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

描述(申请人提供)：墨西哥裔美国人(MA)比非西班牙裔白人(NHW)更容易中风。缺血性卒中在MAS中更常见，卒中后的神经学、功能和认知结果比NHW更差。中风后预后差异的原因尚不清楚。两组的卒中前功能和初始卒中严重程度相似，缺血性卒中亚型也是如此。与NHW相比，MAS的卒中后神经、功能和认知结局较差的一个潜在解释是卒中后康复的分配和有效性。很少有数据表明，与保健工作者相比，多发性硬化患者的康复剂量是否有所不同，更少的信息表明，对于中风后的特定剂量的康复服务，是否存在种族差异的好处。当前应用程序将 利用现有的Corpus Christi(BASIC，NSR0138916)项目基于人群的脑攻击监测(BASIC，NSR0138916)项目的基础设施和牢固的社区关系，开发和试行一种方法，以收集必要的数据，以确定康复在中风后种族差异中的作用。先前的研究表明，观察整体康复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，一种以实践为基础的方法，已被证明与中风结果有关，而且这些联系已被证明因种族而异。然而，这种以实践为基础的方法并没有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，也没有研究在种族多元化的人群中使用这种方法。因此，我们的计划是在以往工作的基础上，在我们的基于人群的卒中研究中开发和利用以实践为基础的设计。具体地说，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，作为实践设计的一部分；3)试行测试数据收集，以收集所有康复环境中中风后康复的具体康复组成部分；4)分析这些数据，以确定这种方法用于更大规模研究的可行性，并提供关于不同种族在获取和有效性方面的差异的初步数据。总体而言，我们的基础设施发展、衡量特定治疗模式的工具的完善和试点测试将使我们能够完美地提交R01申请，以确定在获得康复和特定康复服务方面的种族差异，以及与MA和NHW改善功能结果相关的具体康复服务。

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.