Physical Therapy Delivery Models for Long-Term Parkinsons Disease Management

项目概要/摘要： 帕金森氏病是一种慢性、复杂的神经系统疾病，会导致活动进行性下降 水平、行走和平衡。这些行动障碍与生活质量和死亡率下降有关。 物理治疗（PT）已被证明可以有效地治疗这些流动性问题，运动与此相关。 生活质量更好，身体活动增加。循证PT指南 帕金森病已经发展到支持所有疾病的流动性和运动参与 严重程度，但我们的初步数据表明，PT在美国（US）的使用并不一致。两 这个F32博士后奖学金的研究目标是（1）描述美国目前的PT实践， 评估其反映现有循证指南的程度，然后（2）确定 从患者和提供者的角度来看，提供循证PT的障碍和促进因素。目的 1将调查专家医生/专家和专家物理治疗师为帕金森病患者， 描述他们在疾病各阶段的PT相关转诊和实践决策。的结果 调查将与现有准则相对应，以评价是否符合循证实践。目的 2将使用焦点小组和帕金森病患者，物理治疗师， 和医生解释如何目前的做法是相似的或不同的循证实践。重点 小组和访谈问题将探讨提供循证PT的障碍和促进因素 在美国的医疗保健领域。这些研究的结果促进了合成的改进。 将证据纳入医疗保健服务，并为未来的实施或知识转化工作奠定基础 提高PT交付质量。这些研究目标与AHRQ的2014 - 2018年战略计划相一致 目标1B是"提高医疗质量"，目标1E是确保获得"高质量、文化上合格的医疗服务， 包括为弱势群体提供长期服务和支助"，以及目标3C"改善 以及为残疾人和老年人提供的支助服务的质量。"这些活动的最终结果 研究旨在制定实施策略，以改善高质量，循证PT的提供， 帕金森氏症患者。

Project Summary/Abstract: Parkinson's disease is a chronic, complex neurologic condition that causes progressive declines in activity level, walking, and balance. These mobility impairments are associated with worse quality of life and mortality. Physical therapy (PT) has been shown to effectively treat these mobility problems, and exercise is associated with better quality of life and increased physical activity. Evidence-based PT guidelines for people with Parkinson's disease have been developed to support mobility and exercise participation across all disease severities, but our preliminary data indicates that PT is used inconsistently in the United States (US). The two research objectives of this F32 postdoctoral fellowship are (1) to describe current PT practice in the US and evaluate the extent to which it reflects the existing evidence-based guidelines, and then (2) to determine barriers and facilitators to the delivery of evidence-based PT from patient and provider perspectives. Objective 1 will survey expert physician/referrers and expert physical therapists for people with Parkinson's disease to describe their PT-related referral and practice decisions across the stages of the disease. The results of this survey will be mapped onto existing guidelines to evaluate conformity with evidence-based practice. Objective 2 will use focus groups and key informant interviews of people with Parkinson's disease, physical therapists, and physicians to explain how current practice is similar or different from evidence-based practice. The focus group and interview questions will probe for barriers and facilitators to the delivery of evidence-based PT services within the US healthcare context. The results of these studies promote improved synthesis of evidence into healthcare delivery and form the basis for future implementation or knowledge translation efforts to improve the quality of PT delivery. These research goals are aligned with AHRQ's 2014-2018 Strategic Plan goal 1B to “improve healthcare quality,” goal 1E to ensure access to “quality, culturally competent care, including long-term services and supports for vulnerable populations,” and goal 3C to “improve the accessibility and quality of supportive services for people with disabilities and older adults.” The final outcomes of these studies are to develop implementation strategies to improve the delivery of high-quality, evidence-based PT for people with Parkinson's disease.