Using Treatment Fidelity Measures to Understand Walking Recovery: A Secondary Analysis From the Community Ambulation...

Area of Science:

• Rehabilitation Science
• Geriatric Medicine
• Physical Therapy

Background:

• Physical therapist intervention studies may appear ineffective if not delivered as intended.
• Measuring treatment fidelity (TF) is essential to ensure interventions are implemented correctly.
• This study focuses on a home-based intervention for hip fracture patients.

Purpose of the Study:

• To describe the treatment fidelity (TF) of a home-based intervention.
• To identify factors associated with TF in hip fracture patients.
• To examine the relationship between TF components and changes in 6-minute walk distance (∆6MWD).

Main Methods:

• Secondary analysis of community-dwelling hip fracture participants in the Push intervention (16 weeks of lower extremity training).
• TF defined by delivery (attendance, duration) and receipt (progression, heart rate reserve, exercise position).
• Statistical analyses included descriptive statistics, linear, and logistic regressions.

Main Results:

• High attendance (≥75%) and exercise duration (≥20 min) were observed in most participants.
• Key TF components like training load progression and exercising on the floor were associated with ∆6MWD.
• Exercising on the floor showed the strongest association, with a 62m greater improvement in 6MWD.

Conclusions:

• Treatment fidelity measures should encompass more than just attendance.
• Program attendance, training load progression, endurance duration, and exercising on the floor are significantly related to improved 6MWD post-hip fracture.
• Exercising on the floor demonstrated the most significant association with functional improvement.