Evaluation of a Carepartner-Integrated Telehealth Rehabilitation Program for Persons with Stroke - NICHD K-23

描述：Sarah Blanton，PT、DPT、NCS，是神经康复领域的临床专家，致力于 研究生涯调查促进护理伙伴融入社会的有效方法 中风幸存者的康复。 K23 奖项将建立在先前培训和培训的坚实基础之上 研究并为候选人提供通过以下方式获得高等教育和经验的机会 多学科专家团队。这项以患者为导向的研究的近期目标 职业奖（K23）旨在让候选人获得以下方面所需的技能：（1）高级临床研究 设计和统计方法以及（2）自我管理和成人学习的心理学理论 对中风幸存者及其家人进行和评估以护理伙伴为中心的干预措施。的 候选人的长期目标是成为一名独立资助的临床研究人员，具有以下方面的专业知识 推进和扩大护理伙伴教育和融合作用的创新战略 以家庭为中心的护理中的物理治疗师。 环境：布兰顿博士的培训将使用佐治亚州埃默里大学的资源和导师 州立大学和佐治亚理工学院。邓巴博士和克拉克博士是国际化的 护理研究领域公认的研究人员，将为潜在的行为提供指导 护理伙伴对治疗反应的机制、研究方法和设计，以及 结果数据的解释。通过莱尔斯博士的课程和指导，她将获得 数据管理和统计分析方面的专业知识。 Wolf 博士将提供资助写作和 中风康复干预措施和琼斯先生将提供远程康复方法的指导。 她将通过其他方式继续学习研究方法和数据管理 课程作业并将参加研讨会、专业会议和会议以完成培训。 研究：中风是成人残疾的主要原因，并造成重大的社会和家庭损失 应变。家庭成员是中风康复的关键组成部分，但他们经常经历高风险 负担程度，包括当他们承担这个角色时增加的焦虑、抑郁和社会孤立 的护理伙伴。因此，旨在减少中风对家庭影响的有效干预措施是 需要。该提案的目的是评估一种新颖的、以护理伙伴为中心的干预措施 (CARECITE) 旨在促进问题解决和技能培养，同时促进护理伙伴参与 上肢约束诱导运动疗法（CIMT）的应用。这种心理教育 干预旨在提供一般中风恢复内容（例如中风后 抑郁症），并通过教导护理伙伴方法来加强 CIMT 的家庭应用 营造一个更具治疗性、支持自主性的环境（其特点是同理心、解决问题、 控制语言的选择和减少）。支持这一点的中心假设 研究表明，基于理论、以护理伙伴为中心的干预措施侧重于技能培养和问题解决 将改善中风幸存者的身体功能，同时减少护理伙伴的负面结果， 提高参与的可及性。 [为了检验这一假设以及 CARE-CITE 在 在家庭环境中，我们将使用包含 32 个干预二元组的两组实验设计（CIMT 与 结构化护理伙伴参与）和 16 个控制二元组（没有结构化护理伙伴的 CIMT） 参与）来量化对护理伴侣心理健康、中风周围家庭冲突的影响 恢复和中风幸存者上肢功能。评估者将对小组分配视而不见。 这项研究的结果将为更大范围内使用的干预效果提供初步估计。 未来的临床研究。] 这项研究的创新之处在于定制中风幸存者疗法 干预措施还可以满足护理伙伴的需求，并使用现代远程医疗技术 促进家庭在家庭环境中的参与。该项目的研究结果将提供 关键数据有助于未来探索以家庭为中心的护理的更大规模研究的发展 中风。与公众健康的相关性：本研究计划的总体意义是增加 了解并进一步发展可作为康复模式的干预措施 促进家庭参与康复过程并促进更综合的治疗策略 整个物理治疗实践。

DESCRIPTION: Sarah Blanton, PT, DPT, NCS, is clinical specialist in neurorehabilitation committed to a research career investigating effective methods to facilitate the integration of the carepartner in rehabilitation of the stroke survivor. A K23 award will build upon a strong foundation of prior training and research and provide the candidate an opportunity to gain advanced education and experience through a multidisciplinary team of experts. The immediate goals of this Mentored Patient Oriented Research Career Award (K23) are to allow the candidate to gain the skills needed in: (1) advanced clinical research design and statistical methods and (2) psychological theories of self-management and adult learning to perform and evaluate carepartner-centered interventions for stroke survivors and their families. The candidate’s long-term goals are to become an independently funded clinical researcher with expertise in innovative strategies for advancing and expanding the role of carepartner education and the integration of physical therapists in family-centered care. ENVIRONMENT: Dr. Blanton’s training will use resources and mentors from Emory University, Georgia State University and Georgia Institute of Technology. Dr. Dunbar and Dr. Clark are internationally recognized researchers in caregiving research and will provide guidance in potential behavioral mechanisms underlying carepartner responses to treatment, study methodology and design, and interpretation of outcome data. Through coursework and mentorship with Dr.Lyles, she will gain expertise in data management and statistical analysis. Dr.Wolf will provide guidance in grant writing and stroke rehabilitation interventions and Mr. Jones will offer mentorship in telerehabilitation approaches. She will continue learning about study methodology and data management through additional coursework and will attend seminars, professional conferences and meetings to complete her training. RESEARCH: Stroke is the leading cause of adult disability and creates significant societal and familial strain. Family members are a key component in stroke recovery, but they frequently experience high levels of burden, including increased anxiety, depression and social isolation when they assume the role of carepartner. Thus, effective interventions aimed at reducing the impact of stroke on the family are needed. The objective of this proposal is to evaluate a novel, carepartner focused intervention (CARECITE) designed to foster problem solving and skill building while facilitating carepartner involvement in the application of constraint-induced movement therapy (CIMT) for the upper extremity. This psychoeducational intervention is structured to provide general stroke recovery content (e.g. post-stroke depression) and enhance the home-based application of CIMT by teaching the carepartner ways to foster a more therapeutic, autonomy-supportive environment (characterized by empathy, problemsolving, choice and reduction of controlling language). The central hypothesis underpinning this research is that a theory-based, carepartner-centered intervention focused on skill building and problemsolving will improve stroke survivor physical function while reducing carepartner negative outcomes and increasing accessibility of participation. [To test this hypothesis and the feasibility of CARE-CITE in the home setting, we will use a two-group experimental design with 32 intervention dyads (CIMT with structured carepartner involvement) and 16 control dyads (CIMT without structured carepartner involvement) to quantify the effects on carepartner mental health, family conflict surrounding stroke recovery, and stroke survivor upper extremity function. Evaluators will be blind to group assignment. Results of this study will provide preliminary estimates of the intervention efficacy for use in larger, future clinical studies.] The innovation of this research involves the tailoring of a stroke survivor therapy intervention to also address carepartner needs and the use of contemporary telehealth technology to facilitate engagement of the family within the home environment. The findings of this project will provide critical data that can aid in the development of future larger-scale studies exploring family centered care in stroke. RELEVANCE TO PUBLIC HEALTH: The overall significance of this research plan is to increase understanding and further development of interventions that may serve as models in rehabilitation to foster family involvement in the rehabilitation process and to promote more integrative therapy strategies throughout physical therapy practice.