Treatment fidelity in the Gait Rehabilitation in Early Rheumatoid Arthritis Trial (GREAT) feasibility study

Godfrey, Emma, Sekhon, Mandeep, Hendry, Gordon, Foster, Nadine E., Hider, Samantha, van der Leeden, Marike, Mason, Helen, McConnachie, Alex, McInnes, Iain, Patience, Aimie, Sackley, Catherine, Steultjens, Martijn, Williams, Anita, Woodburn, Jim, Amirova, Aliya and Bearne, Lindsay (2019) Treatment fidelity in the Gait Rehabilitation in Early Rheumatoid Arthritis Trial (GREAT) feasibility study. In: Interdisciplinary behavioural medicine: systems, networks & interventions 16th International Congress of Behavioural Medicine (ICBM); 07-11 Jun 2021, Held online.


Background/purpose: Many people with early rheumatoid arthritis report foot pain and walking disability. Physiotherapists and podiatrists received a two-day bespoke training in a psychologically informed gait rehabilitation intervention (2 compulsory and 4 optional sessions delivered over 3/12), incorporating motivational interviewing (MI) and behaviour change techniques (BCTs), to address this. This study assessed fidelity of delivery within a feasibility study. Methods: Four physiotherapists and two podiatrists delivered 78 sessions across three UK centres. The Motivational Interviewing Treatment Integrity (MITI) Rating Scale and a bespoke tailored treatment fidelity measures were used to assess fidelity to MI and core components plus BCTs. Two independent assessors rated audio recordings of sessions. Results: 28 (80%) participants’ data across 64 sessions were rated for core components and BCTs and 37 (50%) sessions were analysed for MI. Relational (score=4.4) and technical (score=4.2) aspects of MI were delivered with good fidelity. 6 core components and 7/17 BCTs in Session 1 were conveyed with high (over 80%) treatment fidelity. 5 core elements and 3/12 BCTs in Session 2 were provided with high fidelity. Sessions 3 and 4 reliably delivered 3/12 BCTs, while only one session 5 and 6 was delivered. Inter-rater reliability showed agreement of over 80% (range 82- 87%) was reached for all sessions. Conclusions and Implications: Clinicians delivered core components and MI with high fidelity, but not all BCTs. Treatment fidelity might be enhanced with further training or on-going support. Alternatively, the intervention could be amended to specify mandatory BCTs alongside optional ones, depending on the needs of individual participants.

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