Complex behavioural interventions can be evaluated

Papers p 658

Randomised controlled trials remain the most widely accepted way of evaluating new treatments. Clinical services such as speech and language therapy, however, have been particularly reluctant to produce randomised controlled trials as evidence of efficacy of treatment. 1 2 An evidence base is emerging for the efficacy of a number of speech and language therapy interventions, especially in dysphasia, stammering, laryngectomy, and dysphonia.3 Most interventions, however, have been evaluated by uncontrolled before and after comparisons. One of the first randomised controlled trials in speech and language therapy to evaluate voice therapy in dysphonia appears in this issue.4 This trial shows that it is possible to design and carry out randomised controlled trials to examine complex behavioural interventions.

Randomised controlled studies are difficult to apply in some areas5; the limitations of such trials in general medicine, surgery, and behavioural therapies are well documented. 2 6 7 Researchers in speech and language therapy have been reluctant to use randomised controlled designs because of the complexity and individuality of human communication …