Treatment fidelity is a measure of the reliability of the administration of an intervention in a treatment study. It is an important aspect of the validity of a research study, and it has implications for the ultimate implementation of evidence-supported interventions in typical clinical settings.


Aphasia treatment studies published in the last 10 years in 3 journals were reviewed using coding techniques that were adapted from Gresham, Gansle, Noell, Cohen, and Rosenblum (1993). The following items were noted: identifying information, study design, description of both the dependent and independent variables, and whether a measure of treatment fidelity was explicitly included.


Of the aphasia treatment studies published in the last 10 years, 14% explicitly reported treatment fidelity. Most studies reporting treatment fidelity used checking of videotaped sessions by independent raters. Of the reviewed studies, 45% provided sufficient treatment description to support replication.


Treatment fidelity is widely acknowledged as being critical to research validity and is a foundation for the implementation of evidence-based practices, but only a small percentage of aphasia treatment studies published in the last 10 years explicitly reported treatment fidelity. Recommendations for research practices include increased attention to matters of treatment fidelity in the peer review process and explicit incorporation of 3 levels of treatment fidelity in treatment research.

Supplemental Material



  • American Speech-Language-Hearing Associationn.d.). Compendium of EBP guidelines and systematic reviewsRetrieved from http://www.asha.org/members/ebp/compendium
  • Bhar, S. S., & Beck, A. T. (2009). Treatment integrity of studies that compare short-term psychodynamic psychotherapy with cognitive-behavior therapy.Clinical Psychology: Science and Practice, 16, 370–378.
  • Burgio, L., Corcoran, M., Lichstein, K. L., Nichols, L., Czaja, S., Gallagher-Thompson, D., & Schulz, R. (2001). Judging outcomes in psychosocial interventions for dementia caregivers: The problem of treatment implementation.The Gerontologist, 41((4)) 481–489.
  • Cherney, L. R., Patterson, J. P., Raymer, A., & Frymark, T.Schooling, T2008). Evidence-based systematic review: Effects of intensity of treatment and constraint-induced language therapy for individuals with stroke-induced aphasia.Journal of Speech, Language, and Hearing Research, 51, 1282–1299.
  • Des Jarlais, D. C., Lyles, C., & Crepaz, N.the TREND Group2004). Improving the reporting quality of nonrandomized evaluations of behavioral and public health interventions: The TREND statement.American Journal of Public Health, 94, 361–366.
  • Dobson, D., & Cook, T. J. (1980). Avoiding Type III error in program evaluation: Results from a field experiment.Evaluation and Program Planning, 3, 269–276.
  • Fixsen, D. L., Naoom, S. F., Blasé, K. A., Friedman, R. M., & Wallace, F. (2005). Implementation research: A synthesis of the literature (FMHI Publication #231). Tampa, FL: University of South Florida, Louis de la Parte Florida Mental Health Institute, The National Implementation Research Network.
  • Frances, A., Sweeney, J., & Clarkin, J. (1985). Do psychotherapies have specific effects?.American Journal of Psychotherapy, 39, 159–174.
  • Gearing, R. E., El-Bassel, N., Ghesquiere, A., Baldwin, S., Gillies, J., & Ngeow, E. (2011). Major ingredients of fidelity: A review and scientific guide to improving quality of intervention research implementation.Clinical Psychology Review, 31((1)) 79–88.
  • Gresham, F. M., Gansle, K. A., Noell, G. H., Cohen, S., & Rosenblum, S. (1993). Treatment integrity of school-based behavioral intervention studies: 1980–1990.School Psychology Review, 22, 254–273.
  • Hickey, E., Bourgeois, M., & Olswang, L. (2004). Effects of training volunteers to converse with nursing home residents with aphasia.Aphasiology, 18(5–7) 625–637.
  • Hinckley, J. J. (2007). Treatment integrity and problem-solving.In A. M. Guilford, S. Graham, & J. ScheuerleThe speech-language pathologist: From novice to expert (pp. 64–75). Upper Saddle River, NJ: Pearson.
  • Kadaravek, J. N., & Justice, L. M. (2010). Fidelity: An essential component of evidence-based practice in speech-language pathology.American Journal of Speech-Language Pathology, 19, 369–379.
  • Kazdin, A. E. (1986). Comparative outcome studies of psychotherapy: Methodological issues and strategies.Journal of Consulting and Clinical Psychology, 54, 95–105.
  • Lichstein, K. L., Riedel, B. W., & Grieve, R. (1994). Fair tests of clinical trials: A treatment implementation model.Advances in Behaviour Research and Therapy, 16, 1–29.
  • Linnan, L., & Steckler, A. (2002). Process evaluation for public health interventions and research: An overview.In L. Linnan, & A. StecklerProcess evaluation for public health interventions and research (pp. 1–23). San Francisco, CA: Jossey-Bass.
  • McEvoy, M. A., Shores, R. E., Wehby, J. H., Johnson, S. M., & Fox, J. J. (1990). Special education teachers' implementation of procedures to promote social interaction: Reported treatment fidelity among children in integrated settings.Education and Training in Mental Retardation, 25, 267–276.
  • Melton, A., & Bourgeois, M. (2005). Training compensatory memory strategies via the telephone for persons with TBI.Aphasiology, 19(3–5) 353–364.
  • Moncher, F. J., & Prinz, R. J. (1991). Treatment fidelity in outcome studies.Clinical Psychology Review, 11, 247–266.
  • Perepletchikova, F., Treat, T. A., & Kazdin, A. E. (2007). Treatment integrity in psychotherapy research: Analysis of the studies and examination of the associated factors.Journal of Consulting and Clinical Psychology, 75, 829–841.
  • Peterson, L., Homer, A. L., & Wonderlich, S. A. (1982). The integrity of independent variables in behavior analysis.Journal of Applied Behavior Analysis, 15, 477–492.
  • Salter, K., Teasell, R., Bhogal, S., Zettler, L., & Foley, N. (2011). Aphasia. EBRSR: Evidence-based review of stroke rehabilitationRetrieved from http://www.ebrsr.com/reviews_details.php?Aphasia-3
  • Sanetti, L. M. H., Gritter, K. L., & Dobey, L. M. (2011). Treatment integrity of school interventions with children in the school psychology literature from 1995 to 2008.School Psychology Review, 40, 72–84.
  • Schlosser, R. W. (2002). On the importance of being earnest about treatment integrity.Augmentative and Alternative Communication, 18, 36–44.
  • Schulz, K. F., Altman, D. G., & Moher, D. (2010). CONSORT 2010 statement: Updated guidelines for reporting parallel group randomized trials.Annals of Internal Medicine, 152, 1–6.
  • Smith, M. L., Glass, G. V., & Miller, T. I. (1980). The benefits of psychotherapy. Baltimore, MD: Johns Hopkins University Press.
  • Vermilyea, B. B., Barlow, D. H., & O'Brien, G. T. (1984). The importance of assessing treatment integrity: An example in the anxiety disorders.Journal of Behavioral Assessment, 6, 1–11.
  • Waller, G. (2009). Evidence-based treatment and therapist drift.Behaviour Research and Therapy, 47, 119–127.
  • Wheeler, J. J., Baggett, B. A., Fox, J., & Blevins, L. (2006). Treatment integrity: A review of intervention studies conducted with children with autism.Focus on Autism and Other Developmental Disabilities, 21, 45–54.
  • Yeaton, W. H., & Sechrest, L. (1981). Critical dimensions in the choice and maintenance of successful treatment: Strength, integrity, and effectiveness.Journal of Consulting and Clinical Psychology, 49, 156–167.

Additional Resources