Assessing a Stroke Homehealth Aide Recovery Program (SHARP) as a Potential High Impact Strategy for Improving in Functional Mobility after Stroke

项目摘要 该项目的总体目标是改善中风后患者的功能。该项目将试行一项 旨在提高机动性和减少跌倒的创新中风家庭健康辅助恢复计划(SHARP) 在急性居家中风患者中。夏普将通过扩展基于家庭的 康复小组将包括一支专门培训为中风的高级家庭健康助理(HHA)团队 “教练。”教练将转而采用“培训培训者”的方法来训练和支持多面手HHA。 当他们与患者和家属合作实施患者的治疗方案时 医生和康复治疗师。这项试点研究将对10名有经验的家庭健康人员进行培训 助手们将成为夏普的教练，并将随机分配60名同意的、符合条件的患者到夏普 干预组(30)或对照组(30)接受常规护理。这项研究的具体目的是： 目标1：测试尖锐的招募和随机化程序，特别是识别、 招聘并完成10名敏锐教练的培训，以及识别、招募和完成培训的能力 对60名中风后患者进行干预和数据收集活动。 目标2：评估夏普教练计划对教练/直接护理HHA/患者/的接受度 康复治疗师和征求反馈意见，以确定未来可能需要的调整 通过访谈或焦点小组与每个参与小组的成员进行试验。 目标3：通过以下方式评估夏普计划干预组件的实施保真度 监控预期教练来访、运动日志维护等的及时性和完成性 礼仪活动。 目标4：检查选定基线、初级患者的反应负担和心理测量学特性 通过基线和60天跟踪访谈进行次要结果衡量，以供考虑 随后对夏普有效性进行了更大规模的研究。 夏普是一种潜在的劳动力发展解决方案，用于解决最大限度地提高中风的国家优先事项 患者恢复完整和独立生活的能力和可能性。夏普将创建一个新的类别 在卒中后康复和成人学习方面特别准备的具有文化能力的高级卫生保健机构 加强居家康复。该模式将扩大HHA在促进患者功能方面的作用 活动能力，降低跌倒的风险，提高对可能的中风后抑郁的认识，并改善患者的 生活质量。夏普模式有可能成为一种高影响力的方法来增强以家庭为基础的 中风后康复和改善功能活动能力，定义为个人在其 实现日常生活活动的环境。

Project Summary The overall goal of this project is to improve patients’ function following stroke. The project will pilot test an innovative Stroke Homehealth Aide Recovery Program (SHARP) designed to improve mobility and reduce falls in post-acute homebound stroke patients. SHARP would accomplish this by expanding the home-based rehabilitation team to include a corps of advanced home health aides (HHAs) specially trained as stroke “coaches.” The coaches will in turn employ a “train-the-trainer” approach to train and support generalist HHAs as they collaborate with patients and families to implement the therapeutic regimens prescribed by patients’ physicians and rehabilitation therapists. The pilot study will engage and train 10 experienced home health aides to become SHARP coaches and will randomly assign 60 consented, eligible patients to the SHARP intervention (30) or a control group (30) receiving usual care. The specific aims of the study are to:  Aim 1: Test SHARP recruitment and randomization procedures, specifically the ability to identify, recruit and complete training of 10 SHARP coaches and the ability to identify, recruit and complete intervention and data collection activities with 60 post-stroke patients.  Aim 2: Assess the acceptability of the SHARP coaching program to coaches/direct care HHAs/patients/ rehabilitation therapists and solicit feedback to determine adjustments that may be needed in a future trial through interviews or focus group with members of each of the participating groups.  Aim 3: Assess implementation fidelity to the SHARP program intervention components through monitoring the timeliness and completion of expected coach visits, exercise log maintenance, and other protocol activities.  Aim 4: Examine patient response burden and psychometric properties of selected baseline, primary and secondary outcome measures through baseline and 60 day follow-up interviews for consideration of a subsequent larger scale study of SHARP effectiveness. SHARP is a potential workforce development solution for addressing the national priority of maximizing stroke patients’ abilities and likelihood of returning to a full and independent life. SHARP would create a new category of culturally competent advanced HHAs specially prepared in post-stroke rehabilitation and adult learning to enhance home-based rehabilitation. The model would expand the HHAs’ role in promoting patients’ functional mobility, reducing risk of falls, improving recognition of possible post-stroke depression and improving patients’ quality of life. The SHARP model has the potential to be a high impact approach to enhancing home-based post-stroke rehabilitation and improving functional mobility, defined as individuals’ capacity to move within their environment to achieve activities of daily living.