Document Type

Journal Article

Publication Title



Taylor & Francis Group


School of Medical and Health Sciences




This is an Accepted Manuscript of an article published by Taylor & Francis as: Brogan, E., Ciccone, N., & Godecke, E. (2019). Treatment fidelity in aphasia randomised controlled trials. Aphasiology, 33(7), 759-779. Available online here


Background: Treatment fidelity is at the heart of evidence-based practice and treatment fidelity processes help to determine the ‘active ingredients’ of a treatment. Hinckley and Douglas in 2013 reviewed treatment fidelity processes in published aphasia trials and found 14% of aphasia treatment studies reported treatment fidelity. This led the authors to call for journals to make treatment fidelity reporting mandatory.

Aims: To review the implementation and reporting of treatment fidelity processes in recent aphasia RCTs to update on practices since 2012.

Methods and Procedures: Aphasia RCTs published between 2012 and 2017 were sourced from online databases speechBITE, MEDLINE, and CINAHL provided they were: a) an investigation of an impairment-based treatment for post-stroke aphasia; b) not a review, protocol, feasibility, or replication study c) not a surgical or pharmacological intervention and d) published in English. Articles meeting the criteria were rated using Bellg’s treatment fidelity areas with the Template for Intervention Description and Replication (TIDieR) checklist elements.

Outcomes and Results: This search retrieved 110 articles and 42 met the above criteria. Nine (21%) articles explicitly reported on treatment fidelity processes. One article (2%) contained every element of the recommended treatment fidelity areas. Totally, 37 (88%) articles addressed the study design aspect of treatment fidelity by investigating therapy dosage. The least-addressed aspect of treatment fidelity was ensuring participants used the skills gained in treatment in appropriate life settings, with two (2%) articles including this.

Conclusions: The current review identified 21% of articles explicitly reporting treatment fidelity processes. This paper provides updated review evidence from recent RCTs and echoes recommendations for greater incorporation of treatment fidelity in research protocols and resulting publications.