CHEST Guidelines-Assessment-of-Intervention-Fidelity-and-Recommenda

Assessment-of-Intervention-Fidelity-and-Recommenda

Pdf Summary

The document outlines a systematic review conducted by the CHEST Expert Cough Panel to evaluate intervention fidelity in studies addressing the diagnosis and treatment of chronic cough in adults. Intervention fidelity refers to the extent to which interventions are implemented as intended by the study’s design, impacting the validity and reliability of outcomes.

<strong>Background and Methodology:</strong>
The review identifies variability in chronic cough management in prior studies, potentially due to inconsistent implementation of diagnostic and therapeutic interventions. The review evaluated studies from 1998 to 2014 across five areas of intervention fidelity: study design, provider training, treatment delivery, treatment receipt, and enactment. A total of 23 studies were included, comprising 3,636 patients: 17 prospective observational studies, two randomized controlled trials, and four retrospective studies. Data heterogeneity prevented a meta-analysis.

<strong>Findings:</strong>
- <strong>Study Design:</strong> Only 47% based their diagnostic screening on reported guidelines. Validated outcome measures were scarcely used.
- <strong>Provider Training:</strong> Almost no studies mentioned provider training or intervention manuals for consistent intervention application.
- <strong>Treatment Delivery:</strong> Most studies did not consistently adhere to guidelines, particularly for managing conditions like gastroesophageal reflux disease (GERD).
- <strong>Treatment Receipt and Enactment:</strong> There was negligible assessment of patients’ understanding or their ability to adhere to intervention recommendations in daily life.

<strong>Recommendations:</strong>
The panel provided a series of recommendations emphasizing the integration of intervention fidelity in study designs, ensuring the use of evidence-based clinical guidelines and administration manuals. They also suggested training investigators to maximize adherence to guidelines.

<strong>Conclusion:</strong>
The review concludes that insufficient intervention fidelity in studies contributes to variable chronic cough management success. Enhanced intervention fidelity could improve research validity and patient treatment outcomes, forming more reliable evidence for clinical guidelines.

Keywords

intervention fidelity

chronic cough

systematic review

CHEST Expert Cough Panel

diagnosis

treatment

study design

provider training

treatment delivery

evidence-based guidelines