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Interim Treatment Fidelity for a Randomized Controlled Comparative Effectiveness Trial of Two Variants of Semantic Feature Analysis Treatment for Aphasia

Year: 2025

Type: article

Abstract: PURPOSE: This study evaluated treatment fidelity for an ongoing randomized controlled trial comparing two variants of semantic feature analysis (SFA) treatment for naming impairment in aphasia. In this trial, participants are being randomized to treatment conditions (many- or few-features) in which they are asked to generate either 11 or five features per SFA trial. METHOD: Treatment fidelity was addressed via study design, manualization of the treatment, provider training, and maintenance of daily treatment logs, among other approaches. Fidelity was assessed through protocol adherence checks, interrater reliability of feature counting, and analysis of treatment dosage. Protocol adherence was measured using a 20-item checklist. Interrater reliability was evaluated for feature counts on 10% of treatment sessions. Treatment dosage was analyzed to confirm differentiation between many-features and few-features groups in terms of features generated and exposed and equivalence in terms of total treatment time. RESULTS: Overall protocol adherence was 99%. Interrater reliability for feature counting showed good-to-excellent agreement. Analysis of treatment dosage in terms of features per trial confirmed clear differentiation between groups, with the many-features group generating or being exposed to approximately 10-11 features per trial compared to four to five features for the few-features group. Analysis of other aspects of dosage also suggested good fidelity to the design. CONCLUSIONS: This ongoing trial of SFA is being implemented with high levels of treatment fidelity. The study demonstrates the importance and feasibility of comprehensive fidelity monitoring in aphasia treatment research. Detailed fidelity procedures and outcomes support interpretation, replication, and clinical implementation of study findings. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.29230937.

Source: American Journal of Speech-Language Pathology

DOI: 10.1044/2025_ajslp-24-00331