Using Implementation Frameworks to Provide Proactive Physical Therapy for People With Parkinson Disease: Case Report

Abstract

<jats:title>Abstract</jats:title> <jats:sec> <jats:title>Background and Purpose</jats:title> <jats:p>European clinical practice guidelines recommend physical therapy for people with Parkinson disease (PD) soon after diagnosis to provide education, physical activity advice, and individualized interventions when needed. However, therapy is frequently not used until after gait and balance problems occur. The purpose of this administrative case study is to present the application of a proactive physical therapy (PAPT) approach at 1 rehabilitation center using implementation frameworks to support the (1) implementation process, (2) determinants of implementation success, and (3) implementation evaluation.</jats:p> </jats:sec> <jats:sec> <jats:title>Case Description</jats:title> <jats:p>The PAPT program targeted people with PD before the onset of significant mobility dysfunction. It was initiated in 1 outpatient neurological rehabilitation center. The program used shared decision-making to promote long-term maintenance of independent exercise. The Knowledge-to-Action Framework was used by champions to plan implementation processes. Implementation barriers were addressed using the Consolidated Framework for Implementation Research. The program was evaluated using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework with mixed methods.</jats:p> </jats:sec> <jats:sec> <jats:title>Outcomes</jats:title> <jats:p>In the program’s first year, 38 people were referred, 28 were evaluated, and 20 participated in the 6-month program evaluation. Following PAPT, the number of participants reporting regular participation in aerobic, strengthening, and flexibility exercise approximately doubled, while those engaging in balance activities increased from 1 to 8. They reported a median of 140 minutes of aerobic exercise per week. Implementation barriers included location, insurance coverage, and difficulty scheduling long-term follow-up visits. Participants reported physical and emotional benefits of the program.</jats:p> </jats:sec> <jats:sec> <jats:title>Discussion</jats:title> <jats:p>Implementation frameworks assisted with the implementation and evaluation of a PAPT delivery model that helped people with PD to increase and maintain independent exercise participation.</jats:p> </jats:sec>

Sustainment of Proactive Physical Therapy for Individuals with Early-Stage Parkinson’s Disease: A Quality Improvement Study over 4 years

“…Data sources include: [1] administrative data from the outpatient department on referrals and utilization (2016-2019), [2] retrospective electronic medical records (EMR) of rst-time PAPT users in Y1 (2016) and year 3 (Y3) (2018), [3] quality improvement interview recordings of rst-time PAPT users from Y1 and Y3 who responded to a quality improvement phone interview request, and [4] stakeholder survey results from the NHS Sustainability Model and CSAT to evaluate sustainment after completion of year four (Y4). PAPT users include those who were referred and attended the PAPT program.…”

“…The RE-AIM framework organized the initial program evaluation (7). At the end of the rst year, post-participation interviews suggested a demand for regional spread and sustainment to improve the program (4).…”

Sustainment of Proactive Physical Therapy for Individuals With Early-Stage Parkinson’s Disease: A Quality Improvement Study Over 4 Years

“…Despite these guidelines, payer datasets and patient registries reveal infrequent utilization of PT (2,3). The ProActive Physical Therapy (PAPT) program was established in 2016 to provide PT evaluations and individually-tailored recommendations for physical activity and exercise in people with early PD (4). The speci c PAPT care path consists of one to four visits approximately every six months to monitor changes and update PD-speci c exercise prescription.…”

“…The RE-AIM framework organized the initial program evaluation (7). The PAPT care path improved access to PT for individuals with early PD and demonstrated effectiveness through self-reported increases in exercise and high satisfaction levels (4). However, in a post-participation interview, barriers to participation remained.…”

“…Dynamic and adaptable implementation strategies and processes are recommended to increase the likelihood of implementation delity during the sustainment process (5,8,9). Recently, a de nition of sustainability has emerged as " [1] after a de ned period of time, [2] a program, clinical intervention, and/or implementation strategies continue to be delivered and/or [3] individual behavior change (i.e., clinician, patient) is maintained; [4] the program and individual behavior change may evolve or adapt while [5] continuing to produce bene ts for individuals/systems" (10). Several sustainability assessments, including the National Health System (NHS) Sustainability Model and Clinical Sustainability Assessment Tool (CSAT) have been presented and are recommended to be performed repeatedly, but lack research on their psychometric properties and application (11,12).…”