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 中更为常见，并且卒中后其神经系统、功能和认知结果比 NHW 更差。中风后结果差异的原因尚不清楚。两组之间的中风前功能和初始中风严重程度相似，缺血性中风亚型也是如此。与 NHW 相比，MA 中风后神经系统、功能和认知结果较差的一种可能解释是中风后康复的分配和有效性。很少有数据表明，与 NHW 相比，MA 的康复剂量是否有所不同，而关于中风后给定剂量的康复服务是否因种族而异的信息也更少。当前的应用程序将 利用科珀斯克里斯蒂现有的基于人群的脑部攻击监测（BASIC，NSR0138916）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，以确定康复在中风后结果中种族差异中的作用。先前的研究表明，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、职业和言语治疗（一种基于实践的方法）的特定组成部分已被证明与中风结果相关，并且这些关联已被证明因种族而异。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，也没有研究在不同种族的人群中使用这种方法。因此，我们的计划是在之前的工作基础上，在基于人群的中风研究中开发和利用基于实践的设计。具体来说，我们将 1) 继续与社区康复服务提供者建立必要的关系； 2）与当地康复治疗师合作完善数据收集工具，作为基于实践的设计的一部分； 3) 在所有康复环境中收集中风后康复特定康复组成部分的试点测试数据； 4) 分析这些数据，以确定这种方法进行更大规模研究的可行性，并提供有关不同种族的获取和有效性差异的初步数据。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完善以及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，这些差异与 MA 和 NHW 的功能结果改善相关。

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.