Consultative Physical Therapy: A Physical Activity and Exercise Implementation Strategy in Parkinson's

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Project Summary/Abstract: Exercise is a subset of physical activity that is structured and planned, with a goal to increase fitness. Regular exercise is associated with slower declines in Parkinson’s-related mobility outcomes and quality of life. However, fewer than half of people with Parkinson’s disease (PwP) achieve recommended levels of exercise. Exercise barriers include lowknowledge and expectations of the benefits, mobility concerns, and lack of time or convenient exercise options. Research is needed to determine how to facilitate exercise initiation, progression, and maintenance in PwP and those with other disabilities or chronic conditions. Physical therapy (PT) is a healthcare service that can help PwP and other conditions to address personal and environmental barriers to exercise. We have successfully piloted a Consultative PT program to help PwP to increase and maintain their exercise and physical function. We distinguish Consultative PT from traditional PT by using fewer, less frequent visits. Additionally, Consultative PT focuses on exercise promotion in the presence of minimal or stable functional deficits, rather than brief but intense episodes of PT for functional gains. However, referral to Consultative PT challenges traditional perceptions of PT as a treatment for mobility problems. The proposed effectiveness-implementation hybrid type II study will systematically evaluate Consultative PT in two dissimilar contexts to inform effective sustainment, equitable spread to other Parkinson’s programs, and future scaling to other populations that can benefit from exercise monitoring and maintenance. First, we will use mixed effects regression models to evaluate differences in 12-month physical activity trajectories between individuals enrolled during periods of (1) standard care, (2) written exercise guidance from neurologists, and (3) ConsultativePT (Aim1). We will enroll 96 PwP per group. We hypothesize that Consultative PT will help PwP improve and maintain exercise participation, controlling for disease-specific factors and social determinants of health. Second, we will contrast consultative PT implementation determinants, strategies, outcomes, and sustainment between organizations in two dissimilar communities (Aim 2). We will study determinants at the individual, interpersonal, organizational, and community levels. We hypothesize that facilitated implementation will lead to similar fidelity, adoption, acceptability, and appropriateness between organizations, but that the lower-resourced community will experience challenges to reach and sustainment. This proposal is responsive to the National Institutes of Health notice of special interest on developing and testing multilevel physical activity interventions (NOT-OD-21-087). Additionally, the proposed project addresses the Eunice Kennedy Shriver National Institute on Child Health and Human Development’s research theme to advance safe and effective therapeutic interventions for people with disabilities. Targeting two dissimilar communities will facilitate the equity of the current and future work to help us optimize abilities for all.