Physical Therapy Delivery Models for Long-Term Parkinsons Disease Management

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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.