On Sun, 28 Nov 1999 14:03:52 -0000, kevin reese wrote:
> 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.
>
Dear Keith
My first question is why are you so against the RCT for evaluating the role
of physiotherapy in clinical research?
If the methodology of the study is carried out correctly, outcome measures
are appropriate, bias is minimised, results analysed appropriately and an
adequate sample size is used, the RCT is the only type of research study to
prove whether a treatment is effective in terms of the outcomes measured.
There are of course other types of epidemiological study to and the
appropriate type of study should be carried out depending on the question
being asked, for example; case-control studies, cohort studies, surveys,
case series, case reports and qualitative research.
Randomised controlled trials do not have to be conducted under ideal
(experimental) conditions, (explanatory trials). To evaluate the benefit a
treatment produces in routine clinical practice a pragmatic RCT is the
method of choice. The need for purchasers and providers of health care to
use evidence from clinical trials in policy decisions has increased the need
for us to prove that physiotherapy treatment is effective with pragmatic
RCT’s.
Pragmatic trials are ideal for therapy research as they allow for
flexibility of treatment techniques (as in normal clinical practice)
i.e.-different physiotherapists, different numbers of treatment etc. They
investigate a management protocol regardless of compliance. For example to
investigate the role of physiotherapy over a home exercise regime in
patients with fractured neck of humerus; group one receives home exercises
only, group two receives home exercises and in addition a course of
physiotherapy (not standardised), results are analysed by intention to
treat.
Anyway in conclusion I believe the RCT to be the most effective type of
study to prove that one treatment is more beneficial than an alternative,
unless you can convince me otherwise!
Alison Wakefield MSc MCSP
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