Investigating complexity in systematic reviews of interventions by using a spectrum of methods
Investigating complexity in systematic reviews of interventions by using a spectrum of methods
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DOI：
10.1016/j.jclinepi.2013.06.014
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发表时间：
2013-11-01
影响因子：
7.2
通讯作者：
Shemilt, Ian
中科院分区：
文献类型：
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作者：
Anderson, Laurie M.;Oliver, Sandy R.;Shemilt, Ian
PICOS（人群、干预措施、比较、结果和研究设计）框架下的系统评价对于综合干预措施效果的证据很有价值。然而，该框架在探索人群或干预措施内部变化的影响，或被认为调节结果的作用机制或因果途径，其他可能类似地调节结果的背景因素，或这些机制和要素如何以及何时相互作用方面的效用有限。对这些问题的有价值的见解来自配置和聚合的综合方法。本文考虑了可用于干预措施系统评价的证据范围，以调查干预措施及其影响的潜在变异来源的复杂性，并提出了证据综合的连续目的和方法。选择合适的综合方法要考虑综合的目的是产生、探索还是检验理论。在综合经济证据时考虑到复杂性，同样将重点从侧重于聚合的证据综合策略转移到旨在开发、探索和完善（在测试之前）理论或解释的配置策略，这些理论或解释是如何以及为什么干预措施在不同环境中或以不同方式实施时或多或少是资源密集型的、昂贵的或具有成本效益的。(c) 2013爱思唯尔公司版权所有。
Systematic reviews framed by PICOS (Populations, Interventions, Comparisons, Outcomes, and Study designs) have been valuable for synthesizing evidence about the effects of interventions. However, this framework is limited in its utility for exploring the influence of variations within populations or interventions, or about the mechanisms of action or causal pathways thought to mediate outcomes, other contextual factors that might similarly moderate outcomes, or how and when these mechanisms and elements interact. Valuable insights into these issues come from configurative as well as aggregative methods of synthesis. This article considers the range of evidence that can be used in systematic reviews of interventions to investigate complexity in terms of potential sources of variation in interventions and their effects, and presents a continuum of purposes for, and approaches to, evidence synthesis. Choosing an appropriate synthesis method takes into account whether the purpose of the synthesis is to generate, explore, or test theories. Taking complexity into account in a synthesis of economic evidence similarly shifts emphasis from evidence synthesis strategies focused on aggregation toward configurative strategies that aim to develop, explore, and refine (in advance of testing) theories or explanations of how and why interventions are more or less resource intensive, costly or cost-effective in different settings, or when implemented in different ways. (c) 2013 Elsevier Inc. All rights reserved.