Objective: To evaluate implementation of LSVT BIG across diverse health care systems, languages, and culture in Germany, France and Japan.

Background: The goal of implementation science is translation of evidence into clinical practice to impact patient care. Implementation research examines how best to achieve this goal across diverse global settings (e.g., health systems, cultures) [1]. Lee Silverman Voice Treatment (LSVT BIG®), a physical/occupational therapy developed in the USA, improves mobility and activities of daily living in people with Parkinson disease (PD). Published studies in the USA, Germany, Switzerland and Japan [2, 3, 4, 5] support the short-term efficacy of LSVT BIG for people with PD. LSVT BIG provides a standardized framework for treatment and globally standardized training for therapists to support treatment fidelity.

Method: From 2011 – 2018, LSVT BIG Courses were held in Germany (25), France (3) and Japan (7) resulting in more than 790, 142, and 565 LSVT BIG Certified clinicians, respectively. A translated online survey was given to these clinicians to assess implementation of LSVT BIG from the perception of practicing therapists.

Results: Results revealed 94% of German, 93% of French and 73% of Japanese respondents felt they had received effective training in LSVT BIG. Since becoming certified 96% of German, 83% of French and 70% of Japanese respondents have implemented LSVT BIG in their practice. Of those, 93% of German, 90% of French and 36% of Japanese felt confident in their delivery of treatment, and 84%, 77% and 52% respectively felt they were achieving better outcomes with LSVT BIG.  Common challenges to implementation across countries were: 1) inadequate funding for intensive therapy 2) scheduling difficulties and 3) patients unable to commit to the required dosage.  A unique challenge for Japanese clinicians was how to deal with patient co-morbidities.

Conclusion: LSVT BIG is being successfully implemented by many therapists in these countries; however, there remain challenges.  Understanding barriers may facilitate solutions, such as local advocacy, patient/physician education, and access to LSVT resources for certified clinicians. This knowledge may improve adoption and fidelity of evidence-based rehabilitation interventions around the world for people with PD.  These data will be presented at the WPC in Kyoto, Japan, June 4-7, 2019.

References: [1] Peters DH, Adam T, Alonge O, Agyepong IA, Tran N., (2013). Implementation research: what it is and how to do it. BMJ; 347 doi: https://doi.org/10.1136/bmj.f6753 [2] Farley, B.G., & Koshland, G.F. (2005). Training BIG to move faster: the application of the speed-amplitude relation as a rehabilitation strategy for people with Parkinson’s disease. Experimental Brain Research, 167(3), 462-7. [3] Ebersbach, G., Ebersbach, A., Edler, D., Kaufhold, O., Kusch, M., Kupsch, A., & Wissel, J. (2010). Comparing exercise in Parkinson’s disease–the Berlin LSVT® BIG study. Movement Disorders, 25(12), 1902-8. [4] Janssens J, Malfroid K, Nyffeler T, Bohlhalter S, Vanbellingen T. (2014). Application of LSVT BIG intervention to address gait, balance, bed mobility, and dexterity in people with Parkinson disease: a case series. Physical Therapy, 94(7), 1014-23. [5] Ueno, T., Sasaki, M., Nishijima, H., Funamizu, Y., Kon, T., Haga, R., Arai, A., Suzuki, C., Nunomura, J, Baba, M, Tomiyama, M. (2017). LSVT_BIG Improves UPDRS III Scores at 4 Weeks in Parkinson’s Disease Patients with Wearing Off: A Prospective, Open-Label Study. Parkinson’s Disease, Epub Feb 1.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/evaluating-implementation-of-an-evidence-based-physical-and-occupational-therapy-lsvt-big-for-parkinsons-disease-germany-france-and-japan/