Evaluating Dysarthria Treatment in Parkinson Disease Per Patient, Family and Clinician: Treatment Implementation, Barriers and Facilitators, and Outcomes and Adherence - PROJECT SUMMARY Hypokinetic dysarthria, a motor speech disorder affecting approximately 90% of individuals with Parkinson's disease (PD), is characterized by reduced speaking volume, imprecise articulation, impaired prosody, and decreased speech intelligibility. These speech and voice symptoms result in substantial communication difficulties, often leading to social isolation and diminished quality of life. Addressing these symptoms is a crucial component of motor speech interventions, aimed at improving communication and enhancing overall well-being for individuals with PD. While randomized controlled trials have reported on the efficacy of motor speech interventions for hypokinetic dysarthria in highly constrained environments, therapy outcomes and adherence have not been studied in dynamic clinical practice conditions. Real-life healthcare environments differ from clinical research trials in several key respects, including patient diversity, clinician training and experience, and the presence of organizational and structural barriers, such as resource availability, productivity demands, and policy constraints. Pragmatic clinical trials are specifically designed to bridge this gap by evaluating how interventions perform in routine clinical environments. This project will employ a pragmatic clinical trial design to characterize patient outcomes and the contextual factors associated with treatment delivery in real-world clinical settings. Specifically, we will examine treatment outcomes and adherence over time for a broad group of patients with PD in various practice settings (Specific Aim 1). In addition, we will examine changes in therapy outcomes in the context of patient-, disease-, and healthcare factors in order to better understand the factors associated with treatment response (Specific Aim 2). This is an important first step in understanding which patients are most likely to benefit from specific therapy approaches, so we can improve clinical decision-making guidelines. Focus groups with patients and caregivers will explore perceived barriers and facilitators that influence treatment participation and adherence (Specific Aim 3). Finally, using clinician-reported survey and focus group data, we will identify the perceived barriers and facilitators to implementing evidence-based dysarthria interventions across diverse healthcare environments (Specific Aim 4). By identifying the patient, clinician, and system-level factors that influence treatment response and adherence, this research will inform the future development of scalable implementation strategies to enhance the reach, effectiveness, and long-term impact of dysarthria interventions across healthcare settings.
