Intervention fidelity: developing an experience-based model for rehabilitation research.

Abstract

Intervention fidelity is concerned with the extent to which interventions are implemented as intended. Consideration of fidelity is essential if the conclusions of effectiveness studies are to be credible, but little attention has been given to it in the rehabilitation literature. We describe our experiences addressing fidelity in the development of a rehabilitation clinical trial, and consider how an existing model of fidelity may be employed in rehabilitation research. We used a model and methods drawn from the psychology literature to investigate how fidelity might be maximised during the planning and development of a stroke rehabilitation trial. We considered fidelity in intervention design, provider training, and the behaviour of providers and participants. We also evaluated methods of assessing fidelity during a trial. We identified strategies to help address fidelity in our trial protocol, along with their potential strengths and limitations. We incorporated these strategies into a model of fidelity that is appropriate to the concepts and language of rehabilitation. A range of strategies are appropriate to help maximise and measure fidelity in rehabilitation research. Based on our experiences, we propose a model of fidelity and provide recommendations to inform the growing literature of fidelity in this discipline.