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（MAs）比非西班牙裔白人（nhw）更容易患中风。缺血性卒中在ma患者中更为常见，卒中后他们的神经、功能和认知预后比NHWs患者差。中风后结果差异的原因尚不清楚。卒中前功能和初始卒中严重程度在两组之间与缺血性卒中亚型相似。脑卒中后神经系统、功能和认知方面的预后较低，其中一个可能的解释是脑卒中后康复的分配和有效性。非常少的数据表明，与国家卫生保健工作者相比，ma的康复剂量是否不同，关于卒中后给定剂量的康复服务是否存在种族差异的信息更少。当前应用程序将

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.