Measure Up: Implementing Interdisciplinary Outcome Measures in Parkinson’s Rehabilitation with Knowledge Translation Strategies

Research Objectives: To implement consistent measurement of functional outcomes including the Timed Up and Go (TUG), Five Times Sit to Stand Test (5TSTS), Vocal Volume, Voice Handicap Index (VHI) for patients with Parkinson’s Disease in an Inpatient Rehabilitation Facility

Design: A quality improvement study using before and after implementation data

Setting: Inpatient rehabilitation Parkinson’s Disease program with patients in Hoehn and Yahr (H&Y) Stages III-V

Participants: Physical therapists, occupational therapists, and speech and language pathologists

Interventions: Implementation was achieved using the knowledge to action framework. Stakeholders were identified and consulted throughout the project. The problem identified was lack of consistency and standardization in measurement of functional outcomes for patients with Parkinson’s Disease. The outcomes chosen were the TUG, 5TSTS, Vocal Volume and VHI. These were chosen based on ease of completing the measure in a timely manner and evidence supporting these measures as reliable and valid in patients in H&Y Stage I-III. The evidence was adapted to the local context as patients in this inpatient rehabilitation facility are H&Y Stage III-V. Barriers to implementation were space, knowledge, documentation templates, and value identified through focus groups. Interventions included education about how to perform the test reliably, environmental modifications (markings for the TUG, use of an area with low traffic), modifications of the electronic medical record and partnership with the interdisciplinary team to increase the value of measurement. Knowledge use was monitored via regular audits of medical records. Outcomes continue to be evaluated until sustainability is achieved.

Main Outcome Measures: Compliance with set of functional outcome measures including TUG, 5TSTS, Vocal Volume and VHI in the medical record.

Results: A consistent increase in compliance in performing the measures is noted since auditing began in June 2023. Compared to Q3 2023 (n= 32 patients discharged), in Q1 2024 (n= 40 patients discharged), compliance upon admission for the TUG increased from 84.4% to 100.0%, 5TSTS increased from 71.9% to 97.5%, VHI increased from 81.3% to 97.5% and Vocal Volume increased from 96.9% to 100.0%. Compared to Q3 2023, in Q1 2024, compliance upon discharge for the TUG increased from 76.9% to 92.5%, 5TSTS increased from 80.8% to 92.5%, VHI increased from 80.8% to 97.5% and Vocal Volume increased from 88.5% to 97.5%.

Conclusions: Using the knowledge to action framework guided this project and improved compliance with measurement. Creating value in standardized measurement was challenging. Compliance audits and communication of results to team members, providing objective feedback had the greatest impact on achieving positive outcomes.

Author(s) Disclosures: None