Measuring Treatment Fidelity in a Rehabilitation Intervention Study

Abstract

Attaining and demonstrating treatment fidelity is critical in the development and testing of evidence-based interventions. Treatment fidelity refers to the extent to which an intervention was implemented in clinical testing as it was conceptualized and is clearly differentiable from control or standard-of-care interventions. In clinical research treatment fidelity is typically attained by intensive training and supervision techniques and demonstrated by measuring therapist adherence and competence to the protocol using external raters. Yet, in occupational therapy (OT) and physical therapy (PT) outcomes research, treatment fidelity methods have not been utilized, which in our view is a serious gap that impedes novel treatment development and testing in these rehabilitation fields. In this article we describe the development of methods to train and supervise therapists to attain adequate treatment fidelity in a treatment development project involving a novel OT and PT-based intervention. We also present a data-driven model for demonstrating therapist adherence and competence in the new treatment and its differentiation from standard-of-care. In doing so, we provide an approach that rehabilitation researchers can use to address treatment fidelity in OT and PT-based interventions. We recommend that all treatment researchers in rehabilitation disciplines use these or similar methods as a vital step in development and testing of evidence-based rehabilitation interventions.

Improving the Development, Monitoring and Reporting of Stroke Rehabilitation Research: Consensus-Based Core Recommendations from the Stroke Recovery and Rehabilitation Roundtable

“…[8][9][10][11][12][13][14] The consolidated framework for implementation research (CFIR) 10 adopts the metaphor of an arena to highlight factors in different contextual areas that can affect fidelity. Examples of factors in the ''outer'' setting include resources, external policies and incentives, and those in the ''inner'' setting include culture, networks and communication and at an individual level, patients and therapists knowledge and beliefs and personal attributes.…”

The Bobath (NDT) concept in adult neurological rehabilitation: what is the state of the knowledge? A scoping review. Part II: intervention studies perspectives

“…The degree to which a therapist implements an intervention under research conditions (treatment fidelity) is dependent upon the extent and operationalization of the intervention and skill level of the therapist. The determination of causality is dependent upon establishing treatment fidelity [24]. In order to determine study fidelity, we examined: operationalization of the Bobath concept, individualization of intervention, treatment fidelity and clinical adherence.…”

Intervention fidelity: Developing an experience-based model for rehabilitation research

“…For rehabilitation research, it has been suggested that preparation should focus on promoting particular provider behaviours, which can be assessed and corrected both during training and delivery of the intervention (10,16). In our studies, ARNI training was provided by qualified and experienced Exercise professionals, who had been prepared by participation in the ARNI Institute's standard training and accreditation.…”

“…This facilitated the assessment of "differentiation fidelity", which refers to the maintenance of important differences in treatment between two groups compared in a trial (12). In studies concerned with rehabilitation after stroke (4) and other disabling medical events (16), the impact of provider training, monitoring and feedback on intervention fidelity was investigated.…”

“…They identified threats to fidelity and proposed strategies for its enhancement, including standardising the intervention, using the same practitioner to deliver it, and monitoring contextual influences on outcomes. Since then, several rehabilitation studies have specifically addressed intervention fidelity (4,(15)(16)(17).…”