Skip to main content
×
×
Home

The pragmatic randomised controlled trial

  • Matthew Hotopf
Extract

In recent years there has been much debate regarding the evaluation of treatments in medicine. The evidence-based medicine (EBM) movement has formed partly out of the realisation that clinical practice is often poorly informed by the best available evidence, and that many widely used treatments are either completely untested, or tested and proven to be ineffective or even harmful. EBM has been characterised as a stick by which policy-makers and academics beat clinicians (Williams & Garner, 2002). However, another side to EBM has been the realisation that research performed to test new treatments has often been of poor quality, or has asked the wrong questions (Hotopf et al, 1997; Thornley & Adams, 1998; Barbui & Hotopf, 2001). We have previously argued that clinicians could justifiably criticise the research establishment for failing to provide answers to relevant clinical problems of everyday practice (Hotopf et al, 1999).

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      The pragmatic randomised controlled trial
      Available formats
      ×
      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      The pragmatic randomised controlled trial
      Available formats
      ×
      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      The pragmatic randomised controlled trial
      Available formats
      ×
Copyright
References
Hide All
Barbui, C. & Hotopf, M. (2001) Forty years of antidepressant drug trials. Acta Psychiatrica Scandinavica, 104, 9295.
Beck, A. T., Ward, C. H., Mendelson, M. et al (1961) An inventory for measuring depression. Archives of General Psychiatry, 4, 561571.
Bower, P., Byford, S., Sibbald, B. et al (2000) Randomised controlled trial of non-directive counselling, cognitive–behaviour therapy, and usual general practitioner care for patients with depression. II: Cost effectiveness. BMJ, 321, 13891392.
Brugha, T., Bebbington, P., MacCarthy, B. et al (1992) Antidepressants may not assist recovery in practice: a naturalistic prospective cohort. Acta Psychiatrica Scandinavica, 86, 511.
Department of Health (1999) National Service Framework for Adult Mental Health. London: Department of Health.
Derogatis, L. R., Lipman, R. S., Covi, L. et al (1971) Neurotic symptom dimensions (SCL–58). Archives of General Psychiatry, 24, 454464.
Gilbody, S. & Whitty, P. (2002) Improving the delivery and organisation of mental health services: beyond the conventional randomised controlled trial. British Journal of Psychiatry, 180, 1318.
Hamilton, M. (1960) A rating scale for depression. Journal of Neurology, Neurosurgery and Psychiatry, 23, 5662.
Hotopf, M., Lewis, G. & Normand, C. (1997) Putting trials on trial: the costs and consequences of small trials in depression: a systematic review of methodology. Journal of Epidemiology and Community Health, 51, 354358.
Hotopf, M., Churchill, R. & Lewis, G. (1999) Pragmatic randomised controlled trials in psychiatry. British Journal of Psychiatry, 175, 217223.
Katon, W., von Korff, M. & Lin, E. H. (1992) A randomized controlled trial of psychiatric consultation with distressed high-utilizers. General Hospital Psychiatry, 14, 8698.
Katon, W., von Korff, M., Lin, E. H. et al (1999) Stepped collaborative care for primary care patients with persistent symptoms of depression. Archives of General Psychiatry, 56, 11091115.
Montgomery, S. A. & Åsberg, M. (1979) A new depression scale designed to be sensitive to change. British Journal of Psychiatry, 134, 382389.
Roland, M. & Torgensen, S. (1998) Understanding controlled trials: what are pragmatic trials? BMJ, 316, 285.
Schulz, K. F., Chalmers, I., Hayes, R. J. et al (1995) Empirical evidence of bias. JAMA, 273, 408412.
Simon, G. E., von Korff, M., Rutter, C. M. et al (2001) Treatment process and outcomes for managed care patients receiving new antidepressant prescriptions from psychiatrists and primary care physicians. Archives of General Psychiatry, 58, 395401.
Thompson, C., Kinmonth, A. L., Stevens, L. et al (2000) Effects of a clinical-practice guideline and practice based education on detection and outcome of depression in primary care: Hampshire Depression Project randomised controlled trial. Lancet, 355, 185191.
Thornley, B. & Adams, C. (1998) Content and quality of 2000 controlled trials in schizophrenia over 50 years. BMJ, 317, 11811184.
Ward, E., King, M., Lloyd, M. et al (2000) Randomised controlled trial of non-directive counselling, cognitive–behaviour therapy, and usual general practitioner care for patients with depression I: clinical effectiveness. BMJ, 321, 13931399.
Williams, D. D. R. & Garner, J. (2002) The case against ‘the evidence’: a different perspective on evidence-based medicine. British Journal of Psychiatry, 180, 812.
Zigmond, A. S. & Snaith, R. P. (1983) The hospital anxiety and depression scale. Acta Psychiatrica Scandinavica, 67, 361370.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

BJPsych Advances
  • ISSN: 1355-5146
  • EISSN: 1472-1481
  • URL: /core/journals/bjpsych-advances
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Metrics

Altmetric attention score

The pragmatic randomised controlled trial

  • Matthew Hotopf
Submit a response

eLetters

No eLetters have been published for this article.

×

Reply to: Submit a response


Your details


Conflicting interests

Do you have any conflicting interests? *