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Mangset M, Kitzmüller G, Evju AS, Angel S, Aadal L, Martinsen R, Bronken BA, Kvigne KJ, Bragstad LK, Hjelle EG, Sveen U, Kirkevold M. Perceived study-induced influence on the control group in a randomized controlled trial evaluating a complex intervention to promote psychosocial well-being after stroke: a process evaluation. Trials 2021; 22:850. [PMID: 34838094 PMCID: PMC8627040 DOI: 10.1186/s13063-021-05765-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 10/27/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A commonly applied control condition in trials evaluating complex interventions in rehabilitation research is "usual care." The main challenge is to ensure that the control group receives genuine usual care as delivered in everyday clinical practice. The assessment interviews and dialogues with the data collectors may influence the control group participants' reflections on their condition and adjustments. This represents a threat to the internal validity of the trial. Thus, the aim of this study was to explore the perceived study-induced influence of assessment interviews on the adjustment of the members of a control group in a randomized clinical trial. The aim of the trial was to test a dialogue-based psychosocial intervention aiming at promoting the psychosocial well-being and adjustment of stroke survivors. METHODS Fifteen participants in the control group of a multicenter stroke rehabilitation trial participated in narrative semi-structured interviews. Ricoeur's interpretation theory guided the analysis. RESULTS The perceived study-induced influence of the assessment interviews on the adjustment process of members of the control group varied considerably. The results demonstrated that the assessment interviews facilitated some participants' feelings of control and their ability to cope. Other participants' statements indicate that they relied on their existing personal capacity to cope and adjust and that the assessment interviews did not make any difference either on their coping ability or on their process of adjustment. Five themes were identified that described the perceived study-induced influence of the assessment interviews in the control group. The themes illustrated that the assessments served as a safety net, enhanced awareness and understanding, encouraged seeking support, allowed the opportunity to vent disappointment, or did not make any difference either way. CONCLUSIONS RCT assessment interviews may influence the adjustment process and represent a serious problem in measuring interventions over time in trials of complex interventions in rehabilitation research. To uphold rigor and stringency, the usual care control conditions should be thoroughly assessed and described. Informing participants only about the treatment they were allocated to receive might counteract the potential to dilute the difference between the two arms of the trial. TRIAL REGISTRATION ClinicalTrials.gov NCT02338869. Registered on October 4, 2014.
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Affiliation(s)
- Margrete Mangset
- Department of Geriatric Medicine, Oslo University Hospital, Ullevaal, P.O. Box 4956, 0424 Oslo, Nydalen Norway
| | - Gabriele Kitzmüller
- Faculty of Health Sciences, Department of Health and Care Sciences, UiT The Arctic University of Norway, P.O. Box 385, 8505 Narvik, Norway
| | - Anne S. Evju
- Faculty of Health Sciences, Department of Health and Care Sciences, UiT The Arctic University of Norway, P.O. Box 385, 8505 Narvik, Norway
| | - Sanne Angel
- Department of Public Health – Research Unit for Nursing and Healthcare, Department of Science in Nursing, Aarhus University, 8000 Aarhus, Denmark
- Faculty of Health Sciences and Social Care, Molde University College, P.O. Box 2110, NO-6402 Molde, Norway
