Web-based stroke education for patients and families

为患者和家属提供基于网络的中风教育

• 批准号: 7479004
• 负责人: DEBRA L FOX
• 金额: $ 38.55万
• 依托单位: FOX LEARNING SYSTEMS, INC.
• 依托单位国家: 美国
• 财政年份: 2005
• 资助国家: 美国
• 起止时间: 2005-09-15 至 2010-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7479004
• 关键词: Address; African American; Age; American; American Heart Association; Behavior; Blood; Caregivers; Cause of Death; Centers for Disease Control and Prevention (U.S.); Certification; Cognitive deficits; Computers; Cost Savings; Detection; Development; Early identification; Education; Educational Background; Emotional; Family; Family member; Fostering; Goals; Health Promotion; Healthy People 2010; Heart; Hospitals; Hypertension; Impaired cognition; Individual; Inpatients; Institutes; Insurance; Internet; Ischemic Stroke; Knowledge; Lead; Learning; Life; Life Style; Lung; Measures; Medical; Minority; Monitor; Morbidity - disease rate; Nursing Homes; Online Systems; Outcome; Patient Education; Patients; Personal Satisfaction; Persons; Phase; Pilot Projects; Population; Pre-Post Tests; Provider; Psychological reinforcement; Purpose; Quality of Care; Quality of life; Recruitment Activity; Recurrence; Rehabilitation therapy; Risk; Risk Factors; Secondary Prevention; Self Assessment; Self Perception; Small Business Funding Mechanisms; Small Business Innovation Research Grant; Smoking Behavior; Source; Stroke; Stroke prevention; Survivors; Technology; Testing; Time; Training; United States Dept. of Health and Human Services; Week; animation; base; burden of illness; disability; disorder prevention; health disparity; improved; medical specialties; modifiable risk; programs; prototype; stroke education; stroke rehabilitation

DESCRIPTION (provided by applicant): Ischemic stroke is a major source of illness burden in the US. Stroke survivors are at high risk for recurrence and therefore they are an important group for secondary prevention. However, gaps in knowledge among stroke survivors, including inadequate knowledge of the early warning signs of stroke, inadequate understanding of the purpose and goals of rehabilitation, and lack of awareness of personal risk factors, lead to preventable stroke-related morbidity. Education to address these knowledge gaps is typically inadequate during inpatient rehabilitation for stroke. An effective program of education for stroke survivors could improve stroke outcomes by promoting rehabilitation, reducing the risk of another stroke and reducing morbidity of recurrent strokes. In the Phase I SBIR, we established the feasibility of developing a web-based education for stroke survivors and their families. We developed a prototype to impart basic knowledge about stroke, including warning signs, risk factors, and management of one of the common risk factors (hypertension). This prototype is an interactive web-based educational program, using video format and animation, as well as self-assessments and adaptive learning through computer technology to address cognitive deficits. A pilot study of this prototype with 25 stroke patients and 7 caregivers was conducted, with approximately half of the subjects using the Web-based training without adaptive learning, and the other half with adaptive learning. The program was well-accepted and stroke-related knowledge improved significantly compared to baseline for all subjects. Without the adaptive learning, the mean improvement in correct answers on pre-post testing was 2.0. When the adaptive learning component was integrated into the Web-based training, the mean improvement in correct answers on pre-post testing was 5.1. The Phase I prototype can be accessed for review at www.strokelearning.com. We now propose in Phase II to complete the development of this web-based program, so that it addresses all of the main manageable risk factors, provides general stroke knowledge, and provides an understanding of stroke rehabilitation. Importantly, this program will maintain a focus on changing patients' behavior, empowering them to reduce their risk for further strokes and benefit more optimally from rehabilitation. The program will also adapt to patients' level of knowledge and cognitive impairments. It will iteratively measure gains in knowledge by patients and caregivers and in doing so will reinforce learning over multiple sessions. As part of Phase II, we will test the efficacy of this program in improving patient and caregiver stroke knowledge at the time of discharge, and monitor change in risk- related behavior (smoking) at 2 and 6 weeks post-discharge in a controlled trial of 200 stroke patients and family members. This program will be a marketable product to providers of medical treatment for stroke, including rehabilitation hospitals which must meet specific patient education requirements, hospitals which are seeking stroke specialty certification and nursing homes. Additionally, insurance companies that wish to improve stroke prevention efforts (and thus save costs as well as improve patients' quality of care) may be a source of revenue. Stroke, the 3rd leading cause of death and a leading cause of disability in the US afflicts between 700,000 and one million Americans annually, with African-Americans at particularly high risk. The 4.8 million stroke survivors in the US represent a large at-risk group for a recurrence of stroke. In fact, they are at 15 times greater risk of stroke compared to age-matched normals. The overall goal of this application is to develop a web-based interactive video program that would improve the education of stroke survivors and their caregivers while in rehabilitation and beyond, in order to identify personal risk factors, modify behavior, and ultimately reduce the occurrence of repeat strokes and reduction of overall stroke-related morbidity.

