Outcome Measures in Subjects with Parkinson’s Disease: Determining consistent and efficient measures to be utilized in a PD specific physical therapy setting.

Research Report
Population: Adult

Kathleen B. Szirony, PT, DPT, Rehabilitation Manager, Cleveland Clinic szironk@ccf.org

Amy Chan, PT, NCS, PT Clinical Specialist, Cleveland Clinic Foundation chana@ccf.org

Tracee Melaragno, SPT, Student, The Ohio State University tamelaragno@gmail.com

Bridget Gareau, SPT, Student, Cleveland State University b.gareau@vikes.csuohio.edu

Keywords: Participation, Outcomes, Parkinson’s Disease

Purpose: Parkinson’s disease (PD) is a neurodegenerative condition that affects an individual’s functional mobility due to rigidity, bradykinesia and impaired postural control. Outcome measures can be utilized to determine appropriate treatment interventions, measure progress, and monitor change over time. This study was conducted to identify outcome measures that can be consistently and efficiently performed in an outpatient neurological clinical setting. Data analysis was performed to determine which outcome measures were collected during therapy sessions. The information was analyzed to determine how many subjects had a significant change after receiving PD specific physical therapy interventions.

Number of Subjects: 101

Materials/Methods: An IRB approved retrospective review of electronic medical records was completed for all patients with a diagnosis of PD seen at the Cleveland Clinic. 101 participants, 28 females and 73 males, age 31 to 89 years old, participated in the study. The outcome measures consisted of the AM-PAC Basic Mobility, Five Times Sit to Stand, Timed Up and Go (TUG), Timed Up and Go Cognitive (TUGcog), 10 Meter Walk, MiniBEST Test, Six Minute Walk, and/or gait parameters using the GaitRite. The outcome measures were recorded by the physical therapist during the initial evaluation and over the course of treatment. Comparisons were made between baseline and post intervention utilizing the MDC value to determine significant changes. Frequencies in utilization of each outcome measurement were determined.

Results: The Five Times Sit to Stand was utilized 84% at baseline and 32 subjects demonstrated significant improvement. The TUG and TUGcog were completed 93% and 79% respectively at baseline. The MDC values are not available for the TUG and TUGcog. Further analysis will be completed to allow comparison to normative data and cut-off score for fall risk. The 10 Meter Walk was performed 83% at baseline and 40 subjects demonstrated a significant improvement. Improvement in subject performance was also noted in the AM-PAC Basic Mobility, MiniBEST Test, and 6 Minute Walk Test. These later measures were not consistently collected at baseline due to time constraints in the clinical environment.

Conclusions: These findings support the importance of consistent use of outcome measures in clinical patient care management. The outcome measures most consistently utilized in this outpatient setting at the initial evaluation include the Five Times Sit to Stand, TUG, TUGcog, and 10 Meter Walk. Further measures such as the 6 Minute Walk Test and MiniBEST Test could be completed at initial evaluation depending on time constraints or at subsequent follow-up visit.

Clinical Relevance: The Parkinson’s EDGE outcome measures taskforce has made recommendations on clinical outcomes for this patient population. This study looked at the consistency and efficiency of using the recommended outcomes in an outpatient clinical environment. This study determined four outcome measures that can be efficiently completed during the initial evaluation. Positive changes in these outcome measures based on the MDC value demonstrate the benefit of PD specific physical therapy interventions, however, these results are limited due to inconsistent data collection. Consistent use of outcome measures will allow research in the clinical environment to further investigate the benefit of PD specific physical therapy.

Szirony, Kathleen B., PT, DPT; Chan, Amy W., PT, NCS; Melaragno, Tracee , SPT; Gareau, Bridget C, SPT. Outcome Measures in Subjects with Parkinson’s Disease: Determining consistent and efficient measures to be utilized in a PD specific physical therapy setting.. Poster Presentation. IV STEP Conference, American Physical Therapy Association, Columbus, OH, July 17, 2016. Online. https://u.osu.edu/ivstep/poster/abstracts/015_sxirony-et-al/