Cognitive Rehabilitation for Gulf War Illness

海湾战争疾病的认知康复

• 批准号: 8890645
• 负责人: Lisa Marie McAndrew
• 金额: --
• 依托单位: VA NEW JERSEY HEALTH CARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-07-01 至 2017-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8890645
• 关键词: Address; Adherence; Affect; Behavior; Chronic; Clinical Trials; Cognitive; Cognitive Therapy; Coin; Complex; Congestive Heart Failure; Dimensions; Disease; Educational process of instructing; Equipment and supply inventories; Exercise; Exertion; Fatigue; Goals; Gulf War; Health education; Impaired cognition; Impairment; Intervention; Life; Malignant Neoplasms; Massachusetts; Measures; Mediating; Medical; New Jersey; New York; Pain; Patient Self-Report; Patients; Population; Problem Solving; Publishing; Randomized Controlled Trials; Recruitment Activity; Rehabilitation therapy; Report (document); Reporting; Risk; Sampling; Site; Structure; Symptoms; Syndrome; Telephone; Therapeutic Intervention; Time; Veterans; World Health Organization Disability Assessment Schedule; cognitive ability; cognitive rehabilitation; disability; evidence base; improved; innovation; neuropsychological; patient oriented; problem solving therapy; public health relevance; skills; targeted treatment

DESCRIPTION (provided by applicant): Gulf War illness (GWI) is a complex multi-symptom illness which causes as much disability as other major medical diseases such as cancer and chronic heart failure. Previous clinical trials (i.e. cognitive behavioral therapy and graded exercise) for GWI have sought to improve disability by increasing activity regardless of symptom presentation. These previous trials for GWI have shown limited efficacy and poor adherence. An innovative treatment approach is to target a specific component of GWI, namely problem-solving ability, known to be associated with disability. Impairment in problem-solving ability affects over 70% of Gulf War Veterans (GWV) with GWI and is prospectively related to 1.5 times greater risk of disability. This impairment is also related to poorer adherence to medical regimes, making it difficult for GWV to manage other aspects of GWI. Thus, rehabilitation of problem-solving deficits is a critical target to treat a complicated syndrome like GWI. Despite this, there are no established treatments to compensate for problem-solving deficits among GWV. We are proposing to treat the problem-solving deficits of GWI using a state-of-the-art evidence-based approach to cognitive rehabilitation, Problem-Solving Therapy. Problem-Solving Therapy teaches patients skills to overcome factors impacting problem-solving. Because Problem-Solving Therapy teaches patients strategies to address real-life problems it leads to reductions in disability in other populations. This is the first trial of cognitive rehabilitation therapy for GWI. We propose a mult-site randomized controlled trial of telephone-delivered Problem-Solving Therapy versus telephone-delivered Health Education. We will use a 12 session established Problem-Solving Therapy intervention with a structured five step sequential approach to teaching problem-solving. Disability will be measured by the overall composite score from the World Health Organization Disability Assessment Schedule 2.0 which reflects two dimensions of disability: activity limitations and participation restrictions. In order to increase the representativeness of our sample, we will recruit 258 GWV from three VA sites: New Jersey, upstate New York, and Massachusetts.

描述（由申请人提供）： 海湾战争病（GWI）是一种复杂的多症状疾病，其导致的残疾与其他主要医学疾病如癌症和慢性心力衰竭一样多。以前的GWI临床试验（即认知行为疗法和分级运动）试图通过增加活动来改善残疾，而不管症状表现如何。这些先前的GWI试验显示出有限的疗效和较差的依从性。一个创新的治疗方法是针对GWI的一个特定组成部分，即解决问题的能力，已知与残疾有关。问题解决能力的损害影响了超过70%的海湾战争退伍军人（GWV）与GWI，并与1.5倍的残疾风险相关。这种损害也与对医疗制度的遵守较差有关，使GWV难以管理GWI的其他方面。因此，问题解决缺陷的康复是治疗GWI等复杂综合征的关键目标。尽管如此，没有既定的治疗方法来弥补GWV中的问题解决缺陷。我们建议使用最先进的循证认知康复方法，即问题解决疗法来治疗GWI的问题解决缺陷。问题解决疗法教授患者克服影响解决问题的因素的技能。因为问题解决疗法教会患者解决现实生活中问题的策略，它导致其他人群的残疾减少。这是GWI认知康复治疗的首次试验。我们提出了一个多地点的随机对照试验，电话提供的问题解决治疗与电话提供的健康教育。我们将使用一个12个会议建立的问题解决治疗干预与结构化的五步序贯的方法来教解决问题。残疾将通过世界卫生组织残疾评估表2.0的综合得分来衡量，该表反映了残疾的两个方面：活动限制和参与限制。为了增加代表性， 我们的样本，我们将招募258 GWV从三个退伍军人事务部网站：新泽西，北部纽约，和马萨诸塞州。