Abstract
BackgroundImplementation science frameworks aided the development of a new, evidence-based clinical physical therapy program. The purpose of this report is to describe the process of sustaining a clinical program in practice for over 4 years. We present a framework for integrating tools for sustainability with the Knowledge-to-Action model in the context of a proactive physical therapy (PAPT) program for individuals with early-stage Parkinson’s disease.MethodsSustainability of implementation strategies was addressed using the Dynamic Sustainability Framework and sustainability assessment tools. Repeated retrospective medical record reviews and phone interviews were used to evaluate the reach and adoption of the PAPT over 4 years. Characteristics of those who engaged with PAPT, implementation fidelity, and clinical effectiveness were assessed for year 1 and year 3. Sustainability was measured using RE-AIM, NHS Sustainability Model, and Clinical Sustainability Assessment Tool.ResultsReach increased from 28 to 110 total patients per year and spread occurred from one to three sites. PAPT user age, sex, Hoehn and Yahr rating, time since diagnosis, and type of insurance were similar in year 1 and year 3 (p > 0.05). The program sustained its effect to help participants increase or maintain self-reported exercise (Y1, 95%; Y3, 100%). However, upon evaluation PAPT users in year 3 had longer time since symptom onset and worse UPDRS motor scores compared to the PAPT users in year 1 (p < 0.05). All sites sustained the core intervention components, with sustainability scores of 71/100 (± 9.9) on the NHS Sustainability Model and 6.1/7 (± 0.9) on the Clinical Sustainability Assessment Tool.ConclusionsIntegrating multiple sustainability models and assessments supported continued effectiveness, spread, and sustainment of PAPT for 4 years. Effective planning, anticipating common healthcare changes, and addressing sustainability determinants early in program implementation were essential aspects of long-term success.
Highlights
Clinical practice guidelines support physical therapy (PT) in early Parkinson’s disease (PD) [1]
A successful, evidenced-based proactive physical therapy program for individuals with early-stage PD can be sustained with careful attention to processes, staff, and organizational priorities
The results of program spread and sustainment are presented in Table 3 using the RE-AIM framework
Summary
Clinical practice guidelines support physical therapy (PT) in early Parkinson’s disease (PD) [1]. Despite these guidelines, payer datasets and patient registries reveal infrequent utilization of PT, early after diagnosis [2, 3]. The proactive physical therapy (PAPT) program was established in 2016 to provide PT evaluations and individually tailored recommendations for physical activity and exercise in people with early PD [4]. The purpose of this report is to describe the process of sustaining a clinical program in practice for over 4 years. We present a framework for integrating tools for sustainability with the Knowledge-toAction model in the context of a proactive physical therapy (PAPT) program for individuals with early-stage Parkinson’s disease
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