Can Clinical Effectiveness be Measured without a Randomized Controlled Trial?
Effectiveness: Randomized controlled trials are used to determine if an intervention has any benefit(s) or risk(s). With randomized controlled trials there are at minimum two groups: a control group and a test group.
Effectiveness: The degree to which something produces the desired result. The desired result is defined and the performance is evaluated as to whether success occurs.
Quite a few individuals in the rehabilitation world are cognitively challenged by their own bias of what effectiveness is. The context of the discussion is quite relevant when determining which definition is the definition to use when debating effectiveness. From the two definitions, it is relevant to take into consideration what is being asked.
Some clinicians full-heartedly believe that there is no way to determine if a clinician is effective without a randomized control trial. The reason is because they do not believe the natural course of history can be taken into account. Another reason is because there is no control group.
What do you think? Can clinical effectiveness be determined? Continue below if you're interested in my thoughts.
FOTO can definitely determine clinical effectiveness. The reason has to do with definition number 2 and practice based evidence.
FOTO's huge database is been used to predict outcomes. A patient begins services with the FOTO assessment process which provides a current functional status for the individual patient. Not only does FOTO provide a current functional status, it also compares that individual patient to thousands of other similar patients with the same identified factors that affect outcomes. FOTO, through its risk adjustment process, then shares data about similar patients. Through real clinical life and patients, practice based evidence is applied to provide a prediction about how much functional change should happen and in how many visits for the patient sitting in front of the clinician. Obviously a predicted result never includes a control group of individuals who did not receive services. Practice based evidence is focused on what happens in the real, clinical world versus in a controlled world. It's just as important to know what happens in the real world as it is in randomized controlled trials. Practice based evidence can and will take the knowledge gained in the evidence based practice world and implement it into real clinical life.
Effectiveness in the clinical world is based on meeting the predicted result. Risk adjusted data is used to predict the outcome. The data does not address why the predicted result should happen. The data does not determine how the result should happen. The data doesn't even take into consideration what interventions occurred for the predicted result. Clinicians either meet, exceed or do not meet the expected predicted result. If a clinician meets or exceeds the prediction, the clinician is defined as being effective. Definition number two effectiveness is the working definition that FOTO implements.