Ecological Momentary Assessment of Functioning in Schizophrenia

精神分裂症功能的生态瞬时评估

• 批准号: 8439800
• 负责人: ERIC L GRANHOLM
• 金额: --
• 依托单位: VA SAN DIEGO HEALTHCARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-04-01 至 2016-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8439800
• 关键词: Activities of Daily Living; Agreement; Ambulatory Monitoring; Behavior; Chronic Disease; Clinical; Clinical Trials; Cognitive; Comprehensive Health Care; Computer software; Data Collection; Devices; Elements; Employment; Environment; Family; Freedom; Frequencies; Goals; Health; Healthcare; Healthcare Systems; Homelessness; Hour; Impairment; Individual; Knowledge; Lead; Maintenance; Measurement; Measures; Mental Health; Mental disorders; Methodology; Methods; Microcomputers; Modeling; Neurocognition; Neuropsychological Tests; Outcome; Outpatients; Participant; Patient Self-Report; Patients; Performance; Personal Digital Assistant; Personal Satisfaction; Persons; Play; Property; Proxy; Psyche structure; Psychometrics; Public Health; Questionnaires; Recovery; Relative (related person); Reporting; Role; Sampling; Schizoaffective Disorders; Schizophrenia; Signal Transduction; Simulate; Strategic Planning; Symptoms; Techniques; Technology; Testing; Time; Veterans; Work; base; cost; disability; economic impact; experience; follow-up; functional outcomes; hospital bed; improved; in vivo; indexing; informant; innovation; performance tests; psychosocial rehabilitation; public health relevance; social; standard measure; success

DESCRIPTION (provided by applicant): Mental health and well-being and chronic diseases like schizophrenia are health care issues of high priority to VA. Treatment of schizophrenia places a significant burden on the VA healthcare system. Veterans with schizophrenia occupy more hospital beds than veterans with any other illness1 and constitute at least 10% of homeless veterans receiving VA health care2. Although positive symptom reduction remains an important treatment goal, functioning in social and instrumental role domains is an important consumer and public health goal6. The President's New Freedom Commission on Mental Health report7 and the Comprehensive VHA Mental Health Strategic Plan4 emphasize the crucial importance of the Psychosocial Rehabilitation (PSR) approaches, targeting real world functioning outcomes. In order to develop and refine recovery-oriented treatment approaches, valid and sensitive measures of functioning in social and instrumental role domains are needed. As new treatments are tested, the need grows to demonstrate the real world gains by patients. Existing functioning measures are inadequate. We need a low cost, efficient, more objective measure, which is what Ecological Momentary Assessment (EMA) can provide. EMA is an ambulatory data collection technique that allows the real-time in vivo assessment of functioning behaviors, including social, educational, self- maintenance, daily activity, and employment activities. Modern EMA uses PDA microcomputer devices (EMAc) to signal participants several times throughout the day to respond to questionnaires about their recent activities. We propose to examine the convergence of EMAc assessments with real-world functioning ratings generated by patients and knowledgeable informants, performance-based measures of functional capacity, and neuropsychological test performance. This 3-year project will focus on pragmatic and psychometric questions that must be answered before EMAc can be used in clinical trials or in VA clinical settings. Specific Aim 1 (Construct Validity and Longitudinal Stability in a Simulated Clinical Trial): To examine test-retest reliability and construct validity of EMAc measures of real world functioning with regard to convergence between EMAc measures, standard ratings of real world functioning, neuropsychological test performance, performance-based functional capacity, and symptoms in 144 people with schizophrenia or schizoaffective disorder assessed at baseline and again at 4-week follow-up. We hypothesize that EMAc measures of real world functioning will be significantly correlated with standard ratings of real world functioning, neuropsychological test performance, and functional capacity test performance, and EMAc measures will lead to an improved fit compared to than standard self-report ratings of real world functioning in a confirmatory path model of the functional outcome construct that includes neurocognition, functional capacity, and symptom elements. Specific Aim 2 (Sensitivity to Impairment Relative to Healthy Individuals): To administer EMAc assessments to 100 healthy controls to examine sensitivity to patient-control differences and describe psychometric properties (e.g., test-retest reliability) of EMAc assessments in controls. We hypothesize that patients with schizophrenia or schizoaffective disorder will show significantly lower frequency of productive functioning behaviors on the EMAc functioning assessment total score relative to healthy individuals. EMAc is an innovative approach to measuring real world outcomes that takes advantage of advances in modern technology, software and ambulatory monitoring methodology. What EMAc would add to the study of functioning in people with mental disorders is simple and powerful: EMAc would provide an index of what people are actually doing in real-world settings. Accurate, efficient measurement of real world functioning is essential to the ultimate success of recent cognitive and PSR treatment and measurement efforts. The success of these efforts could ultimately lead to reduced disability in people with schizophrenia, which would have significant impact on patients and families, as well as broader societal and economic impact.

