Developing and evaluating complex interventions: Reflections on the 2008 MRC guidance

doi:10.1016/j.ijnurstu.2012.09.009

International Journal of Nursing Studies

Volume 50, Issue 5, May 2013, Pages 585-587

https://doi.org/10.1016/j.ijnurstu.2012.09.009 Get rights and content

Abstract

This invited commentary reflects on the impact of the MRC's revised guidance for the development and evaluation of complex interventions, and considers some of the criticisms that have been published in response to the guidance.

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Cited by (155)

Pre and Post-operative Voice Therapy Intervention for Benign Vocal Fold Lesions: A Systematic Review
2023, Journal of Voice
Citation Excerpt :
The Medical Research Council's framework for developing and evaluating complex interventions29 advocates a structured developmental pathway by undertaking preliminary intervention development work, including a systematic review of the available literature. This reduces the likelihood of research waste, which, is an inevitable consequence of failing to devote adequate time to developing, describing, and testing a complex intervention.30,31 The aim of this systematic review is to critically examine the evidence regarding voice therapy intervention for pre and post-operative voice therapy for patients with BFVLs to inform the development of an evidence-based treatment intervention for this population.
Benign vocal fold lesions cause dysphonia by preventing vocal fold closure, causing irregular vibration and increasing compensatory muscle tension. Voice therapy delivered in addition to phonosurgery may improve voice and quality of life outcomes but the evidence base is lacking and what constitutes voice therapy for this population is not defined. The purpose of this systematic review is to critically evaluate the evidence for pre and post-operative voice therapy to inform the development of an evidence based intervention.
Systematic Review.
Electronic databases were searched using key terms including dysphonia, phonosurgery, voice therapy and outcomes. Eligible articles were extracted and reviewed by the authors for risk of bias and for information regarding the content, timing and intensity of any pre and post-operative voice therapy intervention.
Of the 432 articles identified, 35 met the inclusion criteria and were included in the review. 5 were RCTs, 2 were individual cohort studies, 1 was a case control study and 26 were case series. There was considerable heterogeneity in participant characteristics. Information was frequently lacking regarding the content timing and intensity of the reported voice therapy intervention, and where present, interventions were highly variable.
Reporting in relevant literature is limited in all aspects of content, timing and intensity of intervention. Further intervention development work is required to develop a robust voice therapy treatment intervention for this population, before effectiveness work can commence.
Pre- and Postoperative Voice Therapy for Benign Vocal Fold Lesions: An International Electronic Delphi Consensus Study
2023, Journal of Voice
Voice therapy management of benign vocal fold lesions (BVFLs) is variable and there are currently no clinical guidelines. Poor descriptions of voice therapy interventions lead to unwarranted variation in treatment. Triangulation of the current evidence identifies a number of potential best practice elements, but also a number of outstanding questions to be explored. The aim of this study was to refine and gain global consensus on “best practice” for a pre- and postoperative voice therapy intervention for adults with BVFLs.
An international sample of expert voice therapists (n = 42) were recruited to take part in this three-round electronic modified Delphi study. Participants were presented with statements concerning a pre- and postoperative voice therapy intervention. Statements were developed from previous research and based on the TIDieR checklist (eg, why, when, what, how?) Participants rated the extent to which they agreed or disagreed with a statement and gave comments to support their response. Consensus was defined as >75% of participants agreeing or strongly agreeing with a given statement. If consensus was not reached, participant comments were used to generate new statements and were rated in the next round. Stability of consensus between rounds was assessed.
The 42 international experts achieved consensus on 33 statements relating to components of a best practice pre- and postoperative voice therapy intervention for patients with BVFLs. Consensus on statements ranged from 81% to 100%. These statements were explicitly mapped to the TIDieR checklist to ensure that all aspects of the intervention were considered and the questions of “why, what, how, when and individual tailoring” were addressed.
This study has significantly enhanced our understanding of what should be in a best practice pre- and postoperative voice therapy intervention. It is important to now test these findings for acceptability and feasibility, prior to considering effectiveness research.
Specialist psychotherapy with emotion for anorexia in Kent and Sussex: An intervention development and non-randomised single arm feasibility trial
2024, European Eating Disorders Review
Evidence Synthesis for Complex Interventions Using Meta-Regression Models
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Experiences of Older Adults, Physiotherapists, and Aged Care Staff in the TOP UP Telephysiotherapy Program: Interview Study of the TOP UP Interventions
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Seeking consensus on a play-based intervention framework for promoting play of children with HIV/Aids in a low-resourced setting: A Delphi study
2024, Australian Occupational Therapy Journal

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^☆: This commentary refers to Craig et al. (2013). Developing and evaluating complex interventions: The new Medical Research Council guidance. http://dx.doi.org/10.1016/j.ijnurstu. 2012.09.010.

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CommentaryDeveloping and evaluating complex interventions: Reflections on the 2008 MRC guidance☆

Abstract

International Journal of Nursing Studies

Lancet

International Journal of Nursing Studies

New MRC guidance on evaluating complex interventions

British Medical Journal

Health services research: the gradual encroachment of ideas

Journal of Health Services Research and Policy

Framework for the design and evaluation of complex interventions to improve health

British Medical Journal

Designing and evaluating complex interventions to improve health care

British Medical Journal

Commentary
Developing and evaluating complex interventions: Reflections on the 2008 MRC guidance☆