A new tool to incorporate implementation data into systematic reviews - applying the Oxford Implementation Index

Tags: Workshop
Underhill K, Mayo-Wilson E, Gardner F, Operario D, Montgomery P

Objectives: To disseminate, demonstrate, and discuss a new methodological tool that helps systematic reviewers integrate implementation data throughout the review process. At the end of the session, participants will be prepared to:

- identify variation in implementation across trials;

- use the index to extract implementation data from primary trials;

- evaluate implementation data for completeness and susceptibility to bias;

- use implementation data to inform decisions about analysing trials, investigating heterogeneity, and appraising the clinical relevance of results.

Summary: Although the Cochrane Handbook for Systematic Reviews of Interventions and other guidelines help review authors assess methodological quality across trials, these instructions rarely ask review authors to analyse differences in implementation that make trials more or less comparable. These differences can arise in either trial arm, and they stem from variation in treatment design, delivery by trial staff, uptake by trial participants, and clinical context. Without systematically examining implementation data across trials, review authors may group incomparable treatments, combine trials that make dissimilar comparisons, overlook beneficial or harmful treatment components, or overstate the generalisability of a review's results. The goal of this workshop is to demonstrate the use of the Oxford Implementation Index, a methodological tool that helps systematic review authors extract, appraise, and use implementation data in reviews. The index was developed through a systematic literature search, piloting, and a modified Delphi panel of health and social care experts. Application of the index to Cochrane reviews in HIV prevention and psychosocial intervention will demonstrate that it is efficient and easy to use. Implementation data were integrated into these reviews for three purposes: deciding how to group trials for analysis, investigating heterogeneity arising from implementation differences, and critically appraising the clinical relevance of results. The index also identified implementation characteristics that were under-reported, which review authors noted as sources of uncertainty. The workshop will include the following:

- introduction to the causes/consequences of heterogeneity in implementation across primary trials;

- presentation of the index as a way to address this heterogeneity;

- demonstration of the index using two Cochrane reviews;

- distribution of the index to workshop participants and solicitation of feedback;

- group discussion addressing usability of the index and its applicability to other reviews.

Level of knowledge required to attend: intermediate.

A short reading list will be supplied. Knowledge of the systematic review process is required, and some experience with data extraction and quantitative/narrative synthesis will be helpful. The target audience is review authors, Review Group Co-ordinators, and those engaged in the development of guidelines for systematic reviewing