Abstract
Background
Implementation fidelity is the extent to which an intervention is delivered as intended by intervention developers, and is extremely important in increasing confidence that changes in study outcomes are due to the effect of the intervention itself and not due to variability in implementation. Growing demands on healthcare services mean that multiple condition interventions involving highly prevalent musculoskeletal pain conditions such as chronic low back pain (CLBP) and/or osteoarthritis (OA) are of increasing clinical interest. This is the first in-depth review of implementation fidelity within self-management interventions for any musculoskeletal pain condition.
Methods
Structured self-management interventions delivered by health-care professionals (including at least one physiotherapist) in a group format involving adults with OA of the lumbar spine, hip or knee and/or CLBP were eligible for inclusion. The National Institutes of Health Behaviour Change Consortium Treatment Fidelity checklist was used by two independent reviewers to assess fidelity.
Results
In total, 22 studies were found. Fidelity was found to be very low within the included studies with only one study achieving >80% on the framework. The domain of Training of Providers achieved the lowest fidelity rating (10%) across all studies.
Conclusion
Overall levels of fidelity are poor in self-management interventions for CLBP and/or OA; however it is unclear whether fidelity is poor within the trials included in this review, or just poorly reported. There is a need for the development of fidelity reporting guidelines and for the refinement of fidelity frameworks upon which to base these guidelines.
Conflicts of interest: No conflicts of interest
Sources of funding: This review was conducted as part of Health Research Award HRA_HSR/2012/24 from the Health Research Board of Ireland.