描述(由申请人提供)： 精神健康和幸福感以及精神分裂症等慢性疾病是退伍军人管理局高度优先考虑的医疗保健问题。精神分裂症的治疗给退伍军人管理局的医疗系统带来了巨大的负担。患有精神分裂症的退伍军人比患有任何其他疾病的退伍军人占据更多的医院床位，并且至少占到接受退伍军人医保的无家可归退伍军人的10%。虽然减少阳性症状仍然是一个重要的治疗目标，但在社会和工具作用领域发挥作用是一个重要的消费者和公共卫生目标6。总统关于精神健康的新自由委员会报告7和全面的VHA精神健康战略计划4强调了以现实世界功能结果为目标的心理社会康复(PSR)方法的极端重要性。为了制定和完善面向康复的治疗方法，需要在社会和工具作用领域采取有效和敏感的运作措施。随着新疗法的测试，人们越来越需要证明患者在现实世界中获得的收益。现有的有效措施是不够的。我们需要一种低成本、高效、更客观的方法，这就是生态瞬时评估(EMA)所能提供的。EMA是一种动态数据收集技术，可以在体内实时评估功能行为，包括社交、教育、自我维持、日常活动和就业活动。现代EMA使用PDA微型计算机设备(EMac)在一天中多次向参与者发送信号，以回答有关他们最近活动的问卷。我们建议检查eMac评估与由患者和知情者产生的真实世界功能评级、基于性能的功能能力测量和神经心理测试性能的融合。这个为期3年的项目将专注于在eMac可以用于临床试验或VA临床环境之前必须回答的实用和心理测量学问题。具体目标1 (模拟临床试验中的结构效度和纵向稳定性)：检验重测信度和eMac测量的效度。 对144名精神分裂症或分裂情感障碍患者进行eMac测量、真实世界功能的标准评级、神经心理测试表现、基于表现的功能能力和症状之间的趋同，在基线和4周随访时再次进行评估。我们假设，真实世界功能的eMac测量将与真实世界功能的标准评级、神经心理测试表现和功能能力测试表现显著相关，并且eMac测量将导致在包括神经认知、功能能力和症状元素的功能结果结构的验证性路径模型中，与真实世界功能的标准自我报告评级相比，eMac测量将导致更好的匹配。具体目标2(相对于健康个体对损害的敏感性)：对100名健康对照进行eMac评估，以检查对患者对照差异的敏感性，并描述对照中eMac评估的心理测量学特性(例如，重测可靠性)。我们假设，精神分裂症或分裂情感障碍患者在eMac功能评估总分上表现出的生产性功能行为频率比健康人低得多。EMac是一种利用现代技术、软件和动态监测方法的进步来衡量现实世界结果的创新方法。EMac对精神障碍患者的功能研究的补充是简单而强大的：eMac将提供人们在现实世界环境中实际正在做的事情的索引。准确、有效地测量真实世界的功能对于最近的认知和PSR治疗和测量工作的最终成功至关重要。这些努力的成功最终可能导致精神分裂症患者的残疾减少，这将对患者和家庭产生重大影响，并产生更广泛的社会和经济影响。