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Table 5 Using the iCAT_SR in systematic reviews of the effectiveness of interventions

From: Assessing the complexity of interventions within systematic reviews: development, content and use of a new tool (iCAT_SR)

Stage in the review processa Utility of the iCAT_SR
Formulating the PICO review question and developing criteria for including studies Prompts review authors to identify the key components of the intervention/s and how these interact; the actions to which these components are directed; the organisational levels targeted; the anticipated causal pathway/s or logic model etc. Overall, this may help review authors to conceptualise the intervention and define the scope of the review.
Searching for studies By prompting to review authors to identify the key components of intervention/s and the recipients and organisational levels targeted, the tool may aid in identifying appropriate search terms. This may help in identifying eligible studies where, for example, the interventions of interest are broadly similar in terms of their component parts but have widely varying names in the literature.
Selecting studies for inclusion Makes explicit the key components of the intervention/s and the recipients and organisational levels targeted, and therefore helps to ensure that study inclusion decisions are easier and more consistent across the review author team.
Extracting data Facilitates the organisation and standardisation of data relating to intervention description and intervention complexity. The dimensions of the tool can inform development of the data extraction form for the review.
Analysing data and undertaking meta-analyses Enables classification or grouping of interventions for analysis based on their components and/or participants and levels targeted. The tool may also inform analyses and interpretation by helping to generate a priori hypotheses about explanatory factors that could potentially explain differences in results both across studies and across subgroups within studies. These explanatory factors can then be used to explore heterogeneity in subgroup analyses and meta-regressions.
Presenting results and developing ‘Summary of findings’ tables b Enables classification or grouping of interventions based on their components and/or participants and levels targeted, and thus facilitates clear and logical presentation of the review findings. The tool may also identify important research gaps, for example where the causal pathway of an intervention is not clear or where there are important questions regarding interactions between intervention components.
Interpreting results and drawing conclusions Aids refining a logic model or causal pathway for the intervention/s that was developed at the protocol stage.
  1. aThe stages in this table are based on those for Cochrane reviews, but are also relevant to most other reviews of the effectiveness of interventions
  2. bA summary of findings table shows the quality of evidence and magnitude of relative and absolute effects for each outcome in a review assessed as important by stakeholders [44]