Evaluation of the Content Validity of an Activity-based Therapy Tracking Tool Using Cognitive Debriefing Interviews

Research Objectives: To evaluate the content validity of a prototype activity-based therapy (ABT) tracking tool to be used by clinicians and people living with spinal cord injury or disease (SCI/D) who participate in ABT.

Design: A qualitative study involving cognitive debriefing interviews.

Setting: Three community-based ABT clinics in Canada. Interviews were held over web conferencing.

Participants: A volunteer sample of nine clinicians (1 physical therapist, 7 kinesiologists, 1 exercise physiologist; 2 men, 7 women; mean age 27.8 ±3.9 years) and five persons with SCI/D (5 traumatic tetraplegia; 2 complete, 3 incomplete; 2 men, 3 women; mean age 32.4 ±7.8 years) were recruited through a poster campaign at three community-based ABT clinics in Canada. To be eligible, clinicians and individuals with traumatic or non-traumatic SCI/D (more than 6 months) had to participate in ABT at least once a week for 2 months.

Interventions: Not applicable.

Main Outcome Measures: Participants used a paper-based ABT tracking tool over three ABT sessions, and then completed an individual, semi-structured interview that used cognitive debriefing. The interview guide followed recommendations by Brod and colleagues for determining content validity by probing the appropriateness, comprehensiveness and comprehensibility of the tool. Participants were also probed on how the tool was used and perceived barriers and facilitators of tool use and implementation into practice. A deductive followed by an inductive content analysis was used.

Results: The ABT tracking tool demonstrated content validity. Three themes were identified. (1) Content validity of the ABT tracking tool. The tool was comprehensive and appropriate for all levels and severities of injury. Recommendations, such as adding a comment section and additional parameters to each activity were provided to improve the tool. (2) Facilitators of tool use, dissemination and implementation. Participants perceived using the tool during rest breaks to maximize therapy time or immediately after the session to avoid recall issues. Education and training on use of the tool in an app form would support implementation. Social media and community clinics could aid in dissemination. (3) Barriers of tool use, dissemination and implementation. Anticipated barriers included the paper format, language barrier for non-native English speakers, learning curve, added workload and adapting a new documentation system.

Conclusions: A validated ABT tracking tool may provide a convenient and standardized approach to document the details of ABT sessions within a community-based setting. Addressing anticipated barriers, such as creating an app and developing learning resources to support its use, are important next steps.

Author(s) Disclosures: Funded by Praxis Spinal Cord Institute.