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However, if cognitive outcomes can serve as intermediate outcomes of behavioral change, these may be used in addition to or even as a substitute for current effectiveness outcomes.
You can sort of see some rationale behind it; bee stings obviously have a definite physical effect on the body, they're 100% natural (another substitute for effectiveness), and a localised swelling certainly would remove wrinkles, albeit temporarily and painfully.
Some studies suggest that distraction techniques reduce pain when used in adjunct to analgesics during acute pain and surgical procedures [ 3- 5]; but their effectiveness as a substitute for analgesics has not been assessed.
Although CBT is usually considered a complement (adjuvant) to usual medical treatment, not a substitute for it, we decided to test its effectiveness as a stand-alone intervention.
This paper aims to evaluate the effectiveness of steel slag as a substitute for virgin aggregates on mechanical properties of cold mix recycling asphalt pavement.
In particular, more information is required on the usability and safety of remote monitoring for patient-initiated transmissions and cost-effectiveness of the system as a substitute for routine in-office visits during long-term follow-up.
They are designed not as a substitute for clinical judgment, but rather as a means to improve the effectiveness and efficiency of the procedures.
Migration has tended to be viewed rather as a substitute for development than as a short-term support for increasing the effectiveness of national development efforts.
We conducted a non-inferiority study to evaluate the effectiveness and acceptability of the VL package as a substitute for pharmacological pain relief during TL in rural settings.
However, assessing representativeness is not a substitute for assessing generalisibility, that is, how well clinical trial results would translate into effectiveness and safety in everyday routine care.
To evaluate the incremental cost-effectiveness ratio (ICER) of the use of ticagrelor as a substitute for clopidogrel for secondary prevention of acute coronary syndrome in Chile.
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Since I tried Ludwig back in 2017, I have been constantly using it in both editing and translation. Ever since, I suggest it to my translators at ProSciEditing.

Justyna Jupowicz-Kozak
CEO of Professional Science Editing for Scientists @ prosciediting.com