Hayden Deborah, Namasivayam Aravind Kumar, Ward Roslyn
The PROMPT Institute, Santa Fe, NM, USA.
Department of Speech-Language Pathology, University of Toronto, Canada.
Speech Lang Hear. 2015 Mar;18(1):30-38. doi: 10.1179/2050572814Y.0000000046.
To demonstrate the application of the constructs of treatment fidelity for research and clinical practice for motor speech disorders, using the Prompts for Restructuring Oral Muscular Phonetic Targets (PROMPT) Fidelity Measure (PFM). Treatment fidelity refers to a set of procedures used to monitor and improve the validity and reliability of behavioral intervention. While the concept of treatment fidelity has been emphasized in medical and allied health sciences, documentation of procedures for the systematic evaluation of treatment fidelity in Speech-Language Pathology is sparse.
The development and iterative process to improve the PFM, is discussed. Further, the PFM is evaluated against recommended measurement strategies documented in the literature. This includes evaluating the appropriateness of goals and objectives; and the training of speech-language pathologists, using direct and indirect procedures. Three expert raters scored the PFM to examine inter-rater reliability.
Three raters, blinded to each other's scores, completed fidelity ratings on three separate occasions. Inter-rater reliability, using Krippendorff's Alpha, was >80% for the PFM on the final scoring occasion. This indicates strong inter-rater reliability.
The development of fidelity measures for the training of service providers and treatment delivery is important in specialized treatment approaches where certain 'active ingredients' (e.g. specific treatment targets and therapeutic techniques) must be present in order for treatment to be effective. The PFM reflects evidence-based practice by integrating treatment delivery and clinical skill as a single quantifiable metric. PFM enables researchers and clinicians to objectively measure treatment outcomes within the PROMPT approach.
运用口腔肌肉语音目标重构提示法（PROMPT）保真度测量工具（PFM），展示治疗保真度概念在运动言语障碍研究及临床实践中的应用。治疗保真度指的是用于监测和提高行为干预有效性与可靠性的一系列程序。尽管治疗保真度概念在医学及相关健康科学领域已得到强调，但言语病理学中系统评估治疗保真度的程序文献却很稀少。
讨论了PFM的开发及迭代过程。此外，根据文献中记录的推荐测量策略对PFM进行评估。这包括评估目标的适宜性；以及使用直接和间接程序对言语病理学家进行培训。三位专家评分者对PFM进行评分，以检验评分者间的信度。
三位评分者彼此不知道对方的分数，在三个不同场合完成了保真度评分。在最后一次评分时，使用克里彭多夫α系数，PFM的评分者间信度>80%。这表明评分者间信度很高。
在某些“活性成分”（如特定治疗目标和治疗技术）必须存在才能使治疗有效的专业治疗方法中，为服务提供者培训和治疗实施开发保真度测量工具很重要。PFM通过将治疗实施和临床技能整合为一个可量化指标，反映了循证实践。PFM使研究人员和临床医生能够在PROMPT方法中客观地测量治疗结果。
