Regular physical activity is beneficial to maintain functional mobility and quality of life for people with chronic neurological disorders, including ParkinsonÕs disease. Evidence has shown that when compared to a home exercise program, exercise completed under supervision additionally improves functional mobility. Aerobic training, resistance training and postural control activities show significant benefit in improving motor control and neuroplasticity in this patient population. People with a diagnosis of ParkinsonÕs disease may have difficulties maintaining an exercise program outside of formal physical therapy treatment. The University of Wisconsin-La Crosse Physical Therapy Program identified the need to establish a program that links Physical Therapy education with a community need to provide adults with neurological disorders an opportunity to learn how to maximize their health and wellness. The collaborative learning model was developed to improve student physical therapy clinical skills, specifically in neurological rehabilitation, prior to formal clinical experiences and graduation. The purpose of this paper is to determine whether the supervised student physical therapist led wellness program (EXPAND) demonstrates improvement in outcomes measures for community clients with diagnosed ParkinsonÕs disease; and show whether student confidence in clinical skills increased as a result of participation in the EXPAND program. Subjects: 27 clients with ParkinsonÕs disease (13 female, 14 male; mean age 73.36 +/- 7.33)
Community-dwelling clients with ParkinsonÕs disease are referred for application to the EXPAND (Exercise Program for Adults with Neurologic Disorders) program at the University of Wisconsin Ð La Crosse. Lead faculty review all applications and offer available openings to clients based on criteria, including current level of mobility, past medical history, clientÕs goals and availability for all sessions. Clients are paired with one second year physical therapy student for the duration of the semester. Under the supervision of faculty, students plan and implement one-on-one sessions with the clients 2x/week for 1 hour each session for a total of 13 weeks (25 sessions). Each session focuses on health and wellness and includes exercises for strength, balance and aerobic endurance. Outcome measures are performed at the beginning and end of the semester (6MWT, TUG, FGA, 5xSTS, 10MWT, gait speed, functional reach and alternating step-tap). Of the 44 clients who participated in the fall 2019 semester, 27 clients presented with ParkinsonÕs disease and were chosen for this paper. Post-testing and baseline testing were compared using two-tailed dependent t-tests (alpha = 0.05); CohenÕs d effect size (ES) statistics were also calculated by dividing the difference between the means (post vs. baseline) by average of the standard deviation. Students were surveyed for post-assessment of clinical confidence in 7 categories of clinical practice and patient care.
Clients demonstrated a 15.0% decrease in 5xSTS time (p=.003; ES = 0.48), 17.3% decrease in TUG time (p<.001; ES = 0.74), 10.1% increase in comfortable gait speed (p<.001; ES = 0.48), and 14.5% increase in walk distance (p<.001 ES = 0.56) following training (post-training vs. baseline). Each of these changes reflects improved performance. Students reported high levels of confidence with selecting/using outcome measures, developing a plan of care, selecting/implementing interventions, establishing home exercise programs, discharge planning, supervision of support personnel, and documentation following completion of the program.
Conclusions/Relevance to the conference theme:
A 13-week community-based supervised student-led wellness program with focus on strength, balance and aerobic training, demonstrates improvement in functional outcome measures. Supervised student physical therapist led wellness programs for adults with ParkinsonÕs disease should be considered by graduate physical therapy programs due to the benefit to the client and the student.