Babiak Miranda C, Hula William D, Autenreith Alyssa, Nader Mary M, Hula Shannon Austermann, Swiderski Alexander, Cavanaugh Robert, Nunn Kristen, Johnson Jeffrey P, Dickey Michael Walsh
Audiology and Speech Pathology Service, VA Pittsburgh Healthcare System, PA.
Veterans Health Foundation, VA Pittsburgh Healthcare System, PA.
Am J Speech Lang Pathol. 2025 Jul 10;34(4):2081-2097. doi: 10.1044/2025_AJSLP-24-00331. Epub 2025 Jun 18.
This study evaluated treatment fidelity for an ongoing randomized controlled trial comparing two variants of semantic feature analysis (SFA) treatment for naming impairment in aphasia. In this trial, participants are being randomized to treatment conditions (many- or few-features) in which they are asked to generate either 11 or five features per SFA trial.
Treatment fidelity was addressed via study design, manualization of the treatment, provider training, and maintenance of daily treatment logs, among other approaches. Fidelity was assessed through protocol adherence checks, interrater reliability of feature counting, and analysis of treatment dosage. Protocol adherence was measured using a 20-item checklist. Interrater reliability was evaluated for feature counts on 10% of treatment sessions. Treatment dosage was analyzed to confirm differentiation between many-features and few-features groups in terms of features generated and exposed and equivalence in terms of total treatment time.
Overall protocol adherence was 99%. Interrater reliability for feature counting showed good-to-excellent agreement. Analysis of treatment dosage in terms of features per trial confirmed clear differentiation between groups, with the many-features group generating or being exposed to approximately 10-11 features per trial compared to four to five features for the few-features group. Analysis of other aspects of dosage also suggested good fidelity to the design.
This ongoing trial of SFA is being implemented with high levels of treatment fidelity. The study demonstrates the importance and feasibility of comprehensive fidelity monitoring in aphasia treatment research. Detailed fidelity procedures and outcomes support interpretation, replication, and clinical implementation of study findings.
本研究评估了一项正在进行的随机对照试验的治疗保真度，该试验比较了两种语义特征分析（SFA）治疗方法对失语症命名障碍的疗效。在该试验中，参与者被随机分配到治疗条件（多特征或少特征），要求他们在每次SFA试验中生成11个或5个特征。
通过研究设计、治疗手册化、提供者培训以及维护每日治疗日志等方法来确保治疗保真度。通过方案依从性检查、特征计数的评分者间信度以及治疗剂量分析来评估保真度。使用一份包含20个条目的清单来测量方案依从性。对10%的治疗疗程的特征计数进行评分者间信度评估。分析治疗剂量，以确认多特征组和少特征组在生成和接触的特征方面的差异，以及在总治疗时间方面的等效性。
总体方案依从率为99%。特征计数的评分者间信度显示出良好到优秀的一致性。对每次试验的特征进行治疗剂量分析，证实了两组之间的明显差异，多特征组每次试验生成或接触约10 - 11个特征，而少特征组为4 - 5个特征。对剂量其他方面的分析也表明对设计具有良好的保真度。
这项正在进行的SFA试验以高水平的治疗保真度实施。该研究证明了在失语症治疗研究中进行全面保真度监测的重要性和可行性。详细的保真度程序和结果支持对研究结果的解释、复制和临床应用。
