Telehealth Cognitive-Behavioral Therapy for Depression in Parkinson's Disease

帕金森病抑郁症的远程医疗认知行为疗法

• 批准号: 8985060
• 负责人: ALEJANDRO INTERIAN
• 金额: --
• 依托单位: VA NEW JERSEY HEALTH CARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-07-01 至 2020-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8985060
• 关键词: Address; Address; Adopted; Adopted; Affect; Affect; Aftercare; Aftercare; Antidepressive Agents; Antidepressive Agents; Anxiety; Anxiety; Area; Area; Caregiver Burden; Caregiver Burden; Caregivers; Caregivers; Caring; Caring; Clinical; Cognitive; Cognitive; Cognitive Therapy; Cognitive Therapy; Communication; Communication; Complement; Complement; Country; Country; Data; Data; Depressed mood; Depressed mood; Development; Development; Disease; Disease; Disease Outcome; Distress; Distress; Education; Effectiveness; Effectiveness; Enrollment; Enrollment; Exhibits; Exhibits; Geographic Locations; Geographic Locations; Geography; Glean; Glean; Goals; Goals; Health; Health Care Costs; Health Care Costs; Health Services Accessibility; Health Services Accessibility; Healthcare; Healthcare; Home environment; Home environment; Hybrids; Hybrids; Impaired cognition; Impaired cognition; Intervention; Intervention; Interview; Interview; Knowledge; Knowledge; Level of Evidence; Level of Evidence; Location; Location; Measures; Measures; Medical; Medical; Mental Depression; Mental Depression; Mental Health; Mental Health; Mental Health Services; Mental Health Services; Methods; Methods; Modeling; Modeling; Morbidity - disease rate; Morbidity - disease rate; Motor; Motor; Movement Disorders; Movement Disorders; Outcome; Outcome; Parkinson Disease; Parkinson Disease; Participant; Participant; Patients; Patients; Pharmaceutical Preparations; Pharmaceutical Preparations; Pharmacological Treatment; Pharmacological Treatment; Population; Population; Provider; Provider; Psychotherapy; Psychotherapy; Public Health; Public Health; Quality of life; Quality of life; Randomized; Randomized; Relative (related person); Reporting; Reporting; Research; Research; Research Design; Research Design; Resistance; Rural; Rural; Rural Health; Rural Health; Sampling; Sampling; Service delivery model; Services; Services; Solutions; Telemedicine; Telemedicine; Testing; Time; Time; Transportation; Transportation; Use Effectiveness; Veterans; Veterans; barrier to care; base; base; caregiving; caregiving; clinical center; clinical practice; clinical practice; cognitive disability; depression model; depressive symptoms; depressive symptoms; design; design; disability; disability; eHealth; eHealth; education research; effectiveness clinical trial; effectiveness clinical trial; effectiveness evaluation; effectiveness research; effectiveness research; effectiveness testing; efficacy research; efficacy research; empowered; empowered; empowerment; empowerment; evidence base; evidence base; experience; experience; functional disability; functional disability; functional outcomes; functional outcomes; health care model; health care model; improved; improved; innovation; innovation; intervention effect; intervention effect; medical specialties; medical specialties; meetings; meetings; novel; novel; programmed cell death protein 1; remote health care; skills training; skills training; standard care; standard care; standard measure; standard measure; telehealth; telehealth; therapy resistant; treatment responders

