Adapting Lifestyle Redesign^®: Navigating Fidelity and Contextual Fit Across Four Case Examples.

Area of Science:

• Implementation Science
• Occupational Therapy
• Health Services Research

Background:

• Lifestyle Redesign occupational therapy (LR-OT) originated as a preventive intervention for older adults with positive outcomes.
• LR-OT has been adapted for chronic condition management, but systematic reporting of modifications is lacking.
• This gap reflects a broader need in implementation science for standardized reporting of intervention adaptations.

Purpose of the Study:

• To systematically document adaptations in four LR-OT programs using the Framework for Reporting Adaptations and Modifications-Expanded (FRAME).
• To examine fidelity-consistency by mapping program components to the original Well Elderly program and core LR-OT elements.

Main Methods:

• Four teams implementing adapted LR-OT programs participated in a structured mapping exercise.
• Programs included diabetic foot ulcer self-management, primary care chronic condition management, Remodeler sa Vie, and LR weight management.
• Adaptations were aligned with FRAME and core LR-OT principles.

Main Results:

• Adaptation approaches ranged from highly structured to loosely standardized.
• Despite modifications, all four programs demonstrated strong alignment with LR-OT's core characteristics and domains.
• Fidelity-consistency was maintained across diverse contexts.

Conclusions:

• LR-OT demonstrates significant adaptability across various contexts while preserving its foundational framework and fidelity.
• This study offers a valuable model for systematically documenting and characterizing adaptations in client-centered, evidence-based occupational therapy programs.
• Findings contribute to implementation research by providing a framework for understanding intervention modifications.