Fidelity of GET and activity management: we will monitor protocol adherence and evaluate whether the two interventions are distinct and being delivered in a consistent manner across centres. Two clinicians, from centres other than that in which the session was delivered, will listen to a random sample (∼10%) of the audio-recorded sessions in a blinded fashion and rate them on a five-point Likert scale as being GET or activity management or a mixture of the two using the mandatory, prohibited and flexible elements for each intervention. We will estimate intervention fidelity as the percentage of sessions in each intervention arm which were correctly identified by the clinicians assessing recordings.
They clearly think there is a lot of flexibility in their protocols and overlap. But their measurement as to what is being tested here doesn't seem well defined in terms of an actual question and how to weight different aspects. Also no definition of how differences between the two clinicians are managed or whether they are looking at separate or the same sessions.
They also don't seem to be checking whether the therapists within a center are consistent (but I'm just picking bits at random so it could be elsewhere).