Complex Interventions and Complex Systems in Occupational Therapy: an Alternative Perspective

Abstract

In recent years, there have been numerous discussions of complex interventions and complex systems in the health care literature. The cue for many of these discussions was the publication of an influential document on complex interventions by the Medical Research Council in 2000, and the appearance of an equally influential series of articles on complex systems in the British Medical Journal in 2001. However, it is not always clear that the work published during the intervening period recognises that complex interventions and complex systems are not, in fact, the same thing. This paper discusses a recent contribution to the occupational therapy literature, in which the confusion between complex interventions and complex systems drives the argument. It identifies six claims made by Creek et al (2005) and suggests that only one of them is accurate. Specifically, it argues that, although occupational therapy is sometimes a complex intervention, there is no reason to suppose that it is a complex system; nor is there any good reason to believe that occupational therapy outcomes are intrinsically unpredictable. The paper concludes with an explanation of why this topic is important, and why confusing the two (very different) kinds of complexity risks compromising the idea of evidence-based practice.