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

项目概要/摘要： 锻炼是身体活动的一个子集，它是有组织和有计划的，目的是增加健康。定期 运动与帕金森病相关的行动能力结果和生活质量的缓慢下降有关。然而，在这方面， 只有不到一半的帕金森病（PwP）患者达到了推荐的运动水平。行使 障碍包括对好处的了解和期望不足，流动性问题，以及缺乏时间或方便 锻炼选项。需要研究来确定如何促进运动的开始，进展， 残疾人士及患有其他残疾或慢性病的人士。 物理治疗（PT）是一种医疗保健服务，可以帮助PwP和其他条件，以解决个人 和环境障碍。我们已成功地试行了一项咨询性的PT计划，以帮助PwP 增加和维持他们的运动和身体机能。我们将咨询式PT与传统PT区分开来 通过更少更不频繁的访问此外，咨询PT侧重于在存在的运动促进 最小或稳定的功能缺陷，而不是短暂但强烈的PT发作的功能增益。然而，在这方面， 转诊到咨询性PT挑战了PT作为移动性问题治疗的传统观念。的 拟议的有效性-实施混合II型研究将系统地评估咨询式PT在两个 不同的背景下，以告知有效的维持，公平地传播到其他帕金森的计划， 扩展到其他人群，可以从运动监测和维护中受益。 首先，我们将使用混合效应回归模型来评估12个月身体活动的差异 在（1）标准护理期间登记的个人之间的轨迹，（2）书面锻炼指导， 神经科医师;（3）咨询PT（Aim 1）。我们将招募每组96名PwP。我们假设咨询公司 PT将帮助PwP改善和维持运动参与，控制疾病特异性因素和社会因素。 健康的决定因素。其次，我们将对比咨询式PT实施的决定因素、策略， 在两个不同社区的组织之间实现可持续发展（目标2）。我们将研究 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，可接受性和适当性之间 但资源较低的社区将在接触和维持方面遇到挑战。 该提案是对美国国立卫生研究院关于开发和 测试多水平体力活动干预（NOT-OD-21-087）。此外，拟议的项目还涉及 尤妮斯·肯尼迪·施莱佛国家儿童健康和人类发展研究所的研究主题是， 为残疾人提供安全有效的治疗干预。针对两个不同的 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。

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.