Faculty Opinions recommendation of Complex interventions: how "out of control" can a randomised controlled trial be?

Author(s):  
M Rashad Massoud ◽  
Danika Barry
BMJ Open ◽  
2021 ◽  
Vol 11 (4) ◽  
pp. e043478
Author(s):  
Kirsty Sprange ◽  
Gail Mountain ◽  
Claire Craig

ObjectivesRobust research of complex interventions designed to promote mental well-being in later life is required to inform service development. An essential component is ensuring that such interventions are delivered as intended. We present a detailed description of the design and implementation of a fidelity assessment within a trial of one such intervention (Lifestyle Matters). The findings help to explain the trial results and also inform the design of embedded fidelity assessments within future evaluations of complex interventions.DesignWe conducted a mixed-method fidelity assessment embedded as part of a multicentre pragmatic randomised controlled trial. A conceptual fidelity framework was developed from the Behaviour Change Consortium framework. From this the fidelity assessment was designed. The resulting instrument assessed the following parameters: intervention design, training, supervision; and delivery, receipt and enactment of the intervention.InterventionThe Lifestyle Matters intervention was designed to assist older people to improve and sustain mental well-being through participation in meaningful activity. The aim is to enable participants to engage in both new and neglected activities through a mix of facilitated group meetings and individual sessions.ResultsThe fidelity assessment demonstrated that the intervention was delivered as per protocol for the group component and was tailored to meet individual needs. There was substantial inter-rater agreement for training; and group member performance 0.72; and moderate agreement for facilitator performance 0.55. It was not possible to determine whether small declines seen in facilitator performance were due to facilitator drift or moderating factors such as group dynamics or participant characteristics.ConclusionsThe assessment methods adequately measured criteria identified as being significant indicators of fidelity. Adherence during training, delivery and supervision was good. The subjective nature of identification and rating observed behaviours was the main challenge. Future research should explore alternative methods of assessing fidelity in trials of complex interventions.Trial registration numberISRCTN67209155.


2006 ◽  
Vol 69 (5) ◽  
pp. 217-223 ◽  
Author(s):  
Katherine H O Deane

Occupational therapists need to be able to evaluate the profession's interventions critically: to stop the ineffective, to reduce the hazardous and to promote the effective. Randomised controlled trials are a research tool for testing the efficacy of interventions with small to moderate effects. This review aims to cover the issues to be considered when designing a randomised controlled trial of complex interventions, such as occupational therapy.


BMJ ◽  
2004 ◽  
Vol 328 (7455) ◽  
pp. 1561-1563 ◽  
Author(s):  
Penelope Hawe ◽  
Alan Shiell ◽  
Therese Riley

BMJ Open ◽  
2021 ◽  
Vol 11 (10) ◽  
pp. e046874
Author(s):  
Lisa Wenzel ◽  
Christoph Heesen ◽  
Jutta Scheiderbauer ◽  
Markus van de Loo ◽  
Sascha Köpke ◽  
...  

IntroductionProcess evaluations accompanying complex interventions examine the implementation process of the underlying intervention, identify mechanisms of impact and assess contextual factors. This paper presents the protocol for a process evaluation conducted alongside the randomised controlled trial POWER@MS2. The trial comprises the evaluation of a web-based complex intervention on relapse management in 188 people with multiple sclerosis conducted in 20 centres. The web-based intervention programme focuses on relapse treatment decision making and includes a decision aid, a nurse-led webinar and an online chat. With the process evaluation presented here, we aim to assess participants’ responses to and interactions with the intervention to understand how and why the intervention produces change.Methods and analysisA mixed methods design is used to explore the acceptance of the intervention as well as its use and impact on participants. Participants are people with multiple sclerosis, neurologists, nurses and stakeholders. Quantitative semistandardised evaluation forms will be collected throughout the study. Qualitative semistructured telephone interviews will be conducted at the end of the study with selected participants, especially people with multiple sclerosis and neurologists. Quantitative data will be collected and analysed descriptively. Based on the results, the qualitative interviews will be conducted and analysed thematically, and the results will be merged in a joint display table.Ethics and disseminationThe process evaluation has received ethical approval from the Ethical Committee of the University of Lübeck (reference 19–024). Findings will be disseminated in peer-reviewed journals, at conferences, meetings and on relevant patient websites.Trial registration numberNCT04233970.


2012 ◽  
Author(s):  
Sarah Clement ◽  
Adrienne van Nieuwenhuizen ◽  
Aliya Kassam ◽  
Ian Norman ◽  
Clare Flach ◽  
...  

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