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Trial generalisability (external validity) is a recognised problem in RCTs.
This is despite the fact, that adoption constitutes important knowledge about a trial's external validity.
First, the inclusion criteria of the DICES trial limits the external validity of the present findings.
The sample was not completely representative of women in Karachi, Pakistan, thereby impacting the external validity of the study.
First, although the practical clinical trial design increased external validity (9), interventions took place in one safety net health system.
SCOT is a streamlined safety trial with good external validity as it is conducted in the normal care setting.
The study was conducted at a single site, and this may have impacted the external validity.
There were few differences in poverty or socio-demographic characteristics between operated and un-operated cases limiting the potential impact on external validity.
However, an impact on external validity can be expected.
This may also impact the external validity of the study.
Although such an approach may not have an impact on external validity, it can increase the internal validity of data [ 22].
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