Physical Therapy Delivery Models for Long-Term Parkinsons Disease Management

项目摘要/摘要： 帕金森氏病是一种慢性、复杂的神经系统疾病，会导致活动量进行性下降 水平、行走和平衡。这些行动能力障碍与较差的生活质量和死亡率有关。 物理疗法(PT)已被证明能有效地治疗这些行动不便问题，而运动与此相关 随着生活质量的提高和体力活动的增加。循证PT指南适用于有以下问题的人 帕金森氏症的发展是为了支持所有疾病的活动和运动参与 严重程度，但我们的初步数据表明，PT在美国的使用不一致。两个人 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，以及 评估它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对循证PT实施的障碍和促进者。客观化 1将为帕金森氏症患者调查专家医生/转介和专家物理治疗师，以 描述他们在疾病各个阶段与PT相关的转诊和实践决定。这样做的结果 将根据现有指南进行调查，以评估是否符合循证做法。客观化 2将使用焦点小组和关键线人采访帕金森氏症患者，物理治疗师， 和医生解释目前的做法与循证做法有何相似或不同之处。焦点 小组和面试问题将探讨提供循证PT的障碍和促进者 在美国医疗保健背景下的服务。这些研究的结果促进了改进的合成 将证据纳入医疗保健服务，并形成未来实施或知识转化工作的基础 以提高PT的交付质量。这些研究目标与AHRQ的2014-2018年战略计划保持一致 目标1B是“提高医疗质量”，目标1E是确保获得“高质量、有文化能力的护理”， 包括对弱势群体的长期服务和支持“，以及目标3C：”改善无障碍环境 以及为残疾人和老年人提供的支持性服务的质量。这些活动的最终结果是 研究将制定实施战略，以改善为以下方面提供高质量、循证的培训 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.