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. 2009 Aug;6(8):e1000086.
doi: 10.1371/journal.pmed.1000086. Epub 2009 Aug 11.

Can we systematically review studies that evaluate complex interventions?

Sasha Shepperd  1 , Simon Lewin, Sharon Straus, Mike Clarke, Martin P Eccles, Ray Fitzpatrick, Geoff Wong, Aziz Sheikh
Affiliations

Can we systematically review studies that evaluate complex interventions?

Sasha Shepperd et al. PLoS Med. 2009 Aug.

Abstract

The UK Medical Research Council defines complex interventions as those comprising "a number of separate elements which seem essential to the proper functioning of the interventions although the 'active ingredient' of the intervention that is effective is difficult to specify." A typical example is specialist care on a stroke unit, which involves a wide range of health professionals delivering a variety of treatments. Michelle Campbell and colleagues have argued that there are "specific difficulties in defining, developing, documenting, and reproducing complex interventions that are subject to more variation than a drug". These difficulties are one of the reasons why it is challenging for researchers to systematically review complex interventions and synthesize data from separate studies. This PLoS Medicine Debate considers the challenges facing systematic reviewers and suggests several ways of addressing them.

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Conflict of interest statement

S Shepperd is an editor for the Cochrane Effective Practice and Organisation of Care Review Group. SL is an editor for the Cochrane Consumers and Communication Review Group. MPE is an editor for the Cochrane Effective Practice and Organisation of Care Review Group. AS is PI on a number of evaluations of complex health care interventions funded by the Chief Scientist's Office of the Scottish Government, Health Technology Assessment, National Preventative Research Institute/Medical Research Council and NHS Connecting for Health Evaluation Programme. AS is, in addition, a grant‐holder on complex intervention trials funded by Asthma UK, Intel, and the Patient Safety Research Portfolio. AS is also a grant‐holder on programme grants for the development and evaluation of complex interventions in supportive and palliative care funded by the National Cancer Research Institute and the MRC Translational Medicine Methodology Trial Hub. GW has no competing interests.

References

    1. Craig P, Dieppe P, Macintyre S, Michie S, Nazareth I, et al. Developing and evaluating complex interventions: The new Medical Research Council guidance. BMJ. 2008;337:a1655. doi: 10.1136/bmj.a1655. - DOI - PMC - PubMed
    1. Zwarenstein M, Stephenson B, Johnston L. Case management: Effects on professional practice and health care outcomes (Protocol). Cochrane Database Syst Rev. 2005;1:CD002797. doi: 10.1002/14651858.CD002797. - DOI
    1. Phillips CO, Wright SM, Kern DE, Singa RM, Shepperd S, et al. Comprehensive discharge planning with post discharge support for older patients with congestive heart failure: A meta-analysis. JAMA. 2004;291:1358–1367. - PubMed
    1. Freeman G, Shepperd S, Robinson I, Ehrich K, Richards S. Continuity of Care: Report of a scoping exercise for the national co-ordinating centre for NHS Service Delivery and Organisation R&D (NCCSDO) London: National Institute for Health Research Service Delivery and Organisation; 2001.
    1. McKinstry B, Ashcroft R, Car J, Freeman GK, Sheikh A. Interventions for improving patients' trust in doctors and groups of doctors. Cochrane Database Syst Rev. 2006;3:CD004134. doi: 10.1002/14651858.CD004134.pub2. - DOI - PubMed

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