Balancing Fidelity and Adaptation in a Multi-Site Exercise Intervention for Adults With Multiple Sclerosis

Abstract

<h3>Research Objectives</h3> We utilized a qualitative research design to seek information on adaptations to a multi-site, evidence-based, individualized exercise program for adults with multiple sclerosis (MS). <h3>Design</h3> Behavioral coaches completed open-ended survey questions focused on their experiences implementing the exercise program. The data were subjected to deductive, thematic analysis to identify, analyze, and interpret their opinions and evaluations. <h3>Setting</h3> The STEP for MS study is being conducted in seven clinical and academic facilities across the United States. <h3>Participants</h3> Behavioral coaches (n=7) implementing the exercise program across six study sites. <h3>Interventions</h3> STEP for MS is an ongoing study comparing the effectiveness of a multi-site, 16-week evidence-based, tailored exercise program delivered in a facility-based setting versus a home-based telerehabilitation setting in 400 adults with MS who have walking dysfunction and mobility disability. To ensure treatment fidelity across sites, a fidelity measurement plan was developed prior to program implementation. <h3>Main Outcome Measures</h3> Program implementation and context were explored, including adherence to the fidelity measurement plan, program delivery adaptations, reasons for adaptation, and coaching experience. <h3>Results</h3> The 1st theme, ensure participant comprehension, covered strategies to monitor and tailor participants' experiences in the exercise program. The 2nd theme, minimize drift in coaching skills, involved a priori strategies employed to ensure intervention fidelity. The 3rd theme, ensure program fit, incorporated exercise program adaptations into two subthemes: modify exercise equipment and adapt program delivery. These subthemes included modifications to exercise equipment for participants with higher mobility disability and adaptations to intervention delivery, respectively. Common reasons for adaptations included increasing program engagement and ensuring accurate data collection. <h3>Conclusions</h3> The results of this qualitative inquiry support the notion that adaptations are natural in a multi-site, evidence-based exercise intervention and can be made without sacrificing fidelity. <h3>Author(s) Disclosures</h3> The authors declare that there is no conflict of interest.