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

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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.