Parkinson’s Report Cards for Rural Communities: Bridging Access to Care for Behavior Change and Fall Risk Reduction

Authors

• Jamie Haines, Central Michigan UniversityFollow
• Emily Schubbe, Central Michigan UniversityFollow
• Brooke Alexander, University of Michgan Health-SparrowFollow
• Lachane Ballard, Mary Free Bed Rehabiliatation HospitalFollow
• Chin-I Cheng, Central Michigan UniversityFollow

Abstract

Purpose: People with Parkinson’s disease (PwPD) in rural communities face delayed diagnosis and limited access to specialized care, and lower self-efficacy for disease management. A physical therapist designed the Parkinson’s Report Card Program (PRCP) to provide improved access to symptom monitoring, feedback, education, and follow-up support every six months for one year, aiming to enhance disease management when access to specialized care is challenging. This study evaluated the impact of the Report Card Program on non-motor symptoms, physical function, care-seeking behaviors, and self-efficacy in three rural communities in Michigan. Methods: Twenty-eight participants completed assessments at baseline, 6 months, and 1 year. Measures: Chronic Disease Self-Efficacy Scale, Non-Motor Symptom Questionnaire, Activities-Specific Balance Confidence Scale, 10 Meter Walk Test, 3 Meter Backward Walk Test, Brief Balance Evaluation Systems Test, and 30 Second Sit-to-Stand Test. At each visit, participants received personalized report cards that reflected their physical performance and subjective questionnaire scores, followed by education and recommendations. Testing was repeated at 6 and 12 months, with changes in subjective and physical performance shared. Repeated measures ANOVA, and mixed models were used to examine changes and associations among outcomes. Results: After one year, the use of movement disorder specialists increased by 50%, and 67% of subjects received referrals to physical therapy to address impairments noted during testing. Of the fifteen subjects who previously reported exercising less than 2 days per week, 93% adopted regular exercise at least twice weekly. Significant improvements were observed in comfortable walking speed (p=.023), backward walking speed (p=.002), and functional leg strength (p=.011) as measured by the 30 second sit to stand test, which were maintained at one year. Higher self-efficacy was associated with greater balance confidence, fewer non-motor symptoms, and faster walking, although mean self-efficacy scores did not change significantly. Conclusions: Measures of fall risk, exercise frequency, and outreach to movement disorder specialists improved over the one-year monitoring program. Significant correlations between self-efficacy, non-motor symptoms, balance confidence, and walking abilities underscore the importance of early diagnosis, exercise, and specialist consultation for optimal management of the disease. PwPD living in rural communities require long-term, multi-modal support to overcome continued barriers in obtaining PD-specialized care for optimal disease management.

Author Bio(s)

Jamie Haines, PT, DScPT is a former Associate Professor in the Physical Therapy Department at Central Michigan University (Mt. Pleasant, Michigan, USA). She is a board-certified Neurological Clinical Specialist (NCS) through the American Board of Physical Therapy Specialties and is a licensed physical therapist in Michigan and Florida. She currently works in Florida in an outpatient clinical setting working with people with Parkinson's Disease. 

Emily Schubbe, DPT, EdD is an Assistant Professory in the Physical Therapy Department at Central Michigan University (Mt, Pleasant, Michigan, USA).. She is a board-certified Orthopedic Clinical Specialist (OCS) and Orthopedic Manual Physical Therapist (OMPT)

Brooke Alexander, PT, DPT is a full-time physical therapist for University of Michigan Health-Sparrow in Lansing, Michigan, USA and a recent graduate from Central Michigan University Class of 2024.

Lachane^' Ballard, PT, DPT is a full-time physical therapist for Mary Free Bed Rehabiliation Hospital in Grand Rapids, Michigan, USA abd a recebt graduate from Central Michigan University Class of 2024.

Chin-I Cheng, PhD is a Full Professor in the Department of Statistics and Actuarial and Data Science and is the Director for the Statistical Consulting Center at Central Michigan University (Mt. Pleasant, Michigan, USA)

Acknowledgements

Acknowledgments Supported by grants from the Parkinson’s Foundation the Herbert H. and Grace A. Dow College of Health Professions at Central Michigan University

Recommended Citation

Haines J, Schubbe E, Alexander B, Ballard L, Cheng C. Parkinson’s Report Cards for Rural Communities: Bridging Access to Care for Behavior Change and Fall Risk Reduction. The Internet Journal of Allied Health Sciences and Practice. 2026 Sep 01;24(3), Article 30.