Objectives and Rationale:

For people with Parkinson's disease (PD), a chronic progressive condition, participation in regular exercise has been associated with slower declines in mobility and quality of life. However, it can be very difficult for people with PD to maintain long-term exercise. Decreases in exercise can occur before people experience common PD problems in walking or balance. Some of these changes in physical activity may be due to the non-motor symptoms of PD, such depression, anxiety, apathy, or fatigue.

Physical therapy (PT) is a healthcare service that can help people with PD to increase, maintain, and monitor their exercise routines. Some studies have shown that using digital health technology, such as pedometers, watches, and smart phone applications to track exercise, can help people with PD to increase their physical activity. This technology could be used by physical therapists to set goals based on objective numbers of steps per day, which is a behavioral strategy that could help people with PD gain motivation to exercise. Despite supportive research, physical therapists and people with PD frequently do not use this technology.

The purpose of the proposed project is to study different ways to integrate digital health technology and behavioral interventions into real-world PT settings to improve exercise monitoring and maintenance. We will develop and test tools to help physical therapists and people with PD to use digital health technology more effectively. The project uses a "bring your own device" approach, where people with PD attending PT will be provided resources to help them use their own smart phones to achieve their exercise goals. The majority of adults in the United States, including those over age 65, have smart phones. First, we will systematically study the factors that can make digital health technology harder (barriers) or easier (facilitators) for people with PD and physical therapists to use in their real-world practice. We will then observe a cohort of people with PD attending PT to assess how well physical therapists and people with PD can use digital health technology when they are given appropriate knowledge and tools to help them (adoption and fidelity). Finally, we will determine whether greater use of digital health technology and behavioral intervention strategies are associated with greater changes in fitness and function six months after PT evaluation.

Applicability and Impact:

The proposed study will use digital health technology and behavioral interventions to help people with PD and their physical therapists to monitor daily walking and encourage regular exercise. This research will have a direct impact on the participants, people with early PD, who are newly diagnosed or have mild to moderate motor symptoms. This study is designed to study the strategies that real-world physical therapists use to help people with PD learn to use their smart phones, not just the impact of PT. The study design means that even if the study does not show changes in function in these individuals with mild symptoms, the research team will still learn valuable information about technology use. Understanding the challenges that people face when using digital health technology, and the factors that can make technology easier to use in real-world clinical practice, will help the development of new technologies and treatments to help people with PD to exercise.

Principal Investigator: Career Growth in Parkinson's Disease Rehabilitation

I am a research-trained physical therapist with a career goal to accelerate the integration of research supporting exercise and rehabilitation for people with PD into real-world clinical settings. During my clinical and early research training, I became frustrated with the lag between research and clinical practice. The proposed research plan supports my goal because it is focused on using innovative implementation science methodology to translate the strong research on exercise and technology into PT practice. The future of medicine will require the effective use of digital health technology, and the proposed project will provide valuable information on how the PD clinical and research communities can use technology most effectively.

The researcher development plan supports my goals in three ways. First, I will receive mentorship in clinical management of the non-motor symptoms of PD, specifically behavioral strategies that can be used by physical therapists to help people with PD become more motivated to exercise. Second, the mentorship in digital health technology will help me to understand the pros and cons of various types of technology that can be used in clinical practice and future research studies. Finally, mentorship in advanced research skills, symposium preparation, and implementation research will help me to become a successful independent researcher who can lead PD rehabilitation research.