Intervention fidelity and adaptation in a multi-site exercise training intervention for adults with multiple...

Area of Science:

• Exercise Science
• Rehabilitation Medicine
• Clinical Trials

Background:

• Translating evidence-based exercise interventions into clinical practice requires balancing treatment fidelity and adaptability.
• The Supervised versus Telerehabilitation Exercise Programs for Multiple Sclerosis (STEP for MS) Trial investigated these aspects in delivering exercise programs.
• This paper examines fidelity in study design, provider training, and intervention delivery, alongside challenges and adaptations faced by behavioral coaches.

Purpose of the Study:

• To summarize fidelity of study design, provider training, and intervention delivery strategies from best practice recommendations.
• To report challenges and adaptations experienced by behavioral coaches in the STEP for MS Trial.
• To assess if adaptations compromised the essential elements of the exercise program model.

Main Methods:

• Reflexive thematic analysis was employed to analyze qualitative data.
• Data sources included open-ended survey questions from behavioral coaches, transcripts from team meetings, and audit notes from one-on-one sessions.

Main Results:

• Adaptations to the STEP for MS Trial included virtual sessions, modified equipment, and adjusted delivery methods.
• Behavioral coaches enhanced program fit, engagement, and participant safety through these adaptations.
• Crucially, these modifications did not compromise the core content or fidelity of the intervention.

Conclusions:

• Implementing best practice recommendations enables effective adaptation of exercise interventions.
• Challenges in study design and intervention delivery can be overcome through strategic adaptations.
• Real-world obstacles can be navigated without compromising the fidelity of evidence-based exercise programs.