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A clinical practice guideline on Parkinson disease was developed by an American Physical Therapy Association volunteer guideline development group that consisted of physical therapists and a neurologist. The guideline was based on systematic reviews of current scientific and clinical information and accepted approaches for management of Parkinson disease. The Spanish version of this clinical practice guideline is available as a supplement (Suppl. Appendix 1). [ABSTRACT FROM AUTHOR]

Objective: Academic physical therapy has no universal metrics by which educational programs can measure outcomes, limiting their ability to benchmark to their own historical performance, to peer institutions, or to other health care professions. The PT-Graduation Questionnaire (GQ) survey, adapted from the Association of American Medical Colleges' GQ, addresses this gap by offering both inter-professional insight and fine-scale assessment of physical therapist education. This study reports the first wave of findings from an ongoing multi-site trial of the PT-GQ among diverse academic physical therapy programs, including (1) benchmarks for academic physical therapy, and (2) a comparison of the physical therapist student experience to medical education benchmarks. Methods: Thirty-four doctor of physical therapy (DPT) programs (13.2% nationwide sample) administered the online survey to DPT graduates during the 2019 to 2020 academic year. PT-GQ and Association of American Medical Colleges data were contrasted via Welch's unequal-variance t test and Hedges g (effect size). Results: A total of 1025 respondents participated in the study (response rate: 63.9%). The average survey duration was 31.8 minutes. Overall educational satisfaction was comparable with medicine, and respondents identified areas of curricular strength (eg, anatomy) and weakness (eg, pharmacology). DPT respondents provided higher ratings of faculty professionalism than medicine, lower rates of student mistreatment, and a lesser impact of within-program diversity on their training. One-third of respondents were less than "satisfied" with student mental health services. DPT respondents reported significantly higher exhaustion but lower disengagement than medical students, along with lower tolerance for ambiguity. Of DPT respondents who reported educational debt, one-third reported debt exceeding $150,000, the threshold above which the DPT degree loses economic power. Conclusions: These academic benchmarks, using the PT-GQ, provided insight into physical therapist education and identified differences between physical therapist and medical student perceptions. Impact: This ongoing trial will establish a comprehensive set of benchmarks to better understand academic physical therapy outcomes. [ABSTRACT FROM AUTHOR]

Background Declining physical activity commonly occurs in people with Parkinson disease (PD) and contributes to reduced functional capacity and quality of life. Objective The purpose of this study was to explore the preliminary effectiveness, safety, and acceptability of a mobile health (mHealth)–mediated exercise program designed to promote sustained physical activity in people with PD. Design This was a 12-month single-blind (assessor), pilot, comparative-effectiveness, randomized controlled study. Methods An mHealth-mediated exercise program (walking with a pedometer plus engagement in planned exercise supported by a mobile health application) was compared over 1 year with an active control condition (walking with a pedometer and exercise only). There were 51 participants in a community setting with mild-to-moderately severe (Hoehn and Yahr stages 1–3) idiopathic PD. Daily steps and moderate-intensity minutes were measured using a step activity monitor for 1 week at baseline and again at 12 months. Secondary outcomes included the 6-Minute Walk Test, Parkinson Disease Questionnaire 39 mobility domain, safety, acceptability, and adherence. Results Both groups increased daily steps, moderate-intensity minutes, and 6-Minute Walk Test, with no statistically significant between-group differences observed. In the less active subgroup, changes in daily steps and moderate-intensity minutes were clinically meaningful. An improvement in the Parkinson Disease Questionnaire 39 mobility score favored mHealth in the overall comparison and was statistically and clinically meaningful in the less active subgroup. Limitations The limitation of the current study was the small sample size. Conclusions Both groups improved physical activity compared with expected activity decline over 1 year. The addition of the mHealth app to the exercise intervention appeared to differentially benefit the more sedentary participants. Further study in a larger group of people with low activity at baseline is needed. [ABSTRACT FROM AUTHOR]

Objective: Functional near-infrared spectroscopy (fNIRS) is a non-invasive functional neuroimaging method that indirectly measures cortical activation via task-related changes in oxygenated hemoglobin (HbO). We used fNIRS during a working memory task to assess learning effect over time by assessing brain activity (fNIRS signal) and task performance. We hypothesized that in later blocks of the task, learning (better accuracy) would be correlated to less increase in HbO in prefrontal regions, indicating improved cognitive efficiency. Method: Eighteen healthy adults [mean age = 24.9 (SD = 4.2); 14 female] engaged in 8 blocks of serial-3 subtraction for 30 seconds each followed by 20 seconds of rest. fNIRS data were collected in 8 cortical regions of interest (ROI) broadly covering the frontal lobe. fNIRS signal in each ROI and task-performance data were compared for the first 4 and last 4 blocks to examine learning. Results: fNIRS signal was significantly greater for the first 4 than last 4 blocks (z = −2.1, p < 0.05) in only the right dorsolateral prefrontal cortex ROI. No learning effects appeared for any task-performance variables. Conclusions: These results indicate a dissociation between brain activity and task performance during a working memory task in healthy adults. There was less activity in the right dorsolateral prefrontal cortex during later than earlier trials, indicating an increase in this region's efficiency, without a change in task performance. The results suggest that fNIRS may be sensitive to change in brain activity before it appears clinically, which may be useful in studying people with conditions such as preclinical Alzheimer's disease, and in assessing subtle effects of interventions. [ABSTRACT FROM AUTHOR]

