Development of a Feasible Implementation Fidelity Protocol Within a Complex Physical Therapy-Led Self-Management...

Area of Science:

• Physical Therapy
• Health Services Research
• Implementation Science

Background:

• Implementation fidelity is often overlooked in physical therapy research.
• Lack of established protocols hinders consistent intervention delivery and evaluation.
• This gap impacts the reliability and generalizability of physical therapy findings.

Purpose of the Study:

• To develop a feasible implementation fidelity protocol for a physical therapy-led self-management intervention.
• The target population includes individuals with chronic low back pain or osteoarthritis.
• The goal is to improve the systematic assessment of intervention delivery.

Main Methods:

• A two-phase mixed-methods design was employed.
• Phase 1: Qualitative interviews with stakeholders to inform protocol development.
• Phase 2: Testing feasibility of self-report checklists, direct observations, and audio-recorded observations for fidelity assessment, followed by stakeholder feedback.

Main Results:

• Stakeholder interviews confirmed the acceptability of proposed fidelity strategies.
• Independently rated audio recordings and provider self-report checklists proved more feasible than direct observations.
• High agreement (79.8%-92.8%) was observed across all fidelity assessment methods.

Conclusions:

• A feasible implementation fidelity protocol was successfully developed through stakeholder engagement.
• The study offers practical recommendations for researchers aiming to improve implementation fidelity in physical therapy.
• This work supports more rigorous evaluation of physical therapy interventions.