Developing a system to study stroke rehabilitation in an ethnically diverse community

描述（由申请人提供）：墨西哥裔美国人（MA）比非西班牙裔白人（NHW）更容易患中风。缺血性卒中在MA中更常见，卒中后的神经功能、功能和认知结局比NHW更差。卒中后结局差异的原因尚不清楚。两组之间卒中前功能和初始卒中严重程度相似，缺血性卒中亚型也相似。与NHWs相比，MA中卒中后神经功能、功能和认知结局更差的一个可能解释是卒中后康复的分配和有效性。有非常少的数据表明是否康复剂量不同的MA相比，NHWs，更少的信息是否，对于一个给定剂量的康复服务中风后，有不同的好处种族。当前应用程序将 利用现有的基于人群的科珀斯克里斯蒂脑攻击监测（BASIC，NSR 0138916）项目的基础设施和强大的社区关系，开发和试点一种方法来收集必要的数据，以确定康复在卒中后结局种族差异中的作用。以前的研究表明，观察康复所花费的总时间并不能预测中风后的结果。然而，物理，职业和语言治疗的特定组成部分，一种基于实践的方法，已被证明与中风的结果，这些协会已被证明是不同的种族。然而，这种基于实践的方法尚未在中风患者接受康复服务的各种环境中以基于人群的方式实施，并且没有研究在种族多样化的人群中使用这种方法。因此，我们的计划是通过在我们基于人群的卒中研究中开发和利用基于实践的设计来建立以前的工作。具体而言，我们将1）继续与社区康复服务提供者建立所需的关系; 2）与当地康复治疗师合作，完善数据收集工具，作为以实践为基础的设计的一部分; 3）在所有康复环境中对中风后康复的特定康复部分进行试点测试数据收集;分析这些数据，以确定这种方法在更大规模研究中的可行性，并提供有关种族在获得和有效性方面差异的初步数据。总的来说，我们的基础设施开发、衡量特定治疗方式的工具的改进和试点测试将使我们完全有能力提交R 01申请，以确定获得康复和与MA和NHW功能结果改善相关的特定康复服务方面的种族差异。

DESCRIPTION (provided by applicant): Mexican Americans (MAs) suffer more from stroke than non-Hispanic whites (NHWs). Ischemic stroke is more common in MAs and their neurologic, functional and cognitive outcomes after stroke are worse than in NHWs. The reasons for the disparity in post-stroke outcome are unclear. Pre-stroke function and initial stroke severity are similar between the two groups as are ischemic stroke sub-types. One potential explanation for the worse post-stroke neurologic, functional and cognitive outcome in MAs compared with NHWs is allocation and effectiveness of post-stroke rehabilitation. There is remarkably little data demonstrating whether rehabilitation is dosed differently for MAs compared with NHWs, and still less information about whether, for a given dose of rehabilitative services following stroke, there is differential benefit by ethnicity. The current application will utilize the existing population-based Brain Attack Surveillance in Corpus Christi (BASIC, NSR0138916) project's infrastructure and strong community relations to develop and pilot a method to collect the necessary data to determine the role of rehabilitation in ethnic disparities in post-stroke outcomes. Previous studies have suggested that looking at overall time spent in rehabilitation does not predict post-stroke outcome. However, specific components of physical, occupational and speech therapy, a practice-based approach, has been shown to be associated with stroke outcomes, and these associations have been shown to vary by race. However, this practice-based approach has not been implemented in a population-based manner across the range of settings where stroke patients receive rehabilitation services, and no study has used this approach in an ethnically diverse population. Therefore, our plan is to build on previous work by developing and utilizing a practice-based design in our population-based stroke study. Specifically, we will 1) continue to build the needed relationships with rehabilitation service providers in the community; 2) work with local rehabilitation therapists to refine data collection instruments as part of the practice-based design; 3) pilot test data collection of specific rehabilitation components of post-stroke rehabilitation across all rehabilitation settings; and 4) analyze this data to determine the feasibility of this approach for a larger study and to provide preliminary data on differences in access and effectiveness by ethnicity. In total, our infrastructure development, refinement of tools to measure specific therapy modalities and pilot testing will position us perfectly to submit an R01 application to identify ethnic differences in access to rehabilitation and specific rehabilitation services associated with improved functional outcome in MAs and NHWs.