Measuring treatment fidelity in a rehabilitation intervention study.
Measuring treatment fidelity in a rehabilitation intervention study.
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DOI：
10.1097/phm.0b013e31824ad462
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发表时间：
2012-08
影响因子：
3
通讯作者：
Lenze EJ
中科院分区：
文献类型：
--
作者：
Hildebrand MW;Host HH;Binder EF;Carpenter B;Freedland KE;Morrow-Howell N;Baum CM;Doré P;Lenze EJ
实现和证明治疗的保真度是至关重要的发展和测试的循证干预措施。治疗保真度是指干预措施在临床试验中实施的程度，因为它是概念化的，并且与对照或标准治疗干预措施明显不同。在临床研究中，治疗保真度通常通过强化培训和监督技术来实现，并通过使用外部评估者测量治疗师对协议的依从性和能力来证明。然而，在职业治疗（OT）和物理治疗（PT）结果研究中，治疗保真度方法尚未得到利用，我们认为这是一个严重的差距，阻碍了这些康复领域的新治疗开发和测试。在这篇文章中，我们描述的方法来培训和监督治疗师，以达到足够的治疗保真度在一个治疗开发项目，涉及一种新的OT和PT为基础的干预。我们还提出了一个数据驱动的模型，用于展示治疗师在新治疗中的依从性和能力及其与标准治疗的区别。在这样做的过程中，我们提供了一种方法，康复研究人员可以使用它来解决OT和PT为基础的干预治疗保真度。我们建议康复学科的所有治疗研究人员使用这些或类似的方法作为开发和测试循证康复干预措施的重要步骤。
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.