Difficulties in conducting a randomized controlled trial of health service interventions in intellectual disability: implications for evidence-based practice

• Published in: Journal of intellectual disability research 2002-05, Vol.46 (4), p.340-345
• Main Authors: Oliver, P. C., Piachaud, J., Done, J., Regan, A., Cooray, S., Tyrer, P.
• Format: Article
• Language: English
• Subjects: Assertive community treatment; assertive treatment; Attitude Change; Behavior Disorders; Bioethics; Biological and medical sciences; Caseworker Approach; Community Relations; Community Services; Ethics; Ethics, Medical; Evidence based medicine; Evidence Based Practice; Health Needs; Health Services; Hospitals; Humans; Intellectual Disability; Interpersonal Competence; Interventions; Learning Disabilities; Learning disabled people; Medical sciences; Mental Disorders; Mental Health Programs; Mentally Disabled Persons - psychology; Methodology. Experimentation; Outcome Measures; Program Proposals; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; randomized controlled trial; Randomized Controlled Trials; Randomized Controlled Trials as Topic - methods; Research Committees; Research Design; Research Proposals; Techniques and methods; Treatment Outcome
• ISSN: 0964-2633; 1365-2788
• DOI: 10.1046/j.1365-2788.2002.00408.x

Background In an era of evidence‐based medicine, practice is constantly monitored for quality in accordance with the needs of clinical governance (Oyebode et al. 1999). This is likely to lead to a dramatic change in the treatment of those with intellectual disability (ID), in which evidence for effective intervention is limited for much that happens in ordinary practice. As Fraser (2000, p. 10) has commented, the word that best explains ‘the transformation of learning disability practice in the past 30 years is “enlightenment”.’ This is not enough to satisfy the demands of evidence, and Fraser exhorted us to embrace more research‐based practice in a subject that has previously escaped randomized controlled trials (RCTs) of treatment because of ethical concerns over capacity and consent, which constitute a denial of opportunity which ‘is now at last regarded as disenfranchising’. Conclusions The present paper describes the difficulties encountered in setting up a RCT of a common intervention, i.e. assertive community treatment, and concludes that a fundamental change in attitudes to health service research in ID is needed if proper evaluation is to prosper.