[Development, appraisal and synthesis of complex interventions - a methodological challenge].

Area of Science:

• Health Services Research
• Medical Methodology
• Intervention Science

Context:

• Complex interventions, comprising interdependent components within settings like stroke units, pose appraisal challenges.
• Evaluating complex interventions is more difficult than assessing single treatments like drugs.
• International discussion on methodological procedures for complex interventions is increasing.

Purpose:

• To systematically inventory methodological guidance for developing and evaluating complex interventions.
• To review current discussions and provide suggestions for the development, appraisal, and synthesis of complex interventions.

Summary:

• Five key methodological guidance papers were identified, including UK Medical Research Council guidance.
• Traditional systematic review methods are inadequate for synthesizing complex interventions.
• Alternative synthesis approaches like realist evaluation and methods exploring active components are discussed, but prospective development is crucial.

Impact:

• Complex interventions necessitate multi-stage development, diverse methods, and transparent reporting.
• New synthesis approaches are required for complex interventions.
• Presenting complete evidence for a specific complex intervention may be more beneficial than traditional meta-analytical systematic reviews.