| | - Lena Aadal
- Faculty of Health Sciences and Social Care, Molde University College, P.O. Box 2110, NO-6402 Molde, Norway
- Hammel Neurorehabilitation Centre and University Research Clinic, 8450 Hammel, Denmark
- Department of Clinical Medicine, Aarhus University, C, 8000 Aarhus, Denmark
| | - Randi Martinsen
- Inland Norway University of Applied Sciences, P.B. 400, 2418 Elverum, Norway
| | | | - Kari J. Kvigne
- Inland Norway University of Applied Sciences, P.B. 400, 2418 Elverum, Norway
- The Faculty of Nursing and Health Sciences, Nord University, P.B. 1490, 8049 Bodø, Norway
| | - Line K. Bragstad
- Department of Geriatric Medicine, Oslo University Hospital, Ullevaal, P.O. Box 4956, 0424 Oslo, Nydalen Norway
- University of Oslo, P.O. Box 1130, 0318 Oslo, Blindern Norway
- Institute of Health and Society and Research Center for Habilitation and Rehabilitation Services and Models (CHARM), University of Oslo, P.O. Box 1130, 0318 Oslo, Blindern Norway
| | - Ellen Gabrielsen Hjelle
- University of Oslo, P.O. Box 1130, 0318 Oslo, Blindern Norway
- Institute of Health and Society and Research Center for Habilitation and Rehabilitation Services and Models (CHARM), University of Oslo, P.O. Box 1130, 0318 Oslo, Blindern Norway
| | - Unni Sveen
- Department of Geriatric Medicine, Oslo University Hospital, Ullevaal, P.O. Box 4956, 0424 Oslo, Nydalen Norway
- Oslo Metropolitan University, P.O. Box 4, St. Olavs plass, 0130 Oslo, Norway
| | - Marit Kirkevold
- University of Oslo, P.O. Box 1130, 0318 Oslo, Blindern Norway
- Oslo Metropolitan University, P.O. Box 4, St. Olavs plass, 0130 Oslo, Norway
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Hjelle EG, Bragstad LK, Kirkevold M, Zucknick M, Bronken BA, Martinsen R, Kvigne KJ, Kitzmüller G, Mangset M, Thommessen B, Sveen U. Effect of a dialogue-based intervention on psychosocial well-being 6 months after stroke in Norway: A randomized controlled trial. J Rehabil Med 2019; 51:557-565. [PMID: 31411337 DOI: 10.2340/16501977-2585] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To evaluate the effect of a dialogue-based intervention on psychosocial well-being 6 months after stroke. DESIGN Multicentre, prospective, randomized controlled trial. SUBJECTS Adults (aged ≥ 18 years) who had their first or recurrent stroke within the last month, were medically stable, had sufficient cognitive functioning to participate and understood and spoke Norwegian. METHODS A total of 322 participants were randomly assigned to the intervention (n = 166) or control (n = 156) group. Participants in the intervention group received up to 8 individual sessions aimed at supporting the coping and life skills of stroke survivors in addition to usual care. The primary outcome was the proportion of participants with normal mood measured by the General Health Questionnaire-28 (GHQ-28). The secondary outcomes included health-related quality of life (Stroke and Aphasia Quality of Life Scale; SAQOL-39g), depression (Yale-Brown single-item questionnaire; Yale) and sense of coherence (SOC-13). RESULTS After controlling for the baseline values, no significant benefit was found in the intervention group over the control group (odds ratio (OR): 0.898: 95% confidence interval (95% CI): 0.54-1.50, p = 0.680) 6 months post-stroke. CONCLUSION Psychosocial well-being improved during the first 6 months after stroke in both arms of the trial, but no statistically significant benefit of the dialogue-based intervention was found compared with usual care.
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Affiliation(s)
- Ellen G Hjelle
- Department of Nursing Science and Research Center for Habilitation and Rehabilitation Services and Models (CHARM), Faculty of Medicine, University of Oslo, Oslo, Norway.
