Background
Among the challenges in research in complementary
and alternative medicine (CAM) is the necessity to design
clinical trials that are methodologically rigorous as
well as consistent with prevailing clinical practice patterns
[1-3]. This difficulty has been mentioned in trials
of botanical medicines [3], mind-body interventions [4],
and manual therapies [5,6]. Many CAM disciplines espouse
patient-centered care that often results in some
individualization of treatment. Thus, standardization of
interventions for clinical trials poses a particular challenge.
Clinical trial design of manual therapies may be
especially challenging since techniques are often
practitioner-dependent as well as patient-oriented