Great thoughts.
Part of the difficulty in appraising/interpreting studies for clinical context is the absence of a pre-defined minimally clinically important difference (MICD).
If any effect size greater than zero is sufficient to justify an intervention, then no study will ever be able to completely “rule out” possible benefit.
At some point, we have to say “improvement less than x% absolute or relative difference” means the studied intervention probably does not provide sufficient clinical benefit.
At the end of the day, if folks are interpreting RCTs without predefining the MCID, then expect the goal posts to continue to change if the results don’t go their way.
As for communicating study results, I would always start by asking “what is the MCID”? Is it one value? Do clinicians/patients/etc have different MCID? How do we interpret the confidence interval & results given our clinical expectations?
At the end of the day, If we can’t define or agree upon an MCID, then we should not be surprised that results can be spun as desired.
( For reference, I made a similar point in a previous post in response to Dr. Mandrola comments on Orbita.)