Development of an audit checklist to evaluate treatment fidelity of a complex rehabilitation intervention

Purpose The process of examining treatment fidelity is critical to the successful implementation of rehabilitation interventions. Videotaping is considered the 'gold standard' assessment; however, may be considered resource-intensive and intrusive for intervention providers and patients. An audit checklist is an alternative approach recommended in the literature. The purpose of this study was to develop a documentation audit checklist for assessing treatment fidelity during delivery of SENSe therapy, a complex rehabilitation intervention targeting upper limb somatosensory impairment post-stroke. Methods Checklist development comprised: content determination and design; checklist testing via audit of 38 therapy records from an existing data set; and exploration of rater agreement between two assessors, using a subset of 10 therapy records. Results The developed audit checklist comprised 29 components core to the delivery of SENSe therapy. Six SENSe therapy records were delivered with high fidelity (>80% adherence to core components), and 32 with moderate fidelity (51-79%). Rater agreement was 80% across the subset of 10 records. Conclusion Findings highlight the importance of using a theoretically-guided approach to checklist development, with the use of rater agreement to identify areas for refinement. A documentation audit checklist was developed that can be used to evaluate treatment fidelity of complex rehabilitation interventions.

Automated summary

The study aimed to develop a documentation audit checklist for assessing treatment fidelity of SENSe therapy. After testing and evaluating 38 therapy records, the developed checklist comprised 29 core components. The results showed that 6 records had high fidelity, while 32 had moderate fidelity. The inter-rater agreement was 80%.