Tyranny of the randomised clinical trial

Abstract

Researchers and clinicians often disagree about what it means to provide the best possible care. This paper’s purpose is to propose ways of resolving the disagreements. The first is to have both groups re-examine the three equal components of evidence-based practice, a re-examination that begins with rejection of the randomised clinical trial’s tyranny. The second is for researchers to design rehabilitation research based on a biopsychosocial rather than a biomedical model. The third is for both groups to redefine translational research so that it means both translation from the laboratory to the clinic and from the clinic to the laboratory. The fourth is to advocate for a science of dissemination that is as robust as rehabilitation’s present science of discovery. Most examples are drawn from the literature on acquired neurologic speech and language disorders.

Keywords:

• Efficacy
• Randomized clinical trials
• evidence
• rehabilitation