Barriers to Adherence to Physical Therapy, Occupational therapy, and Speech/Swallowing Therapy in Parkinson’s Disease (P5.073)

Objective: To identify potential barriers to adherence to physical therapy (PT), occupational therapy (OT), and speech/swallow therapy (ST) in Parkinson’s disease (PD). Background: PT, OT, and ST are associated with improved outcomes and quality of life in PD, but many patients do not follow through with these referrals. Design/Methods: The study sample consisted of an established longitudinal cohort of outpatients with PD at our center (n=326). Chart reviews were used to identify all PT, OT, and ST referrals from this cohort within a 2-year period (n=307 referrals, involving 204 subjects). Referral nonadherence was defined as the failure to initiate therapy within 1 year. Referrals were defined as internal if they were to NYU providers, or external if they were to any other site. External referrals were subdivided into in-home versus center-based therapy. Clinical correlates of referrals with nonadherence versus adherence were analyzed using standard statistical methodology. Results: The nonadherence (n=113, 37%) and adherence groups (n=194) were similar with respect to age (68.1±11.8 vs 70.4±9.8, p=0.22), female sex (34% vs 41%, p=0.40), on-state UPDRS motor score (41.3±15.2 vs 38.9±16.9, p=0.12), Beck Anxiety Inventory scores (11.7±8.7 vs 11.5±7.8, p=0.87) and Beck Depression Inventory-2 scores (7.9±6.7 vs 7.7±5.4, p=0.45). Nonadherence was more frequent with referrals to external (versus internal) sites (41% vs 24%, p=0.006) and center-based (versus in-home) therapy (40% vs 16%, p=0.007). Nonadherence was also associated with higher apathy scores on the Apathy Evaluation Scale (11, IQR:7–15 vs 9, IQR:5–14; p=0.028), and a trend towards younger age of PD onset (58.8±11.1 vs 61.2±10.2, p=0.07). Conclusions: Location may be a major factor in adherence to PT/OT/ST referrals in PD. Further study is warranted to determine whether changes in referral patterns to favor internal or in-home locations might increase adherence to these important non-pharmacological treatments. Study Supported by: GWV was supported by an AAN Medical Student Summer Research Scholarship. CVK received support from the Orenstein Family, Dallas, TX. MJN and KMM received support from the New York Stem Cell Foundation. Disclosure: Dr Vurture has nothing to disclose. Dr. Kulick has nothing to disclose. Dr. Montgomery has nothing to disclose. Dr Nirenberg has nothing to disclose.