Background. Declining ambulatory activity represents an important facet of disablement in Parkinson disease (PD). Objective. The primary study aim was to compare the 2-year trajectory of ambulatory activity decline with concurrently evolving facets of disability in a small cohort of people with PD. The secondary aim was to identify baseline variables associated with ambulatory activity at 1- and 2-year follow-up assessments. Design. This was a prospective, longitudinal cohort study. Methods. Seventeen people with PD (Hoehn and Yahr stages 1 -3) were recruited from 2 outpatient settings. Ambulatory activity data were collected at baseline and at 1- and 2-year annual assessments. Motor, mood, balance, gait, upper extremity function, quality of life, self-efficacy, and levodopa equivalent daily dose data and data on activities of daily living also were collected. Results. Participants displayed significant 1- and 2-year declines in the amount and intensity of ambulator)' activity concurrently with increasing levodopa equivalent daily dose. Worsening motor symptoms and slowing of gait were apparent only after 2 years. Concurrent changes in the remaining clinical variables were not observed. Baseline ambulatory activity and physical performance variables had the strongest relationships with 1- and 2-year mean daily steps. Limitations. The sample was small and homogeneous. Conclusions. Future research that combines ambulatory activity monitoring with a broader and more balanced array of measures would further illuminate the dynamic interactions among evolving facets of disablement and help determine the extent to which sustained patterns of recommended daily physical activity might slow the rate of disablement in PD. [ABSTRACT FROM AUTHOR]

A correction to the article "Physical Therapist Management of Parkinson Disease: A Clinical Practice Guideline From the American Physical Therapy Association," by J. A. Osborne at al, that was published in a 2022 issue is presented.

Background. The newly developed Brief-Balance Evaluation System Test (Brief-BESTest) may be useful for measuring balance and predicting falls in individuals with Parkinson disease (PD). Objectives. The purposes of this study were: (1) to describe the balance performance of those with PD using the Brief-BESTest, (2) to determine the relationships among the scores derived from the 3 versions of the BESTest (ie, full BESTest, Mini-BESTest, and Brief-BESTest), and (3) to compare the accuracy of the Brief- BESTest with that of the Mini-BESTest and BESTest in identifying recurrent fallers among people with PD. Design. This was a prospective cohort study. Methods. Eighty participants with PD completed a baseline balance assessment. All participants reported a fall history during the previous 6 months. Fall history was again collected 6 months (n51) and 12 months (n40) later. Results. At baseline, participants had varying levels of balance impairment, and Brief-BESTest scores were significantly correlated with Mini-BESTest (r=.94, P.001) and BESTest (r=.95, P.001) scores. Six-month retrospective fall prediction accuracy of the Brief-BESTest was moderately high (area under the curve [AUC]=0.82, sensitivity 0.76, and specificity=0.84). Prospective fall prediction accuracy over 6 months was similarly accurate (AUC=0.88, sensitivity=0.71, and specificity=0.87), but was less sensitive over 12 months (AUC0.76, sensitivity=0.53, and specificity=0.93). Limitations. The sample included primarily individuals with mild to moderate PD. Also, there was a moderate dropout rate at 6 and 12 months. Conclusions. All versions of the BESTest were reasonably accurate in identifying future recurrent fallers, especially during the 6 months following assessment. Clinicians can reasonably rely on the Brief-BESTest for predicting falls, particularly when time and equipment constraints are of concern. [ABSTRACT FROM AUTHOR]

Background. Environmental and task modifications are powerful methods used to affect action in rehabilitation and are frequently used by therapists. Objective. The purpose of this study was to examine and quantify the relationship between hand size (person characteristics) and object size (environmental characteristics) and the effect of this relationship on the emergent reaching patterns for children and adults with typical development. Design. This was a cross-sectional prospective study. Methods. Seventeen children and 20 adults participated and were required to reach and grasp 10 pairs of cubes of different sizes. The dimensionless ratios were calculated by dividing the cube size by the aperture between index finger and thumb to quantify emergent reach and grasp patterns. A critical ratio was used to establish the shift from a 1-handed to an exclusive 2-handed reach pattern. Results. The results demonstrated no significant difference in the mean critical ratios between the 2 groups. However, a 2-handed reach was used more frequently than a 1-handed reach at a significantly smaller ratio for children in comparison with adults. Limitations. The relational metrics between the cube and hand are only one contribution to the emergent reaching and grasping patterns. Conclusions. Children had more variability of reaching patterns than adults. A personal constraint, such as experience, and a task constraint of accuracy may account for the variability. The results encourage further research on body-scaled information for individuals with different personal constraints (eg, children with cerebral palsy) and the impact of body-scaled information on emergent actions. [ABSTRACT FROM AUTHOR]