Treatment fidelity in Model of Human Occupation research

Abstract

Introduction: Treatment fidelity is an important consideration in occupational therapy efficacy research. It involves methodological strategies that enhance quantitative rigor and improves confidence in research outcomes. This study examines treatment fidelity in Model of Human Occupation efficacy literature because it is a widely used, occupation-focused theory with a substantial evidence base. Method: Relevant articles (n ¼ 17) were coded for treatment fidelity with the Treatment Fidelity Measure. Percentages of articles reporting treatment fidelity strategies and mean adherence to fidelity strategies were calculated. One-way analysis of variance was used to examine fidelity over time. Results: Only one study reported provider training strategies and measured nonspecific treatment effects. Overall mean adherence to treatment fidelity strategies for Model of Human Occupation research was 0.57; one study demonstrated high fidelity with a score of 0.80. Model of Human Occupation efficacy literature trends toward higher levels of treatment fidelity over time. Conclusion: Model of Human Occupation research demonstrates a moderate level of treatment fidelity overall; it has stronger treatment fidelity from 2001 to the present. As the model progresses toward more outcomes studies, Model of Human Occupation scholars should report provider training and strategies that monitor treatment delivery to improve the quality and applicability of research outcomes.

Fidelity Protocol Development for a Telehealth Type 1 Diabetes Occupation-Based Coaching Intervention

“…At the end of this phase, an initial draft of the fidelity protocol was generated reflecting all five fidelity domains as recommended by the NIH BCC. Then, the research team cross-referenced the key fidelity articles identified in the existing literature (Bowyer & Tkach, 2019; Feely et al, 2017; Gearing et al, 2011) to ensure all possible and applicable options for fidelity strategies, activities, and assessments were exhausted and included in the fidelity protocol. The draft of the fidelity protocol was reviewed by the expert panel and the interdisciplinary research team to assess for validity, comprehensiveness, and feasibility in the preservation of fidelity.…”

“…There is a robust body of literature highlighting the importance of establishing fidelity standards in scientific studies, especially when assessing intervention effectiveness in healthcare research (Borrelli, 2011; Gearing et al, 2011; Hand et al, 2018). Fidelity is the degree to which an intervention is delivered as intended across subjects, providers, and time (Bellg et al, 2004; Borrelli, 2011; Bowyer & Tkach, 2019; Gearing et al, 2011; Hand et al, 2018). The ongoing assurance and enhancement of fidelity allow for greater scientific confidence in reliability, validity, and generalizability of a study's outcomes (Bellg et al, 2004; Borrelli, 2011; Bowyer & Tkach, 2019; Gearing et al, 2011; Hand et al, 2018).…”

“…Fidelity is the degree to which an intervention is delivered as intended across subjects, providers, and time (Bellg et al, 2004; Borrelli, 2011; Bowyer & Tkach, 2019; Gearing et al, 2011; Hand et al, 2018). The ongoing assurance and enhancement of fidelity allow for greater scientific confidence in reliability, validity, and generalizability of a study's outcomes (Bellg et al, 2004; Borrelli, 2011; Bowyer & Tkach, 2019; Gearing et al, 2011; Hand et al, 2018). Although working definition, organization, and implementation significantly vary across studies, fidelity elements frequently reported in research studies include duration and dosage, treatment adherence, treatment differentiation, provider competence, and inter-rater agreement (Barton & Fettig, 2013; Bowyer & Tkach, 2019; Feely et al, 2017; Gearing et al, 2011; Hand et al, 2018; Mowbray et al, 2003; Schoenwald & Garland, 2013).…”

“…The ongoing assurance and enhancement of fidelity allow for greater scientific confidence in reliability, validity, and generalizability of a study's outcomes (Bellg et al, 2004; Borrelli, 2011; Bowyer & Tkach, 2019; Gearing et al, 2011; Hand et al, 2018). Although working definition, organization, and implementation significantly vary across studies, fidelity elements frequently reported in research studies include duration and dosage, treatment adherence, treatment differentiation, provider competence, and inter-rater agreement (Barton & Fettig, 2013; Bowyer & Tkach, 2019; Feely et al, 2017; Gearing et al, 2011; Hand et al, 2018; Mowbray et al, 2003; Schoenwald & Garland, 2013). Implementing systematic and methodological strategies to enhance fidelity in these areas can promote precise articulation, monitoring, and reporting of essential features involved in a study.…”

Treatment fidelity

“…The eight fidelity measures evaluated treatment integrity and treatment differentiation most commonly. In this issue, Bowyer and Tkach (2018) provide further introduction to treatment fidelity concepts and review Model of Human Occupation (MOHO) research for its use and reporting of the five treatment fidelity components. They measured treatment fidelity of MOHO research using the Treatment Fidelity Checklist, a tool that was developed for researchers and consumers of research to evaluate the treatment fidelity of their own and others' research (Borrelli et al, 2005).…”