Treatment definition in complex rehabilitation interventions

Abstract

Rehabilitation research is challenged to improve its evidence base, which requires more precise and more consistent conceptualisation and measurement of treatment ingredients. This paper presents the steps in defining and specifying treatments towards the construction of a therapy manual for experimental interventions, or a coding system for observational treatment research. Specifying the active ingredients, identifying the behavioural operations that are aligned with each, and developing procedural details and materials are discussed and illustrated using two on-going trials for treatment of traumatic brain injury. The process of assessing treatment fidelity, that is, the extent to which interventions are delivered, received and used as intended, is also discussed.

Return to work after traumatic brain injury: Cohort comparison and economic evaluation

“…In a systematic review, van Velzen et al [8] estimated that only a mean of 41% (range 0-85%) of TBI survivors who were working prior to their injury are in work at 1 and 2 years post-injury. Study heterogeneity and known difficulty in following TBI people up over time [8][9][10] explain some of the difference in reported outcomes, but ineffective rehabilitation cannot be excluded as a cause. Keeping TBI people in work is also problematic.…”

Return to Work after Stroke: Recording, Measuring, and Describing Occupational Therapy Intervention

“…In this study we have described the rehabilitation intervention in full, as recommended by previous researchers (Hart 2009, Wade 2005, Whyte and Hart 2003. A proforma, previously developed for use in a study of VR following TBI (Phillips et al 2010), was adapted for stroke and used as part of a feasibility RCT, to record and categorize the content of stroke-specific vocational rehabilitation.…”

Combining neuropsychological and cognitive–behavioral approaches for treating psychological sequelae of acquired brain injury

“…Still, this conclusion is still mostly based on studies employing weak research designs with small samples and often creating treatment and control groups of low informative value [12 , 41,42 ]. Furthermore, studies are limited in their choice of outcome measure, focusing on either very specific, change-sensitive outcomes with little external validity or on very complex outcomes that are not easily impacted by interventions.…”