. 03) Kang M, Ragan BG, Park JH. Issues in outcomes research: an overview of randomization techniques for clinical trials. J Athl Train. 2008;43:215-21. 04) Bhandari M, Richards RR, Sprague S, Schemitsch EH. The quality of reporting of randomized trials in the Journal of Bone and Joint Surgery from 1988 through 2000. J Bone Joint Surg Am. 2002;84:388-96. 05) Bridgman S, Engebretsen L, Dainty K, Kirkley A, Maffulli N, Committee IS. Practical aspects of ran-

domization and blinding in randomized clinical trials. Arthroscopy. 2003;19:1000-6. 06) Gummesson C, Atroshi I, Ekdahl C. The quality of reporting and outcome measures in randomized clinical trials related to upper-extremity disorders. J Hand Surg Am. 2004;29:727-34. 07) Haines SJ. Randomized clinical trials in the evaluation of surgical innovation. J Neurosurg. 1979;51:5-11. 08) Kernan WN, Viscoli CM, Makuch RW, Brass LM, Horwitz RI. Stratified randomization for clinical trials. J Clin Epidemiol. 1999;52:19-26. 09) Kirkley A, Griffin S, Richards C, Miniaci A, Mohtadi N. Prospective randomized clinical trial comparing the effectiveness of immediate arthroscopic stabilization versus immobilization and rehabilitation in first traumatic anterior dislocations of the shoulder. Arthroscopy. 1999;15:507-14. 10) Kirkley A, Werstine R, Ratjek A, Griffin S. Prospective randomized clinical trial comparing the effectiveness of immediate arthroscopic stabilization versus immobilization and rehabilitation in first traumatic anterior dislocations of the shoulder: longterm evaluation. Arthroscopy. 2005;21:55-63. 11) Pocock SJ. Allocation of patients to treatment in clinical trials. Biometrics. 1979;35:183-97. 12) Roberts C, Torgerson D. Randomisation methods in controlled trials. BMJ. 1998;317:1301. 13) Solomon MJ, Laxamana A, Devore L, McLeod RS. Randomized controlled trials in surgery. Surgery. 1994;115:707-12. 14) Solomon MJ, McLeod RS. Clinical studies in surgical journals--have we improved? Dis Colon Rectum. 1993;36:43-8. 15) Tan CK, Guisasola I, Machani B, et al. Arthroscopic stabilization of the shoulder: a prospective randomized study of absorbable versus nonabsorbable suture anchors. Arthroscopy. 2006;22:716-20. 16) Zelen M. The randomization and stratification of patients to clinical trials. J Chronic Dis. 1974;27: 365-75.