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Bragstad LK, Bronken BA, Sveen U, Hjelle EG, Kitzmüller G, Martinsen R, Kvigne KJ, Mangset M, Kirkevold M. Implementation fidelity in a complex intervention promoting psychosocial well-being following stroke: an explanatory sequential mixed methods study. BMC Med Res Methodol 2019; 19:59. [PMID: 30876403 PMCID: PMC6419826 DOI: 10.1186/s12874-019-0694-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 02/25/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Evaluation of complex interventions should include a process evaluation to give evaluators, researchers, and policy makers greater confidence in the outcomes reported from RCTs. Implementation fidelity can be part of a process evaluation and refers to the degree to which an intervention is delivered according to protocol. The aim of this implementation fidelity study was to evaluate to what extent a dialogue-based psychosocial intervention was delivered according to protocol. A modified conceptual framework for implementation fidelity was used to guide the analysis. METHODS This study has an explanatory, sequential two-phase mixed methods design. Quantitative process data were collected longitudinally along with data collection in the RCT. Qualitative process data were collected after the last data collection point of the RCT. Descriptive statistical analyses were conducted to describe the sample, the intervention trajectories, and the adherence measures. A scoring system to clarify quantitative measurement of the levels of implementation was constructed. The qualitative data sources were analyzed separately with a theory-driven content analysis using categories of adherence and potential moderating factors identified in the conceptual framework of implementation fidelity. The quantitative adherence results were extended with the results from the qualitative analysis to assess which potential moderators may have influenced implementation fidelity and in what way. RESULTS The results show that the core components of the intervention were delivered although the intervention trajectories were individualized. Based on the composite score of adherence, results show that 80.1% of the interventions in the RCT were implemented with high fidelity. Although it is challenging to assess the importance of each of the moderating factors in relation to the other factors and to their influence on the adherence measures, participant responsiveness, comprehensiveness of policy description, context, and recruitment appeared to be the most prominent moderating factors of implementation fidelity in this study. CONCLUSIONS This evaluation of implementation fidelity and the discussion of what constitutes high fidelity implementation of this intervention are crucial in understanding the factors influencing the trial outcome. The study also highlights important methodological considerations for researchers planning process evaluations and studies of implementation fidelity. TRIAL REGISTRATION ClinicalTrials.gov , NCT02338869; registered 10/04/2014.
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Affiliation(s)
- Line Kildal Bragstad
- Department of Geriatric Medicine, Oslo University Hospital, Ullevål, P. O Box 4956 Nydalen, 0424, Oslo, Norway. .,Institute of Health and Society and Research Center for Habilitation and Rehabilitation Services and Models (CHARM), University of Oslo, P.O. Box 1130 Blindern, 0318, Oslo, Norway.
| | - Berit Arnesveen Bronken
- Faculty of Social and Health Sciences, Department of Health and Nursing Sciences, Inland Norway University of Applied Sciences, P.O. Box 400, 2418, Elverum, Norway
| | - Unni Sveen
- Faculty of Health Sciences, Oslo Metropolitan University, P.O. Box 4 St. Olavs Plass, 0130, Oslo, Norway.,Department of Physical Medicine and Rehabilitation and Department of Geriatric Medicine, Oslo University Hospital, P.O. Box 4956 Nydalen, 0424, Oslo, Norway
| | - Ellen Gabrielsen Hjelle
- Institute of Health and Society and Research Center for Habilitation and Rehabilitation Services and Models (CHARM), University of Oslo, P.O. Box 1130 Blindern, 0318, Oslo, Norway
| | - Gabriele Kitzmüller
- Faculty of Health Sciences, Department of Health and Care Sciences, UIT, the Arctic University of Norway, P.O. Box 385, 8505, Narvik, Norway
| | - Randi Martinsen
- Faculty of Social and Health Sciences, Department of Health and Nursing Sciences, Inland Norway University of Applied Sciences, P.O. Box 400, 2418, Elverum, Norway
| | - Kari J Kvigne
- Faculty of Social and Health Sciences, Department of Health and Nursing Sciences, Inland Norway University of Applied Sciences, P.O. Box 400, 2418, Elverum, Norway
| | - Margrete Mangset
- Department of Geriatric Medicine, Oslo University Hospital, Ullevål, P. O Box 4956 Nydalen, 0424, Oslo, Norway
| | - Marit Kirkevold
- Institute of Health and Society and Research Center for Habilitation and Rehabilitation Services and Models (CHARM), University of Oslo, P.O. Box 1130 Blindern, 0318, Oslo, Norway
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