Pros and Cons of Randomized Controlled Trials and Benchmarking Controlled Trials in Rehabilitation: An Academic Debate within the European Academy of Rehabilitation Medicine

A. Malmivaara*, M. Zampolini, H. Stam, C. Gutenbrunner

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

3 Citations (Scopus)
15 Downloads (Pure)

Abstract

The European Academy of Rehabilitation Medicine (EARM) held a debate in Hannover, Germany, on 1st of September 2016 on the pros  and cons of randomized controlled trials (RCTs) and observational effectiveness studies (benchmarking controlled trials; BCTs). The  debate involved a chairperson, a person presenting the substance of the debate, an opponent, and a rapporteur. The academicians participated in the discussion. Eight propositions and proposed statements formed the substance of the debate. There was agreement that a study question should be the starting point of an effectiveness study, and not the study method, i.e. RCT or BCT. The term "benchmarking" was questioned: does it mean market-oriented medicine? It was clarified that benchmarking refers to the methodological features of this study design: there must always be a comparison between peers. It was agreed that BCTs might be better than RCTs for use in rehabilitation studies, in which one often needs multi-centred studies, such as in the assessment of the effectiveness of pathways when there is complexity of processes, health systems, organizational issues, structures and facilities; or where interactions between therapists, doctors and patients differ between centres; and when assessing the implementation of rehabilitation. In addition, BCTs may deal with ethical issues, e.g. the acceptability of interventions, more easily than RCTs. Recommendations regarding the different approaches (RCTs or BCTs) should be provided by the scientific rehabilitation societies. Concern over the validity of BCTs was considered justified, as the validity criteria of BCTs cover all those related to RCTs and include the risk of selection bias between treatment arms. Appropriate description of the essentials of the study object, including adequate description of how the interventions were actualized in comparison to the study plan, are essential features for a valid and generalizable study for both RCTs and BCTs. BCTs are necessary to widen the evidence-base of effectiveness in rehabilitation. It was suggested that the rehabilitation field should support the concept of BCTs. It was proposed that education regarding BCTs is indicated, and stakeholders need to be convinced that BCTs are a valid alternative to RCTs. EARM and other physical and rehabilitation medicine (PRM) bodies could advance the use of BCTs for clinical and health policy decision-making.

Original languageEnglish
Article numberjrm00319
JournalJournal of Rehabilitation Medicine
Volume54
DOIs
Publication statusPublished - 10 Oct 2022

Bibliographical note

Funding Information:
The authors acknowledge the EARM members for their valuable comments in the debate in Hannover, September 2016: Kristian Borg, Professor, MD, PhD; Anne Chamberlain, Professor, MD, PhD; Jean-Pierre Didier, Professor, MD, PhD; Carlotte Kiekens, MD; Stefano Negrini, Professor, MD; Jean Paysant, Professor MD, PhD; Gilles Rhode, Professor MD, PhD; Johan Rietman, Professor MD, PhD; Bengt Sjölund, Professor MD, PhD; Gerold Stucki, Professor MD, PhD; Guy Vanderstraeten, Professor MD, PhD and Anthony Ward, Professor MD, PhD.

Publisher Copyright:
© 2022 Foundation for Rehabilitation Information. All rights reserved.

Fingerprint

Dive into the research topics of 'Pros and Cons of Randomized Controlled Trials and Benchmarking Controlled Trials in Rehabilitation: An Academic Debate within the European Academy of Rehabilitation Medicine'. Together they form a unique fingerprint.

Cite this