French Cynthia T, Diekemper Rebecca L, Irwin Richard S, Adams Todd M, Altman Kenneth W, Barker Alan F, Birring Surinder S, Blackhall Fiona, Bolser Donald C, Boulet Louis-Philippe, Braman Sidney S, Brightling Christopher, Callahan-Lyon Priscilla, Canning Brendan J, Chang Anne B, Coeytaux Remy, Cowley Terrie, Davenport Paul, Diekemper Rebecca L, Ebihara Satoru, El Solh Ali A, Escalante Patricio, Feinstein Anthony, Field Stephen K, Fisher Dina, French Cynthia T, Gibson Peter, Gold Philip, Gould Michael K, Grant Cameron, Harding Susan M, Harnden Anthony, Hill Adam T, Irwin Richard S, Kahrilas Peter J, Keogh Karina A, Lane Andrew P, Lim Kaiser, Malesker Mark A, Mazzone Peter, Mazzone Stuart, McCrory Douglas C, McGarvey Lorcan, Molasiotis Alex, Murad M Hassan, Newcombe Peter, Nguyen Huong Q, Oppenheimer John, Prezant David, Pringsheim Tamara, Restrepo Marcos I, Rosen Mark, Rubin Bruce, Ryu Jay H, Smith Jaclyn, Tarlo Susan M, Vertigan Anne E, Wang Gang, Weinberger Miles, Weir Kelly
Chest. 2015 Jul;148(1):32-54. doi: 10.1378/chest.15-0164.
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.
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.
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).
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.
在已发表文献中的初步研究里，慢性咳嗽的成功管理方法各不相同。一个潜在原因是研究人员在诊断和/或治疗干预的核心要素方面缺乏干预保真度。
我们进行了一项系统综述，以总结支持干预保真度作为评估用于慢性咳嗽诊断和管理的临床实践指南有效性的重要方法学考量的证据。我们开发并使用了一种工具来评估干预保真度的五个领域。从1998年1月至2014年5月检索了医学期刊数据库（PubMed）、Scopus和Cochrane系统评价数据库。使用美国胸科协会的方法制定并投票表决了针对那些使用指南或方案对成人慢性咳嗽进行诊断和管理的研究的指南建议。
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。这些文章纳入了3636名患者。由于异质性，无法汇总数据进行荟萃分析。与干预保真度五个领域相关的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；在提供者培训方面，23项研究中有2项报告了培训情况，23项中没有一项报告使用干预手册；在治疗实施方面，在评估胃食管反流病的治疗时，23项研究中有3项似乎与作者引用的最新指南/方案一致。在接受治疗方面，23项研究中没有一项提及测量患者 - 干预者对推荐治疗的理解一致性，23项中没有一项提及测量治疗的实施情况，23项中有3项测量了副作用，23项中有2项测量了依从性。所有23项研究的总体平均干预保真度得分较低（48分中得20.74分）。
仅有低质量证据支持在对成人慢性咳嗽进行诊断和管理的初步研究中使用了干预保真度策略。这支持了一种观点，即不明原因或未解决的慢性咳嗽患者报告中的一些差异可能是由于缺乏干预保真度。通过遵循本文中的建议，研究人员可能能够更好地纳入解决干预保真度的策略，从而加强其结果的有效性和可推广性，为制定可靠的指南提供依据。
