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Physical therapy (PT) is an evidence-based intervention that is often underutilized by people with Parkinson’s disease (PD), particularly early in the disease. This mixed methods study blends quantitative and qualitative data to describe current practice, identify barriers to evidence-based practice, and to elicit implementation strategies for improved care.
Aims
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(1) To describe PT delivery patterns across the stages of PD.
(2) To identify patterns of successful preventive and long-term maintenance PT programs, as well as barriers and facilitators to implementation of PT programs for people with early stage PD.
Description of Study Activities
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We sent online surveys to 251 physical therapists (PTs) and 268 doctors (MDs) at 32 academic medical centers with PD expertise in the United States. Surveys addressed PT referral practices, exercise prescription, and use of evidence-based PT measures and interventions. Based on survey results, explanatory focus groups and interviews were conducted with MD, PT, and consumer stakeholders at 6 centers selected for regional variability (urban/rural), proactive PT practice, and use of routine long-term PT monitoring. Discussion topics included PT referral processes, barriers, and improvement strategies.
Results
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We received survey responses from 108 PTs and 78 MDs, for a total sample size of 186. Over 80% of doctors reported referring more than 60% of their patients in PD Hoehn and Yahr (HY) Stages 3-4 to PT, while less than 25% reported frequent referrals in HY 1, 2, and 5. 70% of doctors and PTs recommend that an infrequent exerciser with HY 1 PD should attend PT at least every 6-12 months. Intervals decreased to 1-2 months in HY 4, but only 40% of PTs reported using routine follow-ups.
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Two healthcare delivery patterns emerged form the explanatory interviews:
(1) Centralized expert model of PT
(2) Dispersed knowledge model linking centers of excellence with community PTs
Centers with high PT utilization used both models. People living in rural and suburban areas, particularly those with additional transportation barriers preferred the dispersed knowledge model. Modifiable barriers for both models include: communication and scheduling logistics, patient and clinician knowledge of insurance, routine follow-ups to assess function and provide motivation to exercise, and disseminating research on PT and exercise to patients and clinicians.