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

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.

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.

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.

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.IMPLICATIONS FOR REHABILITATIONDevelopment of an audit checklist that evaluates clinician documentation of therapy delivery, is feasible as one strategy to measure and enhance the treatment fidelity of complex rehabilitation interventions.The process of audit checklist development should be structured and based on conceptual frameworks, to ensure it accurately measures quality of delivery and adherence to core intervention components.Audit checklists can be used to support clinicians delivering complex rehabilitation interventions.