Considering Complexity in Systematic Reviews of Interventions
Introducing a series of methodological articles on considering complexity in systematic reviews of interventions

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Background

Systematic reviews of public health and health care interventions attempt to synthesize high-quality timely research evidence to inform decision making. Practitioners use systematic reviews to find out if an intervention is effective in a given situation, health care consumers use them to weigh potential benefits and harms of alternative courses of care, and policy makers use them to help make choices intended to maximize health and well-being for society. Systematic review authors are

Complex systems

Review of the sentinel work in the field of complex (adaptive) systems research as applied to public health, health care, and social and organizational systems is beyond the scope of this series and can be found elsewhere [1], [2], [3], [4], [5], [6]. However, a conceptual vocabulary of complex adaptive systems may provide a helpful start. One way to begin to understand the interplay between professionals, consumers, and the organizational systems in public health and health care delivery is to

Sources of complexity in interventions

The evaluation of complex interventions, and the need to synthesize evidence on the effects of such interventions, has driven the development of the recent Medical Research Council (MRC) complex interventions framework [9], which moved beyond a more traditional model of drug development [10] (Fig. 1) that traces in a linear fashion the passage of drugs in development through phases 0 and 1 through to phase 4. In its place came an iterative model (Fig. 2) that more accurately reflects how

Considering complexity in systematic reviews of interventions

To what degree do systematic review authors need to make distinctions between simple or complex interventions? Fundamentally, this depends on how the review question is framed and the level of explanation sought about core intervention dynamics and the properties of systems in which the intervention is implemented. For the purpose of the work undertaken in this series of articles, clarity of terminology and context is important. Characteristics of a complex intervention have been defined as

Montebello meeting on systematic reviews of complex interventions

In January 2012, the University of Ottawa, in collaboration with the Ottawa Hospital Research Institute, and with support from The Cochrane Collaboration's Methods Innovation Fund, held a meeting of international experts in Montebello, Quebec, to discuss methodological issues that arise when synthesizing evidence about the effects of complex public health and health care system interventions. Experts from Europe, North American, and Australia gathered to discuss defining and mapping complexity,

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    Finally, 12 publications were included in evidence synthesis (see flow diagram of literature selection in Appendix A Figure at www.jclinepi.com). Among the 12 included publications for the development of recommendations on planning and conducting a SR of CE of TMDs, eight [15–22] described the FSRCIs, one publication [23] on logic models that was referred to the FSRCIs [15], and three publications [24–26] dealt with the evaluation of TMDs or similar technologies. The characteristics of the publications are described in Appendix C Table at www.jclinepi.com.

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Conflict interest: None.

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