Practitioner perspectives on the implementation of the Lee Silverman Voice Treatment BIG® program.

Background: The Lee Silverman Voice Treatment BIG® (LSVT BIG®) intervention, originally designed for the patients with Parkinson's disease, is a high amplitude, high repetition therapy protocol that encourages bigger, more quality movements. The purpose of this study was to understand practitioner utilization and perspectives of the LSVT BIG® intervention as there is no published work in this area. Methods: An electronic survey with optional debriefings was distributed to LSVT BIG® certified practitioners via the Facebook page run by parent company, LSVT Global Inc. Results: Forty-seven practitioners engaged in this study. Practitioners were largely in the outpatient setting. Forty-seven percent reported utilizing the LSVT BIG® intervention for patient populations outside of the Parkinson's disease diagnosis. Sixty-one percent of respondents reported using the same assessment tools and ninety-five percent reported billing insurance for their services. Twenty-three percent reported offering the LSVT BIG® intervention via telehealth. Debriefings identified barriers to implementation. Conclusion: Practitioners are implementing the LSVT BIG® intervention across settings and are most likely to be in the outpatient setting, serving patients who possess a neurological diagnosis, and focus their assessment on lower extremity, gait, and balance. When billing insurance, practitioners routinely select the three CPT® codes: Neuromuscular Re-Education, Therapeutic Activity, and Therapeutic Procedure/Exercise. Practitioners identified several barriers to implementing the LSVT BIG® program, such as the high frequency of in-clinic visits. Practitioners are currently unsystematically modifying the program to meet patient and practitioner needs. Further research should continue to explore the practitioner perspectives on implementation of the LSVT BIG® intervention.