Research & Evidence

Efficacy, Clinical Effectiveness and Evidence-Based Practice

“Efficacy” refers to the determination of a training or treatment effect derived from a systematic evaluation obtained in a controlled clinical trial. “Clinical Effectiveness” assess how well a treatment works in actual clinical settings with typical clinical populations. Evidence-based practice must take into account both clinical efficacy in controlled research settings and effectiveness in the real world of clinical practice.

Rating Criteria 

The AAPB Rating Criteria are:

Level 1 - Not empirically supported. 

Supported only by anecdotal reports and/or case studies in non-peer reviewed journals.

Level 2 - Possibly Efficacious.

At least one study of sufficient statistical power with well identified outcome measures, but lacking randomised assignment to a control condition internal to the study.

Level 3 - Probably Efficacious.

Multiple observational studies, clinical studies, wait list controlled studies, and within subject and intra-subject replication studies that demonstrate efficacy.

Level 4 - Efficacious.

A. In a comparison with a no-treatment control group, alternative treatment group, or sham (placebo) control utilising randomised assignment, the investigational treatment is shown to be statistically significantly superior to the control condition or the investigational treatment is equivalent to a treatment of established efficacy in a study with sufficient power to detect moderate differences, and…
B. The studies have been conducted with a population treated for a specific problem, for whom inclusion criteria are delineated in a reliable, operationally defined manner, and…
C. The study used valid and clearly specified outcome measures related to the problem being treated and
D. The data are subjected to appropriate data analysis, and…
E. The diagnostic and treatment variables and procedures are clearly defined in a manner that permits replication of the study by independent researchers, and…
F. The superiority or equivalence of the investigational treatment have been shown in at least two independent research settings.

Level 5 - Efficacious and Specific.

The investigational treatment has been shown to be statistically superior to credible sham therapy, pill, or alternative bona fide treatment in at least two independent research settings.

Important: Lower efficacy ratings do not necessarily indicate that an intervention is not helpful. In some cases a lower rating has been applied because the relevant research has not yet been conducted. In other cases, a lower rating means that the application benefits some subjects and not others because of wide inter-subject variability. If people cannot tolerate medication-based treatments, or if people wish to avoid medication if possible, then “Possibly Efficacious” (Level 2) rated neurofeedback and biofeedback therapies may be reasonable alternatives.

Level of Evidence for Disorders

Whilst The AAPB Review assessed and rated 42 different disorders the list below is limited to some of the most common conditions:

ADHD - Efficacious and Specific: Level 5.

Anxiety and Anxiety Disorders - Efficacious and Specific: Level 5 (Panic Disorder), Efficacious: Level 4 (Generalised Anxiety Disorder)

Autism - Probably Efficacious: Level 3

Chronic Pain - Efficacious: Level 4 (Chronic Lower Back Pain, Chronic Neck Pain), Probably Efficacious: Level 3 (Other Musculo-skeletal Pain)

Concussion - Probably Efficacious: Level 3

Depression - Efficacious and Specific: Level 5.

Epilepsy - Efficacious: Level 4.

Fibromyalgia - Probably Efficacious: Level 3

Headache - Efficacious: Level 4.

Insomnia - Probably Efficacious: Level 3.

Optimal Performance - Efficacious: Level 4

Post-Traumatic Stress Disorder (PTSD) - Efficacious: Level 4

Traumatic Brain Injury (TBI) - Probably Efficacious: Level 3.