THE CLINICAL UTILITY OF RANDOMIZED CONTROLLED TRIALS

Objective: Efficacy studies using randomized controlled trials (RCTs) on which empirically supported treatments are based, are often rejecte d as having little if any relevance to clinical practice. RCTs are fau lted for allegedly excluding poor prognosis patients and therapists an d treatments that are unrepresentative of clinical practice. Methods: Evidence on the generalizability of findings from RCTs to diverse pati ent populations, different therapists, and varied clinical settings is critically evaluated. Results: Existing research indicates that RCTs commonly include patients with multiple problems and levels of disturb ance as severe as patients in clinical settings. Discussion: The appli cability of the findings of RCTs to clinical practice will be a changi ng function of the nature of the particular study and clinical setting to which the results are to be generalized. Future research should ad dress the clinical utility of the findings of efficacy studies across different patient populations, therapists, and treatment methods. (C) 1998 by John Wiley & Sons, Inc.