Measuring outdoor walking during supervised sessions in the Getting Older adults OUTdoors (GO-OUT) multi-centre study
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Date
2019-06-17
Authors
Hahn, Francine
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Abstract
Treatment fidelity is the extent to which interventions are delivered as intended. Maintaining a high degree of fidelity is important to ensure internal and external validity of the results. Because most randomized controlled trials do not determine treatment fidelity, many ineffective interventions may be disseminated as being effective. The purpose of this study was to analyze the fidelity of supervised outdoor walking sessions included in the Getting Older adults OUTdoors (GO-OUT) study. Walking sessions occurred twice weekly for ten weeks in this study. Quantitative (GPS devices, activity monitors, implementation fidelity form, and process indicators form) and qualitative tools (reflective notes, analysis of project documentation, and observation of one walking session) were used to determine fidelity of treatment delivery, provider training, and study design. Equivalence testing was used to analyze gait and physical activity parameters achieved by older adults during two walking sessions (session 1, week 3 and session 1, week 9) compared to the protocol set for those sessions. Paired t-tests were also conducted to compare participants’ achievements in week 3 and week 9. Analyzing fidelity of treatment delivery, it was observed that all the activities planned for each walking session were performed, attendance rates were high, and participants followed the progressiveness of the protocol. Even though the researchers followed many recommendations from the literature to maintain a high degree of fidelity of provider training, some aspects of the training could have been improved. Finally, in terms of fidelity of study design, the protocol tested the hypotheses of the study, standardized documents were developed to ensure the walking leaders were informed of the most important aspects of the protocol, and the theory that informed the development of the protocol was reviewed during the training of the walking leaders. In conclusion, since most randomized controlled trials do not report on fidelity, this study represents a positive contribution to the physical therapy literature. The study provides specific information about measuring fidelity during a walking intervention trial and reports on the varying levels of fidelity that were achieved.
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Keywords
fidelity, older adults, outdoor walking sessions