The aim of this study was to develop a fidelity tool to support the implementation of clinical practice guidelines to improve physical function for children and young people with cerebral palsy.
An action-research approach was used, with the five-step process for developing fidelity tools as outlined by Walton et al (2020) and mixed-methods evaluation embedded within this design. The five steps included: 1) Reviewing previous measures, 2) Analysing intervention components and developing a framework outlining the content of the intervention, 3) Developing fidelity checklists and coding guidelines, 4) Obtaining feedback about the content and wording of checklists and guidelines, 5) Piloting and refining checklists and guidelines. Steps 1-3 were conducted by the research team while step 4 involved obtaining feedback from 2 international experts in fidelity tools and paediatric disability. Step 5 involved piloting the tool and conducting mixed methods evaluation with clinicians and managers working in both public and private paediatric physiotherapy and occupational therapy services in Queensland, Australia. Quantitative data were collected an online questionnaire including the Theoretical Framework of Acceptability Questionnaire and were analysed descriptively. Qualitative data were collected through 4 focus groups and 1 interview and were analysed using reflexive thematic analysis. Qualitative and quantitative data were then mixed for final thematic synthesis.
Following steps 1 – 4, the tool was piloted and evaluated with 12 participants. Eleven participants took part in one of four focus groups while one participant was interviewed solo. Eight of these 12 participants completed the online questionnaire. For those who completed the questionnaire, 6 were occupational therapists and 2 were physiotherapists while their experience working with children with cerebral palsy ranged from 4 - 38 years. Six key themes were synthesised: 1) It’s a helpful tool that’s easy to use, 2) Education and training helps, 3) A self-reflection tool is more acceptable, 4) Professional identity, skills and knowledge might influence feasibility and acceptability, 5) Workplace setting might influence use and cost, and 6) Family expectations influence practice. Changes were made to the fidelity tool based on themes.
A 21-item fidelity tool representing the core components of the clinical practice guidelines was developed, including sub-sections of goal-setting, intervention and elements seen throughout therapeutic intervention. Future research should focus on the use of this tool across different practice contexts, and in different parts of the world.
The fidelity tool can be utilised by clinicians, supervisors and services to reflect on current practice and align practice with clinical guidelines to improve function in children with cerebral palsy. It is recommended that this fidelity tool be combined with additional knowledge translation strategies across contexts and settings to bring about change.
functional therapy
paediatrics
