The TIDieR-Rehab Checklist: Enhancing the Reporting Quality of Rehabilitation Interventions and Dosage Parameters Through an Extension of the Template for Intervention Description and Replication (TIDieR)

Abstract

Background: Beyond hyperacute care, rehabilitation is the primary mechanism for promoting stroke recovery. The development, evaluation, and implementation of evidence-based stroke rehabilitation requires comprehensive reporting of interventions, particularly intervention delivery methods and dosage parameters such as duration, frequency, length and difficulty. Poor descriptions of stroke rehabilitation interventions pose a significant barrier to their replication in clinical practice and analysis of dosage parameters which directly influence outcomes.

Aim: To develop the TIDieR-Rehab checklist – an extension of the original TIDieR – which critiques the reporting of rehabilitation interventions.

Methods: A modified Delphi process was used to develop the TIDieR-Rehab checklist, and was guided by an interdisciplinary steering committee. Drafts of the TIDieR-Rehab checklist and supplementary manual were distributed using an online survey to interdisciplinary rehabilitation experts (n=35). Quantitative (Likert scales) and qualitative (free-text comments) data was descriptively analysed and triangulated to inform iterative revisions of the checklist and supplementary manual until consensus was achieved.

Results: Two rounds of the modified Delphi process were needed to achieve consensus on the items within the TIDieR-Rehab checklist and supplementary manual. Consensus was demonstrated by high levels of agreement in quantitative data and qualitative feedback that consistently supported the inclusion of items and a shared desire for better reporting. Key feedback and revisions reflected current tensions in stroke rehabilitation, including differentiated understandings of key concepts and terms, and the challenge of reporting highly individualised interventions.

Conclusion: The TIDieR-Rehab checklist and supplementary manual were successfully developed through consultation with interdisciplinary rehabilitation experts. The implementation of this tool has the potential to advance stroke rehabilitation research and practice through better reporting, replication, evaluation, and optimisation of dosage parameters, and subsequently, improved outcomes for people with stroke.