 DESCRIPTION (provided by applicant): Objective: There is a critical need for treatments that address depression and barriers to mental health care among the nearly 100,000 Veterans with Parkinson's Disease (PD) served by the VA. Depression in PD (dPD) is a major complicating factor in the movement disorder, affecting several key functional outcomes such as motor disability, cognitive status, quality of life, and caregiving relationships. The challenge to meeting the treatment needs of Veterans with dPD centers on the lack of clinicians who are knowledgeable about the interactions of PD and depression, the considerable transportation barriers faced by this population, combined with the geographical dispersion of specialized services within the VA, and the paucity of effectiveness research that informs treatments for dPD. The proposed study seeks to overcome these challenges by using a telehealth delivery platform (i.e., video-to-home) to test the effectiveness of a 10-session cognitive-behavioral treatment (CBT) package that has been tailored to address the unique needs of depressed Veterans with PD. The proposed treatment package also provides support and skills-training to the Veteran's Caregiver (3 sessions). This HSR&D proposal will be the first to: 1) to evaluate the effectiveness of TH-CBT for improving Veteran outcomes in dPD, 2) to examine the impact of TH-CBT for dPD on a variety of Caregiver outcomes, and 3) to assess Veteran and Caregiver perspectives on TH-CBT using a mixed-methods sequential explanatory design. Method: A PD-informed, telehealth-administered cognitive behavioral therapy package (TH-CBT) for dPD will be evaluated in a clinical effectiveness trial. 180 participants (90 Veterans and 90 Caregivers) will be enrolled. Half of the sample will receive the study treatment package (TH-CBT), in addition to their standard medical care. The other half will only receive standard medical care. The two groups will be compared at baseline, midpoint (week 5), endpoint (week 10), and 1 and 6 months post treatment. Veterans will be assessed with standard measures of depression, anxiety, quality of life, and motor function, while Caregivers will be evaluated with measures of caregiver burden, empowerment, and communication. Impact: Given the public health impact of improved depression treatment in Veterans with Parkinson's disease, the knowledge to be gained may be significant and the project could directly impact clinical practice. The data gleaned from this study will guide the wide-scale implementation of this remote care model within the VA for meeting the specialized needs of Veterans with PD. Towards this goal, successful results for the proposed study will facilitate a multisite initiative to further examine issues of dissemination, implementation, and effectiveness, using a hybrid research design. Ultimately, these HSR&D data may support the development of a centralized care model, in which highly specialized dPD providers, concentrated in a few locations, provide specialty care to Veterans and Caregivers across the country.

 描述（由申请人提供）： 目的：在帕金森氏病（PD）的近100,000名退伍军人中，迫切需要解决抑郁症和精神卫生保健障碍。 PD（DPD）中的抑郁症是运动障碍的主要复杂因素，影响了几种关键功能结果，例如运动障碍，认知状况，生活质量和护理关系。满足退伍军人的治疗需求的挑战是DPD缺乏对PD和抑郁症相互作用的临床医生的中心，该人群面临的考虑运输障碍，以及VA内专业服务的地理分散以及有效性研究的贫困性，使DPD处理的障碍。拟议的研究旨在通过使用远程医疗传递平台（即视频对家庭）来克服这些挑战，以测试10条经验认知行为治疗（CBT）软件包的有效性，该软件包已量身定制，该软件包已量身定制，以满足PD抑郁症的独特需求。拟议的治疗方案还为退伍军人的护理人员提供了支持和技能培训（3个课程）。该HSR＆D提案将是：1）评估TH-CBT在DPD中改善退伍军人结果的有效性，2）检查TH-CBT对DPD对各种护理人员结果的影响，以及3），以评估退伍军人和Caregiver对TH-CBT对TH-CBT的看法，并使用混合实验性的exprantors sequential Expornators设计。方法：将在一项临床有效性试验中评估一个针对DPD的PD信息，远程医疗管理的认知行为疗法套件（TH-CBT）。将招募180名参与者（90名退伍军人和90名护理人员）。一半 样本除了标准医疗服务外，还将获得研究治疗方案（TH-CBT）。另一半只会获得标准的医疗服务。两组将在基线，中点（第5周），终点（第10周）以及治疗后1和6个月进行比较。退伍军人将通过抑郁，焦虑，生活质量和运动功能的标准测量来评估，而护理人员将通过评估护理人员伯恩，授权和交流进行评估。影响：鉴于帕金森氏病退伍军人改善抑郁症治疗的公共卫生影响，要获得的知识可能很重要，并且该项目可能直接影响临床实践。这项研究收集的数据将指导VA中此遥远护理模型的广泛实施，以满足PD退伍军人的专业需求。为了实现这一目标，拟议的研究的成功结果将促进一项多站点计划，以进一步研究混合研究设计，以进一步研究传播，实施和有效性的问题。最终，这些HSR＆D数据可能支持开发集中的护理模型，其中专业的DPD提供商集中在几个地点，为全国的退伍军人和护理人员提供专业护理。