scholarly journals Implementation of highly challenging balance training for Parkinson’s disease in clinical practice: a process evaluation

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Breiffni Leavy ◽  
Conran Joseph ◽  
Lydia Kwak ◽  
Erika Franzén
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Clinical Practice ◽  
Process Evaluation ◽  
Balance Training ◽  
Outcome Evaluation ◽  
Barriers And Facilitators ◽  
Program Delivery ◽  
Participant Responsiveness ◽  
Core Components

Abstract Background Process evaluations provide contextual insight into the way in which interventions are delivered. This information is essential when designing strategies to implement programs into wider clinical practice. We performed a process evaluation of the HiBalance effectiveness trial investigating the effects of a 10-week of highly challenging and progressive balance training for mild-moderate Parkinson’s disease (PD). Study aims were to investigate i) the quality and quantity of intervention delivery and ii) barriers and facilitators for implementation. Methods Process outcomes included; Fidelity; Dose (delivered and received) Recruitment and Reach. Investigation of barriers and facilitators was guided by the Consolidated Framework for Implementation Research. Program delivery was assessed across four neurological rehabilitation sites during a two-year period. Data collection was mixed-methods in nature and quantitative and qualitative data were merged during the analysis phase. Results Thirteen program trainers delivered the intervention to 12 separate groups during 119 training sessions. Trainer fidelity to program core components was very high in 104 (87%) of the sessions. Participant responsiveness to the core components was generally high, although adherence to the home exercise program was low (50%). No significant context-specific differences were observed across sites in terms of fidelity, dose delivered/ received or participant characteristics, despite varying recruitment methods. Facilitators to program delivery were; PD-specificity, high training frequency and professional autonomy. Perceived barriers included; cognitive impairment, absent reactional balance among participants, as well a heterogeneous group in relation to balance capacity. Conclusion These findings provide corroborating evidence for outcome evaluation results and valuable information for the further adaptation and implementation of this program. Important lessons can also be learned for researchers and clinicians planning to implement challenging exercise training programs for people with mild-moderate PD. Trial registration ClinicalTrials.gov, NCT02727478, registered 30 march, 2016 − Retrospectively registered.

scholarly journals Implementation of Highly Challenging Balance Training for Parkinson’s disease in Clinical Practice: A Process Evaluation

2020 ◽  
Author(s):  
Breiffni Leavy ◽  
Conran Joseph ◽  
Lydia Kwak ◽  
Erika Franzén
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Clinical Practice ◽  
Process Evaluation ◽  
Balance Training ◽  
Outcome Evaluation ◽  
Barriers And Facilitators ◽  
Program Delivery ◽  
Participant Responsiveness ◽  
Core Components

Abstract Background: Process evaluations provide contextual insight into the way in which interventions are delivered. This information is essential when designing strategies to implement programs into wider clinical practice. We performed a process evaluation of the HiBalance effectiveness trial investigating the effects of a 10-week of highly challenging and progressive balance training for mild-moderate Parkinson’s disease (PD). Study aims were to investigate i) the quality and quantity of intervention delivery and ii) barriers and facilitators for implementation.Methods: Process outcomes included; Fidelity; Dose (delivered and received) Recruitment and Reach. Investigation of barriers and facilitators was guided by the Consolidated Framework for Implementation Research. Program delivery was assessed across four neurological rehabilitation sites during a two-year period. Data collection was mixed-methods in nature and quantitative and qualitative data were merged during the analysis phase.Results: Thirteen program trainers delivered the intervention to 12 separate groups during 119 training sessions. Trainer fidelity to program core components was very high in 104/110 (94%) of the sessions. Participant responsiveness to the core components was generally high, although adherence to the home exercise program was low (50%). No significant context-specific differences were observed across sites in terms of fidelity, dose delivered/ received or participant characteristics, despite varying recruitment methods. Facilitators to program delivery were; PD-specificity, high training frequency and professional autonomy. Perceived barriers included; cognitive impairment, absent reactional balance among participants, as well a heterogeneous group in relation to balance capacity. Conclusion: These findings provide corroborating evidence for outcome evaluation results and valuable information for the further adaptation and implementation of this program. Important lessons can also be learned for researchers and clinicians planning to implement challenging exercise training programs for people with mild-moderate PD. Trial registration: ClinicalTrials.gov, NCT02727478, registered 30 march − Retrospectively registered. https://clinicaltrials.gov/ct2/show/NCT02727478

scholarly journals Implementation of Highly Challenging Balance Training for Parkinson’s disease in Clinical Practice: A Process Evaluation

