Title : Enhancing physical therapy referral practices for patients with parkinson’s disease: A quality improvement initiative
Abstract:
Background: Parkinson’s disease (PD) is a neurodegenerative disorder that affects older adults and is the second most common neurodegenerative disease. The cardinal motor features of PD include bradykinesia, rigidity, postural instability, and tremor. Evidence for the efficacy of rehabilitation therapies in the treatment and management of PD has been expanding, demonstrating improvements in function, activities of daily living, speech volume, and quality of life. Despite these positive studies, rehabilitation therapy, including physical therapy and speech therapy, remains underutilized. The goal of this project is to establish a baseline referral percentage to Parkinson disease- specific rehabilitative services, determine any specific factors that affect referral to rehabilitation therapy, and find ways to improve and increase referral to rehabilitative services for a better quality of life in patients with PD.
Methods: We reviewed the electronic medical records of patients (n=127) who presented to our Parkinson’s Disease center, with a diagnosis of Parkinson’s disease in the year of 2021 as a new patient visit. Patients were excluded if they had severe limitations to mobility at baseline or had severe dementia. Patient data was analyzed and reasons for referral and non-referral were collected, if available.
Results: 127 patients were included in the final analysis. 73 (57%) patients were male and 103 (81%) were white, with an average age of 72.5 (standard deviation (SD) = 10.7). 31 (24%) patients were recommended PT, 8 (6.3%) OT, and 4 (3.1%) ST. There were no clear finding regarding specific factors facilitating or limiting patient access to rehabilitative services. Race and sex showed no significant association with therapy referrals (p = 0.58, p =
0.16 respectively). 51 (40%) patients with PD had a secondary diagnosis which affected gait. The most common secondary diagnosis that affected gain were back pain (12.6 %), lower extremity arthritis (10.2 %), and neuropathy (6.3%). A diagnosis of back pain was the only diagnosis significantly associated with referral to PT (p = 0.02).
Conclusions: Research shows the benefits of early intervention with physical therapy and exercise services in persons with Parkinson’s Disease, however in actual practice we see that less than a quarter of patients are referred to therapy services. Future studies might include larger databases of patients in different settings, a review and evaluation of steps taken to increase referral numbers, and perhaps outcome measures for patients referred to therapy versus those that weren't. We plan to collect data for the year 2022 as a possible limitation for referral may have been due to COVID during the year of 2021. Furthermore, we are interested in reviewing the number of patients that attend community-based therapy services as well such as Rock Steady Boxing, Dance for PD, and LSVT BIG. Our goal is to improve referrals and use of rehabilitative services for patients with Parkinson’s Disease to improve their quality of life.
