Implementation of highly challenging balance training for Parkinson’s disease in clinical practice: a process evaluation

Abstract Background Process evaluations provide contextual insight into the way in which interventions are delivered. This information is essential when designing strategies to implement programs wider clinical practice. We performed a process evaluation of HiBalance effectiveness trial investigating effects 10-week highly challenging and progressive balance training for mild-moderate Parkinson’s disease (PD). Study aims were investigate i) quality quantity intervention delivery ii) barriers facilitators implementation. Methods outcomes included; Fidelity; Dose (delivered received) Recruitment Reach. Investigation was guided by Consolidated Framework Implementation Research. Program assessed across four neurological rehabilitation sites during two-year period. Data collection mixed-methods nature quantitative qualitative data merged analysis phase. Results Thirteen program trainers delivered 12 separate groups 119 sessions. Trainer fidelity core components very high 104 (87%) Participant responsiveness generally high, although adherence home exercise low (50%). No significant context-specific differences observed terms fidelity, dose delivered/ received or participant characteristics, despite varying recruitment methods. Facilitators were; PD-specificity, frequency professional autonomy. Perceived cognitive impairment, absent reactional among participants, as well heterogeneous group relation capacity. Conclusion These findings corroborating evidence outcome results valuable further adaptation implementation this program. Important lessons can also be learned researchers clinicians planning people with PD. Trial registration ClinicalTrials.gov, NCT02727478 , registered 30 march, 2016 ? Retrospectively registered.