Fidelity to the Lee Silverman Voice Treatment® big intervention : the state of practice and recommendations for increased clinical utility
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The Lee Silverman Voice Treatment® BIG (LSVT BIG®) is a high-intensity, high-amplitude intervention used by occupational and physical therapy practitioners. Originally designed for, and primarily used with individuals with Parkinson's disease, this intervention promotes larger, more functional movements. While its clinical outcomes are well-studied, little is known about fidelity to LSVT in practice. This study examines practitioner fidelity to the LSVT BIG® protocol using a convergent mixed-methods approach, including an electronic survey (135 respondents) and semi-structured interviews (five participants) with certified practitioners. Findings indicate low fidelity to both the program structure and core components, with the four weekly in-clinic visit structure and BIG walking component most frequently modified. Reasons for modification exist at a variety of levels. Practitioners reported using a patient-centered approach when making modifications. These results highlight the need for further research into a modified protocol to increase clinical feasibility. We propose a modified protocol designed to address these concerns through a reduction in weekly in-clinic visits from four to two, a reduction in repetitions to reduce time-burden, and increased education on how to incorporate BIG walking throughout the intervention protocol.
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Ph. D.