描述（由申请人提供）：缺血性卒中是美国疾病负担的主要来源。中风幸存者复发的风险很高，因此他们是二级预防的重要群体。然而，中风幸存者的知识差距，包括对中风早期预警信号的知识不足，对康复的目的和目标的理解不足，以及缺乏对个人风险因素的认识，导致可预防的中风相关发病率。在中风住院康复期间，解决这些知识差距的教育通常是不够的。对中风幸存者进行有效的教育可以通过促进康复、降低再次中风的风险和降低复发性中风的发病率来改善中风预后。在第一阶段SBIR中，我们确定了为中风幸存者及其家属开发基于网络的教育的可行性。我们开发了一个原型，传授有关中风的基本知识，包括警告信号，危险因素和常见危险因素之一（高血压）的管理。这个原型是一个基于网络的交互式教育程序，使用视频格式和动画，以及自我评估和适应性学习，通过计算机技术来解决认知缺陷。对25名中风患者和7名护理人员进行了该原型的试点研究，其中大约一半的受试者使用基于网络的培训，而不使用自适应学习，另一半使用自适应学习。该计划被广泛接受，与基线相比，所有受试者的卒中相关知识均显著改善。在没有自适应学习的情况下，前后测试中正确答案的平均提高为2.0。当自适应学习组件集成到基于Web的培训中时，前后测试正确答案的平均提高为5.1。第一阶段的原型可在www.strokelearning.com上查阅。我们现在建议在第二阶段完成这个基于网络的项目的开发，以便它解决所有主要的可管理的风险因素，提供一般的中风知识，并提供对中风康复的理解。重要的是，该计划将继续关注改变患者的行为，使他们能够降低进一步中风的风险，并从康复中获得更佳的收益。该计划还将适应患者的知识水平和认知障碍。它将反复衡量患者和护理人员的知识增益，这样做将加强多个会话的学习。作为II期研究的一部分，我们将在一项包含200名卒中患者及其家庭成员的对照试验中，测试该项目在出院时改善患者和护理人员卒中知识方面的疗效，并监测出院后2周和6周风险相关行为（吸烟）的变化。该计划将成为中风医疗提供者的适销产品，包括必须满足特定患者教育要求的康复医院，正在寻求中风专科认证的医院和疗养院。此外，希望改善中风预防工作（从而节省成本并提高患者护理质量）的保险公司可能是收入来源。中风是美国第三大死亡原因和残疾的主要原因，每年折磨70万至100万美国人，非洲裔美国人的风险特别高。美国有480万卒中幸存者，是卒中复发的一大风险人群。事实上，他们患中风的风险是同龄正常人的15倍。该应用程序的总体目标是开发一个基于网络的交互式视频程序，该程序将改善卒中幸存者及其护理人员在康复期间及以后的教育，以识别个人风险因素，改变行为，并最终减少重复卒中的发生率和降低卒中相关的总体发病率。