Cognitive Rehabilitation for Gulf War Illness

海湾战争疾病的认知康复

• 批准号: 8658967
• 负责人: Lisa Marie McAndrew
• 金额: --
• 依托单位: VA NEW JERSEY HEALTH CARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-07-01 至 2017-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8658967
• 关键词: Address; Adherence; Affect; Behavior; Chronic; Clinical Trials; Cognitive; Cognitive Therapy; Coin; Complex; Dimensions; Disease; Educational process of instructing; Equipment and supply inventories; Exercise; Exertion; Fatigue; Goals; Gulf War; Health education; Heart failure; Impaired cognition; Impairment; Intervention; Life; Malignant Neoplasms; Massachusetts; Measures; Mediating; Medical; New Jersey; New York; Pain; Patient Self-Report; Patients; Population; Problem Solving; Publishing; Randomized Controlled Trials; Recruitment Activity; Rehabilitation therapy; Report (document); Reporting; Risk; Sampling; Site; Structure; Symptoms; Syndrome; Telephone; Therapeutic Intervention; Time; Veterans; World Health Organization Disability Assessment Schedule; cognitive rehabilitation; disability; evidence base; improved; innovation; neuropsychological; patient oriented; problem solving therapy; public health relevance; skills

DESCRIPTION (provided by applicant): Gulf War illness (GWI) is a complex multi-symptom illness which causes as much disability as other major medical diseases such as cancer and chronic heart failure. Previous clinical trials (i.e. cognitive behavioral therapy and graded exercise) for GWI have sought to improve disability by increasing activity regardless of symptom presentation. These previous trials for GWI have shown limited efficacy and poor adherence. An innovative treatment approach is to target a specific component of GWI, namely problem-solving ability, known to be associated with disability. Impairment in problem-solving ability affects over 70% of Gulf War Veterans (GWV) with GWI and is prospectively related to 1.5 times greater risk of disability. This impairment is also related to poorer adherence to medical regimes, making it difficult for GWV to manage other aspects of GWI. Thus, rehabilitation of problem-solving deficits is a critical target to treat a complicated syndrome like GWI. Despite this, there are no established treatments to compensate for problem-solving deficits among GWV. We are proposing to treat the problem-solving deficits of GWI using a state-of-the-art evidence-based approach to cognitive rehabilitation, Problem-Solving Therapy. Problem-Solving Therapy teaches patients skills to overcome factors impacting problem-solving. Because Problem-Solving Therapy teaches patients strategies to address real-life problems it leads to reductions in disability in other populations. This is the first trial of cognitive rehabilitation therapy for GWI. We propose a mult-site randomized controlled trial of telephone-delivered Problem-Solving Therapy versus telephone-delivered Health Education. We will use a 12 session established Problem-Solving Therapy intervention with a structured five step sequential approach to teaching problem-solving. Disability will be measured by the overall composite score from the World Health Organization Disability Assessment Schedule 2.0 which reflects two dimensions of disability: activity limitations and participation restrictions. In order to increase the representativeness of our sample, we will recruit 258 GWV from three VA sites: New Jersey, upstate New York, and Massachusetts.

描述（由申请人提供）： 海湾战争疾病 (GWI) 是一种复杂的多症状疾病，与癌症和慢性心力衰竭等其他主要疾病一样造成残疾。之前针对 GWI 的临床试验（即认知行为疗法和分级运动）试图通过增加活动来改善残疾，无论症状如何。之前的这些 GWI 试验显示疗效有限且依从性较差。一种创新的治疗方法是针对 GWI 的特定组成部分，即解决问题的能力，已知与残疾相关。超过 70% 的海湾战争退伍军人 (GWV) 患有 GWI，解决问题的能力受损，并且预计与 1.5 倍的残疾风险相关。这种损害还与医疗制度依从性较差有关，使得 GWV 难以管理 GWI 的其他方面。因此，解决问题能力缺陷的康复是治疗 GWI 等复杂综合征的关键目标。尽管如此，还没有既定的治疗方法可以弥补 GWV 解决问题的缺陷。我们建议使用最先进的循证认知康复方法（问题解决疗法）来治疗 GWI 解决问题的缺陷。问题解决疗法教会患者克服影响解决问题的因素的技能。由于问题解决疗法教会患者解决现实生活问题的策略，因此可以减少其他人群的残疾。这是针对 GWI 的认知康复治疗的首次试验。我们建议对电话提供的问题解决疗法与电话提供的健康教育进行多中心随机对照试验。我们将使用 12 节已建立的问题解决疗法干预，并采用结构化的五步顺序方法来教授解决问题的方法。残疾将通过世界卫生组织残疾评估表 2.0 的总体综合分数来衡量，该分数反映了残疾的两个方面：活动限制和参与限制。为了增加代表性 在我们的样本中，我们将从三个 VA 地点招募 258 GWV：新泽西州、纽约州北部和马萨诸塞州。