Conclusion
stroke
STROKE
The early design phase is critical in trials investigating complex interventions. The complexity of the social processes underpinning intervention delivery is greater than typically considered in stroke rehabilitation research, which mostly focuses on the ‘what’ and not the ‘how and why’. Understanding the process of implementation is crucial, as erroneous conclusions may be drawn as to the efficacy of an intervention if insufficient thought has been given to maximising fidelity at the trial stage, and the human and organisational processes underpinning this. How teams (rather than individuals) work together is central to how complex interventions are understood and subsequently implemented. It is possible that new complex interventions work best in contexts where there are ‘flexible’ cultures, and that researchers should consider, and potentially measure this, before they can effectively implement and evaluate an intervention.