Are randomised control trials best for evaluating the effect of complex physical therapy interventions?

Well-executed randomised controlled trials (RCTs) provide high levels of evidence for treatment efficacy. They enable the cause and effect of sports physical therapy treatments to be explored under ideal circumstances, with one treatment element often evaluated at a time. However, treatment elements are rarely delivered in isolation in contemporary practice and are inherently complex. Treatments are customised to address a patient’s impairments, with intervention dose, frequency and intensity adjusted for each individual. Treatment elements may also have interacting effects. If an RCT evaluates only one aspect of a treatment, there would be evidence for that individual component’s efficacy, but it would be inefficient and expensive to study all components in isolation and interactions between treatment elements would go unrecognised. Therefore, RCTs have potential limitations when considering the most efficient path forward for sports physiotherapy research.