In 2016, our team at the Shirley Ryan AbilityLab (SRAlab) designed and implemented an evidence-based consultative outpatient physical therapy program to reach people newly diagnosed with Parkinson’s Disease, a population that does not typically receive therapy under usual care guidelines. After a formal implementation evaluation at the SRAlab site, we immersed ourselves in efforts to promote continued program development and sustainment that would be resilient to the dynamic health care landscape.

We assembled a sustainment team consisting of a staff physical therapist, practice leader, and implementation researcher, and we obtained pilot funding to investigate and enhance program sustainment. We received a $20,000 grant to cover one clinician’s time to study program sustainment from 2018-2020. Engaging local outpatient therapy teams and leaders to learn how they viewed the program, we employed several tools and frameworks to inform our activities. 

• We employed the Knowledge-to-Action (KTA) Cycle to organize our sustaining processes
• We revisited some implementation frameworks that we had used to guide initial implementation:
  • The Consolidated Framework for Implementation Research – Expert Recommendations for Implementing Change (CFIR – ERIC) helped identify and adapt implementation strategies for sustainment
  • The RE-AIM framework (Reach, Effectiveness, Adoption, Implementation, and Maintenance) was used to evaluate implementation outcome measures in the maintenance phase
• We applied new tools and frameworks focused on sustainment: 
  • The Dynamic Sustainability Framework (DSF) guided acceptance of adaptations to our original implementation plan to adjust for changes within the inner setting (e.g. staffing changes, differences between clinics) as well as the broader health care context (e.g. pandemic, telehealth)
  • The National Health Service Sustainability Model and the Clinical Sustainability Assessment Tool (CSAT) helped us frame sustainability comprehensively across multiple relevant domains.

Today, the consultative physical therapy program for individuals with mild PD continues at three locations, bolstered by engaged champions and staff who continue to refine the program. Incorporating sustainability assessment has helped us to identify and thoughtfully respond to clinical implementation and sustainability challenges (e.g. staffing and leadership changes, long-term patient retention, administrative burdens). 

We recommend assessing and addressing sustainability early. We also encourage flexible implementation and documentation of adaptations to optimize program sustainability. Integrating program processes into organizational culture, workflow, and systems has promoted prolonged sustainment now for three years after funding was completed.