Practitioner Perspectives on the Implementation of the Lee Silverman Voice Treatment-BIG® Program

Research Objectives To explore practitioner perspectives on the LSVT-BIG® certification and the current state of implementation. Design Quantitative design through an electronic survey, followed by optional debriefing through 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 practitioners participated in the study in some capacity. Interventions Not applicable. Main Outcome Measures Not applicable. Results The LSVT-BIG® program is a high amplitude, high repetition therapy protocol designed originally for patients with Parkinson's disease. This program is available through certification for occupational therapy and physical therapy practitioners. Forty-seven practitioners participated in the study in some capacity; questions varied in response rate. Respondents consisted largely of clinicians in the outpatient setting (n = 30). Forty-seven percent (n = 17) reported utilizing the LSVT-BIG® program for patient populations outside of the Parkinson's disease diagnosis. Sixty-one percent (n = 22) of respondents reported using the same assessment battery with all patients. Ninety-five percent (n = 21) of respondents reported billing insurance for their services. 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 (n =5) reported offering the LSVT-BIG® program via telehealth. Debriefings introduced the topic of clinical usability, citing challenges of protocol frequency and patient factors. Conclusions We now have a beginning idea of how the LSVT-BIG® program is being used in practice. Practitioners vary in their settings, use of assessment, and billing. Though there is ample evidence to support the use of this program, further research should continue to explore the practitioner perspectives on the barriers to implementation. A deeper look into the practitioner perspectives on the protocol, such as the high frequency of in-clinic visits, should be explored to identify ways to increase clinical usability. Author(s) Disclosures Leah Botkin - employed by Boone Health and the University of Missouri Rachel Proffitt – none.