Rosi:

There are ethical standards in research. It is through the American Psychological Association I get my standards. I believe that honesty in research is the best way to inform others. If something negative happens it needs to be documented in the research. Events should be documented in a graph and written form. I know from experience that clear and concise is the best way to illuminate results.

This answer is vague because I have never heard of standards other than ethical standards.What kind of research are you doing, qualitative, quantitative or mixed methods?

Susan

The case study series was originally designed for qualitative data. His was the most advanced in terms of Hoehn and Yahr staging, of the cases I have worked with, at a 4-4.5. I used 5 standardized, well validated tools to assess symptoms of Parkinson's--motor, nonmotor, QoL. Towards the end of his life, he was unable to fill out rating scales. So I relied on my observations, and verbal reports from himself and his wife and documents his wife supplied, e.g. medication charts. My documentation is in the form of narrative SOAP notes, Does this make it mixed methods--since it became qualitative towards the end? It was not part of the design!

It is speculative if and how the interventions contributed to his balance problems and falls. He continued to do his exercises, I continued to do the massage and mind-body interventions, and he was certainly standing up straighter. He was having falls, especially in turning. My observation was that his walker was no longer set to the correct height for his postural improvement. It looked to me as though he needed to have P.T., to learn better body mechanics to adapt to his change of stature and changes of gait. My observations and opinions were not from my training as a massage therapist, but rather from my experience as a foster caregiver for elderly, and as a caregiver for my uncle who had Parkinson's. So I have a mix of perspectives and it perhaps muddied my role.

Frankly, it is still hard to be objective. I don't have a template that tells me what to do and where. Yet I recognize there may be an ethical need to report it somewhere. I wish to do so to raise the possibility that beneficial symptom changes in Parkinson's might require a medication reevaluation. If that is indeed what happened?

Previously, the Medicare guidelines required demonstrated improvement in condition to cover P.T. Some of these issues might now be moot, since the new January 2014 guidelines allow P.T. where it might improve QoL or prevent falls. A great advantage for people who have conditions such as Parkinson's.

Thank you, Susan for your sharing.