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

咨询物理治疗：帕金森病的身体活动和锻炼实施策略

• 批准号: 10565287
• 负责人: Miriam Rose Rafferty
• 金额: $ 47.24万
• 依托单位: REHABILITATION INSTITUTE OF CHICAGO D/B/A SHIRLEY RYAN ABILITYLAB
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-06-13 至 2028-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10565287
• 关键词: Academic Medical Centers; Academy; Accelerometer; Address; Administrator; Adoption; Aerobic; Aerobic Exercise; American; Behavior; Caring; Child Health; Chronic; Clinical; Communities; Community Hospitals; Diagnosis; Disabled Persons; Effectiveness; Enrollment; Equilibrium; Equity; Evaluation; Exercise; Future; Goals; Guidelines; Health; Hour; Human Development; Individual; Intervention; Interview; Low income; Maintenance; Measures; Medical; Modeling; Monitor; Neurologist; Neurology; Outcome; Parkinson Disease; Participant; Patient Outcomes Assessments; Patient Self-Report; Patients; Perception; Persons; Physical Exercise; Physical Function; Physical activity; Physical therapy; Population; Practice Guidelines; Quality of life; Questionnaires; Recommendation; Rehabilitation therapy; Reporting; Research; Resource-limited setting; Resources; Severity of illness; Site; Structure; Symptoms; Testing; Therapeutic Intervention; Time; United States National Institutes of Health; Visit; Work; Writing; community-level factor; disability; disease diagnosis; disorder control; effectiveness measure; effectiveness/implementation hybrid; effectiveness/implementation trial; exercise intervention; exercise prescription; exercise regimen; expectation; experience; fear of falling; fitness; flexibility; formative assessment; functional gain; health care service; implementation determinants; implementation facilitation; implementation outcomes; implementation strategy; improved; interest; mortality; physical model; processing speed; programs; provider adoption; research and development; social health determinants; standard care; suburb; therapeutically effective; traditional therapy; urban area; verbal; vigorous intensity

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.

项目摘要/摘要： 锻炼是体力活动的一个子集，它是有组织和有计划的，目的是增加健康。常规 运动与帕金森氏症相关的活动结果和生活质量的下降速度较慢有关。然而， 只有不到一半的帕金森氏症患者达到了推荐的运动量。锻炼 障碍包括对好处的低知识和期望、机动性问题以及缺乏时间或便利 锻炼选项。需要研究来确定如何促进运动的开始、进展和 工务计划及其他残疾人士或长期病患者的赡养费。 物理治疗(PT)是一种医疗服务，可以帮助PWP和其他疾病解决个人 以及需要行使的环境障碍。我们已经成功地试行了一项咨询性PT计划，以帮助工务计划 增加和维持他们的锻炼和身体机能。我们将咨询型PT与传统PT区分开来 通过使用更少、更不频繁的访问。此外，咨询PT侧重于在现场进行运动推广 最小或稳定的功能缺陷，而不是短暂但激烈的PT发作以获得功能收益。然而， 转诊至咨询性PT挑战了将PT视为行动不便问题治疗方法的传统观念。这个 拟议的有效性-实施混合类型II研究将在两个阶段对咨询性PT进行系统评估 不同的背景为有效的维持提供信息，公平地传播到其他帕金森病项目，以及未来 扩大到其他可以从运动监测和维护中受益的人群。 首先，我们将使用混合效应回归模型来评估12个月体力活动的差异 在(1)标准护理，(2)书面锻炼指导期间登记的个人之间的轨迹 神经科医生，以及(3)咨询PT(Aim1)。我们每组将招收96名PWP。我们假设咨询公司 PT将帮助PWP改善和保持运动参与度，控制疾病特定因素和社会 健康的决定因素。第二，我们将对比协商性PT实施的决定因素、战略、 两个不同社区的组织之间的成果和维持(目标2)。我们会研究 个人、人际、组织和社区层面的决定因素。我们假设 促进实施将导致类似的保真度、采用率、可接受性和适当性 但资源较少的社区将面临接触和维持方面的挑战。 这项建议是对美国国立卫生研究院关于开发和开发的特别关注通知的回应 测试多层次体力活动干预(非-OD-21-087)。此外，拟议的项目还涉及 尤尼斯·肯尼迪·施莱弗国家儿童健康和人类发展研究所的研究主题是 推进对残疾人安全有效的治疗干预。瞄准两个不同的人 社区将促进当前和未来工作的公平性，帮助我们优化所有人的能力。