Adapting Lifestyle Redesign<sup>®</sup>: Navigating Fidelity and Contextual Fit Across Four Case Examples.

Abstract

<h4>Background</h4>Lifestyle Redesign^® occupational therapy (LR-OT) originated in the Well Elderly studies as a preventive intervention for older adults, demonstrating positive health and cost outcomes. Although LR-OT later expanded to chronic condition management and inspired numerous programme adaptations for different contexts and populations, systematic reporting of intervention modifications remains scarce. This gap extends beyond OT, reflecting a broader movement in implementation science.<h4>Purpose</h4>This study applies the Framework for Reporting Adaptations and Modifications-Expanded (FRAME) to systematically document adaptations across four LR-OT programmes. Additionally, we examine fidelity-consistency by mapping programme components to the Well Elderly programme and core LR-OT elements.<h4>Methods</h4>Four teams implementing adapted programmes-diabetic foot ulcer self-management, primary care chronic condition management, <i>Remodeler sa Vie</i> for French-Canadian older adults, and LR weight management-participated in a structured mapping exercise to align programmes with FRAME and LR-OT principle components.<h4>Results</h4>Adaptation approaches varied from highly structured to loosely standardized methods. Despite numerous modifications, all programmes strongly aligned with LR-OT's core characteristics and domains.<h4>Conclusion</h4>This study highlights LR-OT's adaptability across diverse contexts while maintaining fidelity to its foundational framework. Findings contribute to implementation research, providing a model for systematically documenting and characterizing adaptations made to client-centred, evidence-based OT programmes.