Effectiveness in practice-based research. Looking for alternatives to the randomized controlled trial (RCT)

Louis Tavecchio


Over the last decade, the status of the randomized controlled trial (RCT), hallmark of evidence-based medicine (research), has been growing strongly in general practice, social work and public health. But this type of research is only practicable under strictly controlled and well-defined settings and conditions. In addition, persons are randomly assigned to experimental and control groups. However, in the daily practice of social work and public health professionals, this type of research is hardly feasible. Moreover, due to political, legal or ethical considerations, random selection or assignment will often be impossible. It is argued that the external validity of research outcomes will suffer from many of the features of the control in classic explanatory RCTs, not only for population-level interventions, but these outcomes will also be only marginally useful for deriving guidelines for professional practices and activities. Another big disadvantage of the RCT supremacy is the gap – i.e., loss of time and information - between research and practice, as illustrated by the ‘pipeline fallacy’ metaphor. In short, RCT may be the gold standard of study design in (bio) medical research, but it is often not feasible, ethical, or generalizable in the context of practice-based or practically-oriented research. In recent years, the appreciation and use of alternative research designs and data sources - that will overcome the disadvantages and limitations of RCTs - have increased. The article concludes with the description of alternatives to the classic explanatory RCT, i.e., methodological remedies for practice-based research with less emphasis on internal and more emphasis on external validity.

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