Poltawski Leon, Norris Meriel, Dean Sarah
, University of Exeter Medical School, St Luke's Campus, Magdalen Rd, Exeter EX1 2LU, United Kingdom.
J Rehabil Med. 2014 Jul;46(7):609-15. doi: 10.2340/16501977-1848.
Intervention fidelity is concerned with the extent to which interventions are implemented as intended. Consideration of fidelity is essential if the conclusions of effectiveness studies are to be credible, but little attention has been given to it in the rehabilitation literature. We describe our experiences addressing fidelity in the development of a rehabilitation clinical trial, and consider how an existing model of fidelity may be employed in rehabilitation research.
We used a model and methods drawn from the psychology literature to investigate how fidelity might be maximised during the planning and development of a stroke rehabilitation trial. We considered fidelity in intervention design, provider training, and the behaviour of providers and participants. We also evaluated methods of assessing fidelity during a trial.
We identified strategies to help address fidelity in our trial protocol, along with their potential strengths and limitations. We incorporated these strategies into a model of fidelity that is appropriate to the concepts and language of rehabilitation.
A range of strategies are appropriate to help maximise and measure fidelity in rehabilitation research. Based on our experiences, we propose a model of fidelity and provide recommendations to inform the growing literature of fidelity in this discipline.
干预保真度关注的是干预措施按预期实施的程度。如果有效性研究的结论要可信，那么对保真度的考量至关重要，但康复文献中对此关注甚少。我们描述了在开展一项康复临床试验过程中处理保真度的经验，并探讨如何在康复研究中运用现有的保真度模型。
我们采用了心理学文献中的一个模型和方法，来研究在中风康复试验的规划和开展过程中如何使保真度最大化。我们考量了干预设计、提供者培训以及提供者和参与者的行为方面的保真度。我们还评估了试验期间评估保真度的方法。
我们确定了有助于在试验方案中处理保真度的策略，以及它们潜在的优势和局限性。我们将这些策略纳入了一个适合康复概念和语言的保真度模型。
一系列策略有助于在康复研究中使保真度最大化并进行测量。基于我们的经验，我们提出了一个保真度模型，并提供建议，以为该领域日益增多的保真度文献提供参考。
