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Challenges of complex interventions: a worked example

Date and Location




Saturday 21 September 2013 - 10:30 - 12:00


Presenting author and contact person

Presenting author

Dell Horey

Contact person

Dell Horey
Abstract text
Background: Complex interventions pose significant challenges for Cochrane reviews, especially when there is lack of consensus in a particular field with relatively little experience or commitment to RCTs. In a review of a widely used complex intervention we found 5 RCTs but little agreement on how the interventions were described or the outcomes selected. Objectives: To demonstrate a systematic approach to managing a complex intervention in a Cochrane review Methods: We compared interventions and outcomes from 5 RCTs by mapping components to a conceptual model (derived from theory) developed for the protocol and by applying common Cochrane approaches to minimise bias. Outcomes were grouped into categories to increase the potential for meta-analyses. Results: The evidence generated by the review was low to medium quality due to methodological weaknesses in the included studies. However all components in the conceptual framework were addressed and outcomes for all primary outcomes were identified. The conceptual framework provides the basis for further work to establish agreement on the core components of the intervention and how the intervention can be evaluated in future trials. Conclusions: The processes of the review provided the means to develop a robust framework that will be used to develop consensus on how a complex intervention will be described and evaluated in future studies.