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Designing a service evaluation tool for service users with mild-moderate stage Parkinson’s disease

Parkinson’s disease (PD) is a neurodegenerative disorder with both motor and non-motor symptoms. The management of PD focuses on symptom management through pharmacological therapy [1–2]. Despite the benefits of pharmacological interventions, people living with PD can still experience reductions in mobility, balance and daily functioning [3]. Therefore, there has been a significant shift towards the inclusion of rehabilitation and allied health professionals in the management of people living with PD [4]. This has been further supported by the publication of specific European physiotherapy guidelines for people living with PD [5]. The guidelines highlight 5 core areas for physiotherapy assessment and management, physical capacity, transfer ability, manual activities, balance and gait [5], which should be routinely assessed in individuals living with PD. The guidelines highlight the importance of goal orientated and patient centred treatment plans and identifies valid and reliable outcome measures that can be used in this clinical population. Involving patients in goal setting and treatment plan development has a beneficial effect on treatment adherence, satisfaction and motivation [6–8]. Furthermore, the guidelines for professional practice in physiotherapy state that physiotherapists should ensure that the patient is fully involved in developing any treatment plan and that the goals of the individual and their carers should be considered when designing a management plan [5]. Service evaluation and clinical audit are important components of physiotherapy practice that ensures safe, effective, equitable, patient-centred and evidence based care is delivered to service users. To the authors’ knowledge no service evaluation tool based on the European physiotherapy guidelines for PD exists that assesses the quality of service delivered to individuals living with mild-moderate PD. Therefore, we aimed to design and utilise a service evaluation tool for service users with mild to moderate stage PD based on the European Guidelines for physiotherapy in PD. A retrospective chart review was completed of individuals living with mild-moderate PD attending the neurology outpatient physiotherapy service in St. James’s Hospital Dublin between February 2019 and February 2021. The physiotherapy records were examined and the service provided to the service user evaluated using a service evaluation tool that included the 5 core areas identified in European Guidelines for physiotherapy [5]. In addition, the evaluation tool recorded whether a validated outcome measure was used with each service user and whether treatment goals were discussed. Permission to complete the study was granted by the St. James’s Hospital Research and Innovation office. Eighty-three (53 male, 30 female; mean age 68.5 ± 11.3 years) service users with mild to moderate PD (Mean Hoehn & Yahr rating 1.5 ± 0.7) were included in the study. Transfers, physical capacity, gait and balance were assessed in 98% of service users while manual activities assessed were assessed in 72% of service-users. Treatment goals were agreed and set with 88% of service users and an outcome measure was completed with 88% of service users. The Berg balance scale (n1⁄4 47) and the 5 times sit to stand (n1⁄4 43) were the most commonly used outcome measures. The mean Berg score was 49/56 (4.7) (range 38–56) and the mean 5TSTS time was 13.0 s (5.7) (range 5.6–33.0s). There were no differences between outcome measure scores between males and females. The mean number of falls reported by service users in the past year was 1.0 (1.5) (range 0–6). Our main findings are that the European Physiotherapy guidelines for Parkinson’s disease can be used to develop an easily administered service evaluation tool. We found that 4 of the core areas of physiotherapy in PD were assessed 98% of the time with the exception of manual activities and that goals were discussed with the majority of service users. This indicates that a high quality, evidence based service was being delivered to service-users. This study highlighted some further aspects for service development. Firstly, the service-user experience was not captured. The next step in developing this evaluation tool will be to include patient feedback to ensure that the service is meeting their needs. Secondly, the lower percentage of the assessment of manual activities compared to the other core areas of physiotherapy in PD merits investigation. Possible reasons for this could be that impairments in manual activities were not reported by the service user subjectively or that there may not have been a section of the clinic assessment form for manual activities which could act as a subconscious prompt for assessment of this area. In summary, our results show that a comprehensive and easily used service evaluation tool can be designed based on the European Physiotherapy Guidelines for Parkinson’s disease.