BMJ  2005;331:507-509 (3 September), doi:10.1136/bmj.331.7515.507

Education and debate

Analysis of quality of interventions in systematic reviews

¹ Centre for Evidence-Based Physiotherapy, University of Sydney, PO Box 170, Lidcombe, NSW 1825, Australia, ² Norwegian School of Sport Sciences, Department of Sport Medicine, Oslo, Norway

The quality of interventions can affect the results of clinical trials. Reviews of complex interventions need to take this into account

The first 150 words of the full text of this article appear below.

Introduction

Complex health interventions, such as surgery or physiotherapy, can be administered well or badly. Variation in the quality of administration of interventions may explain some of the variability in estimates of effects between trials in systematic reviews. We argue that systematic reviews of complex interventions should assess the quality of interventions, and we suggest how to make such assessments.

View larger version (21K): [in this window] [in a new window]   Effect of training pelvic floor muscle on urinary incontinence in pregnancy. Pooled estimate for all trials with sufficient data (top) and excluding a trial without supervised exercise (bottom)

 

Best evidence

Randomised controlled trials provide the best test of the efficacy of preventive or therapeutic interventions because they can separate the effects of the intervention from those of extraneous factors such as natural recovery and statistical regression. When more than one trial has examined a particular intervention, systematic reviews potentially provide the best summaries of the available evidence.¹

Systematic reviewers can summarise findings of . . . [Full text of this article]

Heterogeneity

Effect of quality

Assessing quality

Conclusions

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Rapid Responses:

Read all Rapid Responses

Quality of clinical trial methods

Alan H. Morris
bmj.com, 2 Sep 2005 [Full text]

Quality of interventions: Estabishing a benchmark.

Nurudeen T Amusat
bmj.com, 4 Sep 2005 [Full text]

Systematic reviews should consider quality of intervention beyond design, to include delivery and evaluation of mechanisms of action

Wendy Hardeman, et al.
bmj.com, 9 Sep 2005 [Full text]