Assessment of Intervention Fidelity and Recommendations for Researchers Conducting Studies on the Cough in the Adult CHEST Guideline and Expert Panel Report
Assessment of Intervention Fidelity and Recommendations for Researchers Conducting Studies on the Cough in the Adult CHEST Guideline and Expert Panel Report
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DOI：
10.1378/chest.15-0164
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发表时间：
2015-07-01
期刊：
影响因子：
9.6
通讯作者：
Irwin, Richard S.
中科院分区：
文献类型：
--
作者：
French, Cynthia T.;Diekemper, Rebecca L.;Irwin, Richard S.
背景：在文献报道的初步研究中，慢性咳嗽的成功治疗方法各不相同。其中一个潜在的原因是缺乏对研究人员使用的诊断和/或治疗干预的核心要素的干预忠实度。方法：我们进行了一项系统综述，总结了支持干预保真度作为评估慢性咳嗽诊断和治疗临床实践指南有效性的重要方法学考虑因素的证据。我们开发并使用了一个工具来评估五个领域的干预保真度。检索了1998年1月至2014年5月的Medline （PubMed）、Scopus和Cochrane系统评价数据库。针对那些使用指南或方案来诊断和管理成人慢性咳嗽的研究人员，制定了指南建议和建议，并使用CHEST组织的方法进行了投票。结果：共有23项研究（17项非对照前瞻性观察性研究、2项随机对照研究和4项回顾性观察性研究）符合我们的纳入标准。这些文章包括3,636名患者。由于异质性，数据不能汇总进行荟萃分析。与干预保真度的五个领域相关的研究结果包括三个主要与提供者相关的领域和两个主要与患者相关的领域。在研究设计方面，23项研究中有11项似乎以单一指南/方案为基础；对于提供者的培训，23项研究中有2项报告了培训，23项研究中没有一项报告使用了干预手册；在提供治疗方面，在评估胃食管反流病的治疗时，23项研究中有3项与作者引用的最新指南/方案一致。对于接受治疗，23项研究中没有一项提到测量患者干预者对推荐治疗的理解的一致性，23项研究中没有一项提到测量治疗的实施，23项研究中有3项测量副作用，23项研究中有2项测量依从性。所有23项研究的总体平均干预忠实度评分较差（20.74分/ 48分）。结论：只有低质量的证据支持在进行成人慢性咳嗽诊断和治疗的初步研究时使用干预保真策略。这支持了这样一种观点，即不明原因或未解决的慢性咳嗽患者报告的一些可变性可能是由于缺乏干预的保真度。通过遵循本文中的建议和建议，研究人员可能能够更好地整合策略来解决干预保真度问题，从而加强其结果的有效性和普遍性，为制定可信赖的指导方针提供基础。
BACKGROUND: Successful management of chronic cough has varied in the primary research studies in the reported literature. One of the potential reasons relates to a lack of intervention fidelity to the core elements of the diagnostic and/or therapeutic interventions that were meant to be used by the investigators.METHODS: We conducted a systematic review to summarize the evidence supporting intervention fidelity as an important methodologic consideration in assessing the effectiveness of clinical practice guidelines used for the diagnosis and management of chronic cough. We developed and used a tool to assess for five areas of intervention fidelity. Medline (PubMed), Scopus, and the Cochrane Database of Systematic Reviews were searched from January 1998 to May 2014. Guideline recommendations and suggestions for those conducting research using guidelines or protocols to diagnose and manage chronic cough in the adult were developed and voted upon using CHEST Organization methodology.RESULTS: A total of 23 studies (17 uncontrolled prospective observational, two randomized controlled, and four retrospective observational) met our inclusion criteria. These articles included 3,636 patients. Data could not be pooled for meta-analysis because of heterogeneity. Findings related to the five areas of intervention fidelity included three areas primarily related to the provider and two primarily related to the patients. In the area of study design, 11 of 23 studies appeared to be underpinned by a single guideline/protocol; for training of providers, two of 23 studies reported training, and zero of 23 reported the use of an intervention manual; and for the area of delivery of treatment, when assessing the treatment of gastroesophageal reflux disease, three of 23 studies appeared consistent with the most recent guideline/protocol referenced by the authors. For receipt of treatment, zero of 23 studies mentioned measuring concordance of patient-interventionist understanding of the treatment recommended, and zero of 23 mentioned measuring enactment of treatment, with three of 23 measuring side effects and two of 23 measuring adherence. The overall average intervention fidelity score for all 23 studies was poor (20.74 out of 48).CONCLUSIONS: Only low-quality evidence supports that intervention fidelity strategies were used when conducting primary research in diagnosing and managing chronic cough in adults. This supports the contention that some of the variability in the reporting of patients with unexplained or unresolved chronic cough may be due to lack of intervention fidelity. By following the recommendations and suggestions in this article, researchers will likely be better able to incorporate strategies to address intervention fidelity, thereby strengthening the validity and generalizability of their results that provide the basis for the development of trustworthy guidelines.