Cochrane, https://www.cochrane.org/, formerly the Cochrane collaboration, aims to provide high quality, independent evidence in healthcare. Its library is an important source of evidence but it is based on an essentially rigid model (Hierarchy of Evidence) that focuses on RCT (Randomised Controlled Trial) findings. To that extent it is very much following the arguments of the late Archie Cochrane who was one of the earliest effective proselytisers for RCTs. We argue that counselling and psychotherapy are complex interventions that simply don’t fit this hierarchy of evidence and need a “web of evidence” (our term, though hardly one we can claim as a trademark!)
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Archie Cochrane’s famous monograph (Cochrane, A. L. (1972). Effectiveness and efficiency. Random reflections on health services. Nuffield Provincial Hospitals Trust) had a great impact on CE when he caught up with it in about 1981. As well as lobbying for RCTs (excessively!) Cochrane was the first to cement the meaning of the terms efficacy, effectiveness and efficiency which continue to be important and pertinent to ROM work (a mix of effectiveness and, if it embraces health economic evaluation, efficiency).
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Efficacy, effectiveness and efficiency
Hierarchy of Evidence
RCT (Randomised Controlled Trial)
NICE
EST (Empirically Supported Treatments)
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Not mentioned explicitly in the book but pertinent to Chapter 10. Cochrane zealots (known in that realm as “Cochrane nasties” or worse) often hold our “Myth 1(b): the ‘we know, we don’t need ROM’ argument”.
