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

基本信息

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
项目类别：
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

项目摘要

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：锻炼是有组织和有计划的身体活动的一部分，其目标是增强体质。运动与帕金森病相关的活动能力和生活质量的下降速度较慢有关。不到一半的帕金森病 (PwP) 患者达到了建议的运动水平。包括对好处的了解和期望不足、流动性问题以及时间或便利的障碍需要进行研究来确定如何促进锻炼的开始、进展和锻炼。 PwP 和患有其他残疾或慢性病的人的维持。物理治疗 (PT) 是一种医疗保健服务，可以帮助 PwP 和其他病症解决个人问题我们已成功试行了咨询 PT 计划，以帮助 PwP 实现以下目标：增加和维持他们的运动和身体机能我们将咨询性 PT 与传统 PT 区分开来。此外，咨询性 PT 还通过减少访问频率来重点促进现场锻炼。轻微或稳定的功能缺陷，而不是短暂但强烈的 PT 以获得功能增益。转诊咨询性 PT 传统挑战了将 PT 作为行动障碍治疗方法的观念。拟议的有效性-实施混合型 II 研究将系统地评估以下两个方面的协商性 PT 不同的背景为有效维持、公平传播到其他帕金森病项目以及未来提供信息扩展到可以从运动监测和维护中受益的其他人群。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 (3) 咨询PT（目标 1）我们将每组招募 96 名 PwP。 PT 将帮助 PwP 改善和维持运动参与，控制疾病特定因素和社会因素其次，我们将对比咨询性 PT 实施的决定因素、策略、我们将研究两个不同社区的组织之间的结果和维持（目标 2）。个人、人际、组织和社区层面的决定因素。促进实施将导致相似的保真度、采用性、可接受性和适当性组织，但资源较低的社区将面临达到和维持的挑战。该提案是对美国国立卫生研究院关于开发和应用特别关注的通知的回应。此外，拟议项目还涉及测试多层次的身体活动干预措施（NOT-OD-21-087）。尤尼斯·肯尼迪·施赖弗国家儿童健康和人类发展研究所的研究主题是针对两种不同类型的残疾人的安全有效的治疗干预措施。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。