2020 ◽  
Author(s):  
Breiffni Leavy ◽  
Conran Joseph ◽  
Lydia Kwak ◽  
Erika Franzén
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Clinical Practice ◽  
Process Evaluation ◽  
Balance Training ◽  
Outcome Evaluation ◽  
Barriers And Facilitators ◽  
Program Delivery ◽  
Participant Responsiveness ◽  
Core Components

Abstract Background Process evaluations provide contextual insight into the way in which interventions are delivered. This information is essential when designing strategies to implement programs into wider clinical practice. We performed a process evaluation of the HiBalance effectiveness trial investigating the effects of a 10-week of highly challenging and progressive balance training for mild-moderate Parkinson’s disease (PD). Study aims were to investigate i) the quality and quantity of intervention delivery and ii) barriers and facilitators for implementation. Methods Process outcomes included; Fidelity; Dose (delivered and received) Recruitment and Reach. Investigation of barriers and facilitators was guided by the Consolidated Framework for Implementation Research. Program delivery was assessed across four neurological rehabilitation sites during a two-year period. Data collection was mixed-methods in nature and quantitative and qualitative data were merged during the analysis phase. Results Thirteen program trainers delivered the intervention to 12 separate groups during 119 training sessions. Trainer fidelity to program core components was very high in 104/110 (94%) of the sessions. Participant responsiveness to the core components was generally high, although adherence to the home exercise program was low (50%). No significant context-specific differences were observed across sites in terms of fidelity, dose delivered/ received or participant characteristics, despite varying recruitment methods. Facilitators to program delivery were; PD-specificity, high training frequency and professional autonomy. Perceived barriers included; cognitive impairment, absent reactional balance among participants, as well a heterogeneous group in relation to balance capacity. Conclusion These findings provide corroborating evidence for outcome evaluation results and valuable information for the further adaptation and implementation of this program. Important lessons can also be learned for researchers and clinicians planning to implement challenging exercise training programs for people with mild-moderate PD. Trial registration: ClinicalTrials.gov, NCT02727478, registered 30 march − Retrospectively registered. https://clinicaltrials.gov/ct2/show/NCT02727478

scholarly journals Implementation of Highly Challenging Balance Training for Parkinson’s disease in Clinical Practice: A Process Evaluation

2020 ◽  
Author(s):  
Breiffni Leavy ◽  
Conran Joseph ◽  
Lydia Kwak ◽  
Erika Franzén
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Clinical Practice ◽  
Process Evaluation ◽  
Balance Training ◽  
Outcome Evaluation ◽  
Barriers And Facilitators ◽  
Program Delivery ◽  
Participant Responsiveness ◽  
Core Components

Abstract Background: Process evaluations provide contextual insight into the way in which interventions are delivered. This information is essential when designing strategies to implement programs into wider clinical practice. We performed a process evaluation of the HiBalance effectiveness trial investigating the effects of a 10-week of highly challenging and progressive balance training for mild-moderate Parkinson’s disease (PD). Study aims were to investigate i) the quality and quantity of intervention delivery and ii) barriers and facilitators for implementation. Methods: Process outcomes included; Fidelity; Dose (delivered and received) Recruitment and Reach. Investigation of barriers and facilitators was guided by the Consolidated Framework for Implementation Research. Program delivery was assessed across four neurological rehabilitation sites during a two-year period. Data collection was mixed-methods in nature and quantitative and qualitative data were merged during the analysis phase. Results: Thirteen program trainers delivered the intervention to 12 separate groups during 119 training sessions. Trainer fidelity to program core components was very high in 104 (87%) of the sessions. Participant responsiveness to the core components was generally high, although adherence to the home exercise program was low (50%). No significant context-specific differences were observed across sites in terms of fidelity, dose delivered/ received or participant characteristics, despite varying recruitment methods. Facilitators to program delivery were; PD-specificity, high training frequency and professional autonomy. Perceived barriers included; cognitive impairment, absent reactional balance among participants, as well a heterogeneous group in relation to balance capacity. Conclusion: These findings provide corroborating evidence for outcome evaluation results and valuable information for the further adaptation and implementation of this program. Important lessons can also be learned for researchers and clinicians planning to implement challenging exercise training programs for people with mild-moderate PD. Trial registration: ClinicalTrials.gov, NCT02727478, registered 30 march − Retrospectively registered. https://clinicaltrials.gov/ct2/show/NCT02727478

scholarly journals Implementation of Highly Challenging Balance Training for Parkinson’s disease in Clinical Practice: A Process Evaluation

