Applying / Adapting the Rehabilitation Treatment Specification System for Documenting Standard Clinical Care

Research Objectives

To describe methods for applying/adapting the Rehabilitation Treatment Specification System (RTSS) to specifying standard care clinical practice, as well as the challenges encountered and solutions.

Design

Iterative qualitative interviews. One coder produced RTSS specifications per videotaped voice and/or upper airway treatment session. This specification was sent to the treating speech-language pathologist (SLP) and two RTSS experts for feedback and iterative revisions until consensus was reached.

Setting

Outpatient voice centers in the United States: Massachusetts General Hospital, Emory University, New York University, University of Connecticut, and University of Wisconsin-Madison.

Participants

Five clinicians and two RTSS and voice rehabilitation experts watched a single videotaped treatment session for fifty-nine patients diagnosed with a voice and/or upper airway disorder(s). One non-SLP and RTSS expert read through the specifications.

Interventions

Standard care treatment for voice and/or upper airway disorder(s).

Main Outcome Measures

Consensus for each specification, where the clinicians reported no critical treatment aspects were missing, redundant, or incorrect and the RTSS experts reported correct use of the RTSS framework.

Results

Decision rules were developed to help specify Representations and Skills and Habits treatment components. Organ Functions treatment components were rarely identified in vocal rehabilitation. Two Representations specification difficulties were commonly encountered: (1) When did volition ingredients have their own targets versus added ingredients to a Skills and Habits target? and (2) When was information considered a volition versus feedback ingredient? For Skills and Habits, the most common difficulty was deciding which modified patient functions were mechanisms of action, the singular target, and/or aims of treatment. Also, commonly encountered, theory-driven variations in volition, feedback, and practice ingredients will be discussed.

Conclusions

An iterative process identified and addressed commonly encountered difficulties with creating RTSS specifications for standard care clinical practice. Broader implications for implementation into clinical practice will be discussed as well as next steps needed to further bridge the gap between theory and practice.

Author(s) Disclosures

No conflicts of interest to report.