Practitioner perspectives on the implementation of the Lee Silverman Voice Treatment-BIG® Program

Abstract

Objective To explore clinician perspectives on the LSVT-BIG® certification and the individual implementation of LSVT-BIG® programs. Design Mixed methods design consisting of a survey and semi-structured interviews. Setting This study was conducted virtually through use of electronic surveys and video conferencing for interviews. Participants Participants were recruited through the LSVT-BIG® certified clinicians Facebook page run by parent company LSVT-Global®. Forty-seven clinicians participated in the study in some capacity. Results Respondents consisted largely of clinicians in the outpatient setting (n = 30). Forty-seven percent reported utilizing the LSVT-BIG® program for patient populations outside of the Parkinson’s Disease diagnosis (n = 17). Sixty-one percent of respondents reported using the same assessment battery with all patients (n = 22). Ninety-five percent of respondents reported billing insurance for their services (n = 21). Neuro-Muscular Re-Education (n = 17), Therapeutic Activity (n = 16), and Therapeutic Procedure/Exercise (n = 15) were the highest reported CPT® codes. Twenty-three percent reported offering the LSVT-BIG® program via telehealth (n = 5). Semi-structured interviews identified patient payment burden, frequency of in-clinic visits and clinical space as barriers to implementation. Conclusions Clinicians have identified several barriers to implementing the LSVT-BIG® program. High frequency of in-clinic visits presents as a feasibility challenge as well as a contributor of high payment burden on the patient. Clinicians vary in their settings, use of assessment and billing. Further research should continue to explore the clinician perspectives on the barriers to implementation of the LSVT-BIG® program. A deeper look into the clinician perspectives on the protocol, such as the high frequency of in-clinic visits, should be explored to identify ways to make the LSVT-BIG® program more feasible. Additionally, further research should continue to explore the differences in implementation between clinicians in areas of assessment and billing to understand best implementation practices. Key Words Occupational therapy, physical therapy, neurological rehabilitation