2020 APTA Combined Sections Meeting Scientific Poster Presentation: How Well Do Clinical Walking Measures Predict Natural Walking Behavior In Parkinson Disease?

Declines in the amount and intensity of natural walking behavior in people with Parkinson disease (PD) may precede declines in motor behavior, gait, and balance. Physical interventions targeting walking behavior in PD may have the greatest impact on slowing the progression of disability. Despite a lack of supporting evidence, however, clinicians may be more likely to rely on quick performance measures of walking speed, capacity, and balance to make inferences about a patient’s walking health, rather than direct measures of natural walking behavior. Our primary purpose, therefore, was to examine the extent to which clinical walking measures might predict natural walking behavior in early to mid-stage PD. Secondarily we sought to explore differences in the predictive capability of clinical measures between relatively less active and more active participants.https://dune.une.edu/pt_facpost/1006/thumbnail.jp

Updated Poster Presentation Abstract (n = 58) From 2020 Combined Sections Meeting Of The American Physical Therapy Association: How Well Do Clinical Walking Measures Predict Natural Walking Behavior In Parkinson Disease?

Declines in the amount and intensity of natural walking behavior in people with Parkinson disease (PD) may precede declines in motor behavior, gait, and balance. Physical interventions targeting walking behavior in PD may have the greatest impact on slowing the progression of disability. Despite a lack of supporting evidence, however, clinicians may be more likely to rely on quick performance measures of walking speed, capacity, and balance to make inferences about a patient’s walking health, rather than direct measures of natural walking behavior. Our primary purpose, therefore, was to examine the extent to which clinical walking measures might predict natural walking behavior in early to mid-stage PD. Secondarily we sought to explore differences in the predictive capability of clinical measures between relatively less active and more active participants

Economic costs of implementing group interventions to reduce diabetes distress in adults with type 1 diabetes mellitus in the T1-REDEEM trial

AimsThis study evaluated the implementation costs of two group interventions, one focused on diabetes education (KnowIt) and one focused directly on diabetes distress (OnTrack), that reduced diabetes distress and HbA1C in adults with poorly controlled type 1 diabetes (T1DM) in the T1-REDEEM trial.MethodsResources used to provide interventions were enumerated using activity-based micro-costing methods. Costs were assigned to resources in 2017 US dollars. US median wage and benefit rates were used to calculate costs of staff time. Cost per unit change was calculated for diabetes distress and HbA1C.ResultsFor both interventions, per participant implementation costs were approximately $250 and cost per 1.0 percentage point (11 mmol/mol) change in HbA1C was$1400. Cost per unit change in diabetes distress was $364 for KnowIt and$335 for OnTrack. No statistically significant differences in costs were observed.ConclusionsThis is the first study to examine the costs of implementing interventions targeting diabetes distress in the context of T1DM. Both interventions had per participant implementation costs in the lower end of the range of previously examined diabetes self-management interventions ($219 to$5390). These inventions and their costs merit further attention because reducing diabetes distress may impact long term T1DM outcomes.Clinical trials registrationClinicalTrials.govNCT02175732

T1-REDEEM: A Randomized Controlled Trial to Reduce Diabetes Distress Among Adults With Type 1 Diabetes

ObjectiveTo compare the effectiveness of two interventions to reduce diabetes distress (DD) and improve glycemic control among adults with type 1 diabetes (T1D).Research design and methodsIndividuals with T1D (n = 301) with elevated DD and HbA1c were recruited from multiple settings and randomly assigned to OnTrack, an emotion-focused intervention, or to KnowIt, an educational/behavioral intervention. Each group attended a full-day workshop plus four online meetings over 3 months. Assessments occurred at baseline and 3 and 9 months. Primary and secondary outcomes were change in DD and change in HbA1c, respectively.ResultsWith 12% attrition, both groups demonstrated dramatic reductions in DD (effect size d = 1.06; 78.4% demonstrated a reduction of at least one minimal clinically important difference). There were, however, no significant differences in DD reduction between OnTrack and KnowIt. Moderator analyses indicated that OnTrack provided greater DD reduction to those with initially poorer cognitive or emotion regulation skills, higher baseline DD, or greater initial diabetes knowledge than those in KnowIt. Significant but modest reductions in HbA1c occurred with no between-group differences. Change in DD was modestly associated with change in HbA1c (r = 0.14, P = 0.01), with no significant between-group differences.ConclusionsDD can be successfully reduced among distressed individuals with T1D with elevated HbA1c using both education/behavioral and emotion-focused approaches. Reductions in DD are only modestly associated with reductions in HbA1c. These findings point to the importance of tailoring interventions to address affective, knowledge, and cognitive skills when intervening to reduce DD and improve glycemic control