Nielsen Brittni, Tse Tamara, Haslam Brendon, Carey Leeanne M
Occupational Therapy, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia.
Occupational Therapy Department, Alfred Health, Melbourne, Victoria, Australia.
Disabil Rehabil. 2023 Apr;45(7):1131-1138. doi: 10.1080/09638288.2022.2052977. Epub 2022 Mar 31.
The process of examining treatment fidelity is critical to the successful implementation of rehabilitation interventions. Videotaping is considered the 'gold standard' assessment; however, may be considered resource-intensive and intrusive for intervention providers and patients. An audit checklist is an alternative approach recommended in the literature. The purpose of this study was to develop a documentation audit checklist for assessing treatment fidelity during delivery of SENSe therapy, a complex rehabilitation intervention targeting upper limb somatosensory impairment post-stroke.
Checklist development comprised: content determination and design; checklist testing via audit of 38 therapy records from an existing data set; and exploration of rater agreement between two assessors, using a subset of 10 therapy records.
The developed audit checklist comprised 29 components core to the delivery of SENSe therapy. Six SENSe therapy records were delivered with high fidelity (>80% adherence to core components), and 32 with moderate fidelity (51-79%). Rater agreement was 80% across the subset of 10 records.
Findings highlight the importance of using a theoretically-guided approach to checklist development, with the use of rater agreement to identify areas for refinement. A documentation audit checklist was developed that can be used to evaluate treatment fidelity of complex rehabilitation interventions.IMPLICATIONS FOR REHABILITATIONDevelopment of an audit checklist that evaluates clinician documentation of therapy delivery, is feasible as one strategy to measure and enhance the treatment fidelity of complex rehabilitation interventions.The process of audit checklist development should be structured and based on conceptual frameworks, to ensure it accurately measures quality of delivery and adherence to core intervention components.Audit checklists can be used to support clinicians delivering complex rehabilitation interventions.
检查治疗保真度的过程对于康复干预措施的成功实施至关重要。录像被视为“金标准”评估方法；然而，对于干预提供者和患者而言，录像可能被认为资源消耗大且具有侵入性。文献中推荐使用审核清单作为一种替代方法。本研究的目的是开发一份文档审核清单，用于评估感觉运动疗法（SENSe疗法）实施过程中的治疗保真度，这是一种针对中风后上肢体感障碍的复杂康复干预措施。
清单开发包括：内容确定与设计；通过审核现有数据集中的38份治疗记录对清单进行测试；并使用10份治疗记录的子集探索两名评估者之间的评分者一致性。
所开发的审核清单包含29个SENSe疗法实施的核心组成部分。6份SENSe疗法记录以高保真度交付（对核心组成部分的依从性>80%），32份以中等保真度交付（51 - 79%）。在10份记录的子集中，评分者一致性为80%。
研究结果强调了采用理论指导方法进行清单开发的重要性，并利用评分者一致性来确定需要改进的领域。开发了一份文档审核清单，可用于评估复杂康复干预措施的治疗保真度。
对康复的启示
开发一份评估临床医生治疗实施记录的审核清单，作为衡量和提高复杂康复干预措施治疗保真度的一种策略是可行的。
审核清单的开发过程应结构化并基于概念框架，以确保其准确衡量实施质量和对核心干预组成部分的依从性。
审核清单可用于支持实施复杂康复干预措施的临床医生。
