Treatment fidelity procedures for an aphasia intervention within a randomized controlled trial: Design, feasibility, and results

Elissa L. Conlon, Emily J. Braun, Edna M. Babbitt, Leora R. Cherney*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

16 Scopus citations


Purpose: This study reports on the treatment fidelity procedures implemented during a 5-year randomized controlled trial comparing intensive and distributed comprehensive aphasia therapy. Specifically, the results of 1 treatment, verb network strengthening treatment (VNeST), are examined. Method: Eight participants were recruited for each of 7 consecutive cohorts for a total of 56 participants. Participants completed 60 hr of aphasia therapy, including 15 hr of VNeST. Two experienced speech-language pathologists delivered the treatment. To promote treatment fidelity, the study team developed a detailed manual of procedures and fidelity checklists, completed role plays to standardize treatment administration, and video-recorded all treatment sessions for review. To assess protocol adherence during treatment delivery, trained research assistants not involved in the treatment reviewed video recordings of a subset of randomly selected VNeST treatment sessions and completed the fidelity checklists. This process was completed for 32 participants representing 2 early cohorts and 2 later cohorts, which allowed for measurement of protocol adherence over time. Percent accuracy of protocol adherence was calculated across clinicians, cohorts, and study condition (intensive vs. distributed therapy). Results: The fidelity procedures were sufficient to promote and verify a high level of adherence to the treatment protocol across clinicians, cohorts, and study condition. Conclusion: Treatment fidelity strategies and monitoring are feasible when incorporated into the study design. Treatment fidelity monitoring should be completed at regular intervals during the course of a study to ensure that high levels of protocol adherence are maintained over time and across conditions.

Original languageEnglish (US)
Pages (from-to)412-424
Number of pages13
JournalAmerican journal of speech-language pathology
Issue number1 Special Issue
StatePublished - 2020

ASJC Scopus subject areas

  • Developmental and Educational Psychology
  • Speech and Hearing
  • Otorhinolaryngology
  • Linguistics and Language


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