2021 ◽  
Author(s):  
Breiffni Leavy ◽  
Conran Joseph ◽  
Lydia Kwak ◽  
Erika Franzén
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Clinical Practice ◽  
Process Evaluation ◽  
Balance Training ◽  
Outcome Evaluation ◽  
Barriers And Facilitators ◽  
Program Delivery ◽  
Participant Responsiveness ◽  
Core Components

Abstract Background: Process evaluations provide contextual insight into the way in which interventions are delivered. This information is essential when designing strategies to implement programs into wider clinical practice. We performed a process evaluation of the HiBalance effectiveness trial investigating the effects of a 10-week of highly challenging and progressive balance training for mild-moderate Parkinson’s disease (PD). Study aims were to investigate i) the quality and quantity of intervention delivery and ii) barriers and facilitators for implementation. Methods: Process outcomes included; Fidelity; Dose (delivered and received) Recruitment and Reach. Investigation of barriers and facilitators was guided by the Consolidated Framework for Implementation Research. Program delivery was assessed across four neurological rehabilitation sites during a two-year period. Data collection was mixed-methods in nature and quantitative and qualitative data were merged during the analysis phase. Results : Thirteen program trainers delivered the intervention to 12 separate groups during 119 training sessions. Trainer fidelity to program core components was very high in 104 (87%) of the sessions. Participant responsiveness to the core components was generally high, although adherence to the home exercise program was low (50%). No significant context-specific differences were observed across sites in terms of fidelity, dose delivered/ received or participant characteristics, despite varying recruitment methods. Facilitators to program delivery were; PD-specificity, high training frequency and professional autonomy. Perceived barriers included; cognitive impairment, absent reactional balance among participants, as well a heterogeneous group in relation to balance capacity. Conclusion: These findings provide corroborating evidence for outcome evaluation results and valuable information for the further adaptation and implementation of this program. Important lessons can also be learned for researchers and clinicians planning to implement challenging exercise training programs for people with mild-moderate PD. Trial registration: ClinicalTrials.gov, NCT02727478, registered 30 march 2016 − Retrospectively registered. https://clinicaltrials.gov/ct2/show/NCT02727478

scholarly journals Rehabilitation Therapy Utilization in Patients with Parkinson’s Disease in Korea

2018 ◽  
Vol 2018 ◽  
pp. 1-7 ◽  
Author(s):  
Han Gil Seo ◽  
Sang Jun Park ◽  
Jiah Seo ◽  
Seong Jun Byun ◽  
Byung-Mo Oh
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Health Insurance ◽  
Clinical Practice ◽  
Patient Characteristics ◽  
National Sample ◽  
Present Evidence ◽  
Rehabilitation Therapy ◽  
Swallowing Therapy ◽  
Over Time

Objective. Although evidence and guidelines recommend appropriate rehabilitation from the beginning of diagnosis in patients with Parkinson’s disease (PD), there is a lack of data addressing the utilization of rehabilitation therapies for these patients in practice. The aim of this study is to investigate the rate of rehabilitation therapy utilization over time in patients with PD using a nationwide cohort in Korea. Methods. Patients were identified using the registration code for PD in the program for rare, intractable disease from the National Health Insurance Service-National Sample Cohort database, which consists of 979,390 Korean residents. Data were divided into four periods: 2004–2006, 2007–2009, 2010–2012, and 2013–2015. We assessed the utilization of rehabilitation therapies and the associated patient characteristics. Results. The numbers of patients with PD were 384 in 2004, 855 in 2007, 1,023 in 2010, and 1,222 in 2013. The numbers of physiatrist visits per person were 0.58, 0.96, 1.97, and 2.91, in the respective periods. Among the patients, 35–40% had claims for physical therapy, 16–19% for occupational therapy, and 4–6% for swallowing therapy. There were no remarkable differences between these rates between the study periods. Sex, age, income, disability, and levodopa-equivalent dose were significantly associated with the utilization of rehabilitation therapy. Conclusion. This study demonstrated that the rate of rehabilitation therapy utilization did not change remarkably in patients with PD from 2004 to 2015 in Korea although the number of physiatrist visits increased dramatically. The present evidence and guidelines may have not been adequately integrated into clinical practice during the period of study. Additional efforts may be warranted to provide adequate rehabilitation therapies in clinical practice for patients with PD.

