BACKGROUND: Fidelity in rehabilitation refers to faithfulness of an intervention to underlying therapeutic principles and clinical guidelines. Lack of intervention fidelity measures is a long-standing, critically important problem in rehabilitation research and practice. Fidelity measures are necessary for conclusions to be confidently drawn about the uniformity and efficacy of the intervention in research trials. Clinically, high fidelity ensures stakeholders of consistency between the treatment provided in research trials and clinician-led interventions in the community. It is essential that valid and reliable rehabilitation fidelity measures be developed and utilized to ensure the consistent delivery of high-quality, evidence-based interventions in research trials and clinical practice.

PURPOSE: Conduct a systematic review to elucidate the reliability and validity of existing rehabilitation intervention fidelity measures (RIFMs).

DESIGN: A systematic search of six databases was conducted. Medical subject headings (MeSH) terms and text terms were fidelity, intervention, rehabilitation, occupational therapy, and physical therapy. The a priori inclusion criteria required that (1) articles be published in a peer-reviewed journal in English, (2) articles describe the development of a RIFM or evaluate the psychometrics of an existing RIFM, and (3) the RIFM be observational in nature.

Articles were excluded if they (1) described an evaluative assessment of intervention outcome measures or baseline status, (2) described fidelity assessment outside the field of rehabilitation, or (3) described a theoretical model for approaching intervention fidelity.

Eligible assessments were evaluated as follows: (1) Names of eligible RIFMs were extracted, and additional instrument specific searches of the literature were conducted; (2) psychometric data for all eligible RIFMs were extracted; and (3) reviewers compared findings and established consensus.

ANALYSIS: Data were extracted using the CanChild Outcome Measures Rating Form and summarized for all variables descriptively. Quality ratings for validity, reliability, and clinical utility were based on the criteria in the CanChild Outcome Measures Rating Form.

RESULTS: The search strategy yielded 24 articles for 6 RIFMs that met inclusion criteria for this review: (1) Tool for Measuring Fidelity to Assertive Communication Treatment, (2) Ayres Sensory Integration Fidelity Measure, (3) Motivational Interviewing Treatment Integrity Scale, (4) Pediatric Rehabilitation Observational Fidelity Measure, (5) Diversified Placement Approach Fidelity Scale, and (6) Taxonomy of Behavior Change Techniques for Smoking Cessation.

DISCUSSION: Most instruments reported internal consistency and rater reliability estimates in the adequate to excellent range. Construct validity was evaluated using the known groups method, hypothesis testing, and factor analytical approaches. Clinical utility of the RIFMs was highly variable.

IMPACT STATEMENT: Additional research is recommended to validate existing RIFMs and to develop novel RIFMs for other areas of occupational therapy treatment. Clinicians and researchers must place greater emphasis on the development and implementation of RIFMs to ensure uniformity in intervention delivery and high-quality, evidence-based care.

FUNDING SOURCE: 1R01HD074574-01, Multi-Site RCT of 3 Neurorehabilitation Therapies for Infants with Asymmetrical CP, and 5R01HD068345-03, Multi-Site RCT of Pediatric Constraint-Induced Movement Therapy