Some within the spinal cord injury (SCI) research community are criticising randomised controlled trials (RCTs) and advocating alternate research methodologies to answer questions about treatment effectiveness and to guide practice. The underlying objection, whether stated or not, is that RCTs frequently fail to demonstrate treatment effectiveness. If RCTs consistently confirmed the treatments we believe in were effective, then most researchers and clinicians would be happy to acknowledge that RCTs provide the best quality evidence and should inform treatment decisions. However, often RCTs in the area of SCI are inconclusive or demonstrate that treatments are ineffective.1 This frustrates researchers, clinicians and people with SCI, fuelling antagonism towards RCTs. However, the problem is not RCTs. If RCTs throw doubt on the effectiveness of interventions then perhaps we should be questioning the intervention rather than the research methodology.

Critics of RCTs often argue that RCTs were designed for testing drugs and were not designed for testing complex interventions administered to diverse populations such as patients with SCI. There are two parts to this criticism, pertaining to the complexity of the interventions and the heterogeneity of people with SCI.

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