‘Adults with Parkinson's disease and hallucinations or delusions can have treatment with clozapine if they need to’

2021 ◽  
pp. 1-3
Author(s):  
Eileen Joyce
Keyword(s):  
Mental Health ◽  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Clinical Practice ◽  
National Health Service ◽  
Quality Standards ◽  
Antipsychotic Treatment ◽  
Current Clinical Practice ◽  
Clozapine Treatment ◽  
Care Systems

SUMMARY Clozapine is the only antipsychotic licensed for treatment of Parkinson's disease psychosis (PDP) but is infrequently used in the National Health Service because of obstacles to the integration of hospital-based neurological/geriatric services with clozapine clinics run by community mental health teams. This commentary points out the mismatch between NICE quality standards on antipsychotic treatment for PDP and current clinical practice. It suggests that forthcoming integrated care systems should be able to overcome these obstacles, enabling innovative models for providing clozapine treatment for PDP such as those described by Taylor et al, so that clozapine treatment becomes a right for patients and their families.

scholarly journals Effect of endurance exercise on attention and depression in Parkinson’s disease patients - A new approach

2019 ◽  
Vol 10 (3) ◽  
pp. 1592-1595
Author(s):  
Sujatha B ◽  
Sarumathi S ◽  
Tinu Priya R
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Endurance Exercise ◽  
Balance Training ◽  
Depression Scale ◽  
Exercise Program ◽  
Depression Symptoms ◽  
Digit Symbol ◽  
Rehabilitation Centre ◽  
Group B

Aim of the study is to determine the effects of endurance exercise on depression and attention deficiency in people with Parkinson’s disease patients. The methodology of the study is,15 participants with Parkinson's disease were selected both male and female from the neurological rehabilitation centre, Chennai. The purpose and procedure of the study were completely explained to the participants, and informed consent was obtained from all the participants. Depression scale and the digit-symbol task was evaluated before starting the exercise program and participants were randomized into two groups (Group A and Group B). This study compared the effect of endurance exercise to stretch-balance training. The exercise program was given for a duration of 12 weeks. After 12 weeks, Hospital anxiety & depression scale and digit-symbol task were used to check for the progress. The result we determine from the statistical analysis, it has been revealed that depression symptoms decreased with endurance exercise and stretch-balance training but didn't show any significant improvement on attention with endurance exercise while with stretch-balance training it shows minimal improvement. Hence, we conclude that endurance exercise is a viable intervention in PD that can be used as a protective technique against depression symptoms and can also be used for improving attention in people with Parkinson’s.

scholarly journals Postural control learning dynamics in Parkinson’s disease: early ‎improvement with plateau in stability, and continuous progression in ‎flexibility and mobility

2020 ◽  
Author(s):  
Zahra Rahmati ◽  
Saeed Behzadipour ◽  
Alfred C. Schouten ◽  
Ghorban Taghizadeh ◽  
Keikhosrow Firoozbakhsh
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Postural Control ◽  
Training Program ◽  
Center Of Pressure ◽  
Balance Training ◽  
Patient Specific ◽  
Learning Dynamics ◽  
Early Improvement ◽  
Model Based

Abstract Background: Balance training improves postural control in Parkinson’s disease (PD). However, a systematic approach for the development of individualized, optimal training programs is still lacking, as the learning dynamics of the postural control in PD, over a training program are poorly understood. Objectives: We investigated the learning dynamics of the postural control in PD, during a balance-training program, in terms of the clinical, posturographic, and novel model-based measures. Methods: Twenty patients with PD participated in a balance-training program, 3 days a week, for 6 weeks. Clinical tests assessed functional balance and mobility pre-training, mid-training, and post-training. Center-of-pressure (COP) was recorded at four time-points during the training (pre-, week 2, week 4, and post-training). COP was used to calculate the sway measures and to identify the parameters of a patient-specific postural control model, at each time-point. The posturographic and model-based measures constituted the two sets of stability- and flexibility-related measures. Results: Mobility- and flexibility-related measures showed a continuous improvement during the balance-training program. In particular, mobility improved at mid-training and continued to improve to the end of the training, whereas flexibility-related measures reached significance only at the end. The progression in the balance- and stability-related measures was characterized by early improvements over the first three to four weeks of training, and reached a plateau for the rest of the training. Conclusions: The progression in balance and postural stability is achieved earlier and susceptible to plateau out, while mobility and flexibility continues to improve during the balance training.

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