The fidelity of treatment delivery can be assessed in treatment outcome studies: a successful illustration from behavioral medicine

• Published in: Journal of clinical epidemiology Vol. 62; no. 1; pp. 81 - 90
• Main Authors: Leeuw, M, Goossens, M.E.J.B, de Vet, H.C.W, Vlaeyen, J.W.S
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01-01-2009; Elsevier; Elsevier Limited
• Subjects: Biological and medical sciences; Chronic Disease; Delivery of health care; Delivery of Health Care - standards; Delivery. Postpartum. Lactation; Diseases of the osteoarticular system; Diseases of the spine; Epidemiology; Guideline adherence; Gynecology. Andrology. Obstetrics; Humans; Internal Medicine; Low back pain; Low Back Pain - psychology; Low Back Pain - therapy; Medical sciences; Miscellaneous; Outcome Assessment (Health Care) - methods; Pain; Process assessment (health care); Public health. Hygiene; Public health. Hygiene-occupational medicine; Reproducibility of Results; Therapists; Therapy; Treatment contamination; Treatment fidelity; Treatment Outcome; Process assessment (health care); Guideline adherence; Treatment outcome; Delivery of health care; Treatment fidelity; Treatment contamination; Human; Prognosis; Lumbar spine; Low back pain; Diseases of the osteoarticular system; Spine disease; Recommendation; Care; Medicine; Pain; Treatment; Rachialgia; Treatment compliance; Behavior; Public health
• ISSN: 0895-4356; 1878-5921
• DOI: 10.1016/j.jclinepi.2008.03.008

Abstract Objectives Treatment outcome studies ought to assess the fidelity of their treatments, including treatment delivery, but practical guidelines and examples for this are lacking. Based on general recommendations in available literature, this study proposes and illustrates the design and application of a Method of Assessing Treatment Delivery (MATD) in a behavioral medicine trial comparing two treatments for chronic low back pain. Study Design and Setting In designing MATD, two experts identified several feasible treatment elements. Agreement between the experts in classifying these elements into five categories (essential and unique, essential but not unique, unique but not essential, compatible, prohibited) was assessed. In applying MATD, treatment recordings were evaluated by two independent raters, who coded the (non)-occurrence of MATD elements and who categorized each session as belonging to one of the two treatments. Results MATDs content validity was supported by adequate agreement between the experts' classifications of the treatment elements. MATDs interrater reliability was good. Conclusion Comprehensive illustrations of designing and applying MATD may encourage the verification of treatment delivery as a partial reflection of treatment fidelity in forthcoming treatment outcome studies.