In message <000101bf39a9$8a9f1180$7c45a8c2@kevinree>, kevin reese
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>Dear Lists
>
>WITH APOLOGIES FOR CROSS REFERENCING
>
>I am curious to know why the RCT is considered a Gold Standard when
>conducting therapy research. Any thoughts ?
>
>Kevin Reese PT UK.
>
Methinks you are a little mischievous Kevin.
All research methods have their strengths and weaknesses. Weaknesses
especially when applied to the wrong question.
The problem with RCT's in the case of many PT interventions is that you
may just control out the very factor that makes the difference in the
therapeutic process. However, if you have a full understanding of the
subject under enquiry and you want to test the outcome of two
interventions with the objective of seeing which produces the best
outcome over a large group of individuals then an RCT may be an
appropriate choice.......
In many rehab areas - for instance my own speciality area of traumatic
brain injury - many of the questions have yet to be fully defined and/or
the potential contributory factors to any outcome are so many to make
the results of an RCT clinically meaningless.
In many cases I think practice development would be served better by
*documenting* the genesis of treatment strategies that are based on
basic science, i.e. hypothesis development from first principles, to
demonstrate that our interventions have science behind them and then are
differentially applied to individual situations. I suppose I would
argue for sound hypothesis development from formal research or formal
documentation of the root of frequently used theories, followed by
multiple single case experiments that would generate more qualitative
information as well as having the potential to be grouped over time.
Whatever we do we must have the confidence to argue for research design
appropriate to the question - and remember that RCT's have their roots
in agricultural research where all perameters could be controlled.
--
Maggie Campbell
Neurophysiotherapist
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+44 (0)114 268 6963
Sheffield UK
and
Research co-ordinator
Directorate of Professional Services
Royal Hallamshire Hospital, Sheffield
(0)114 271 1750 (voice-mail)
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