Carepartner Collaborative Integrated Therapy in Sub-Acute Stroke

亚急性中风的护理伙伴协作综合治疗

• 批准号: 9906277
• 负责人: Sarah R. Blanton
• 金额: $ 23.66万
• 依托单位: EMORY UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-04-03 至 2022-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9906277
• 关键词: Acute; Address; Caregivers; Caring; Chronic; Complement; Conflict (Psychology); Control Groups; Coupled; Data; Empathy; Family; Family member; Feasibility Studies; Fostering; Frustration; Future; Goals; Health; Health Technology; Home environment; Hour; Impairment; Individual; Intervention; Interview; Joints; Language; Lead; Mental Depression; Methods; Motivation; Online Systems; Outcome; Outpatients; Patients; Perceived quality of life; Perception; Personal Satisfaction; Persons; Phase; Physical Function; Pilot Projects; Problem Solving; Process; Qualitative Methods; Quality of life; Randomized; Randomized Controlled Trials; Recovery; Rehabilitation therapy; Research; Research Design; Research Priority; Residual state; Self Efficacy; Self Management; Site; Stress; Stroke; Structure; Testing; Therapeutic Intervention; Translations; United States; United States National Institutes of Health; Upper Extremity; Work; acute stroke; attentional control; base; chronic stroke; clinical practice; cohort; comparison intervention; constraint induced movement therapy; depressive symptoms; design; disability; efficacy testing; exhaust; experience; experimental group; functional independence; functional loss; improved; mortality risk; negative affect; novel; physical conditioning; post intervention; post stroke; programs; psychosocial; rehabilitation research; satisfaction; skills; stroke outcome; stroke recovery; stroke rehabilitation; stroke survivor; supportive environment; theories; therapy design; therapy development; trend; user-friendly

Abstract DESCRIPTION: Stroke is a leading cause of serious, long-term disability. Family carepartner (CP) management and support can improve stroke survivor (SS) recovery; but can also increased the CP’s depression, frustration, and resentment. CPs frequently feel overwhelmed and exhausted, while unmet CP needs negatively affect the rehabilitation of the SS and increase CP risk of mortality. We have developed a theory-based, family-centered intervention, Carepartner Collaborative Integrated Therapy (CARE-CITE) designed to positively engage CPs during SS upper extremity functional task practice in the home setting. Using exemplary and interactive videos of family scenarios in the home, CARE-CITE guides the CP in collaborative goal setting and creating an autonomy supportive environment with the SS to promote motivation and creative problem solving in upper extremity self-management. To date, CARE-CITE has been evaluated in SS with chronic stroke and coupled with a well-established and structured intensive upper extremity task practice intervention called constraint-induced movement therapy. The specific objective of this proposal is to refine and test our mobile, web-based self-management intervention as an adjunct to usual and customary upper extremity care sooner after stroke when SS are in outpatient rehabilitation and in the sub-acute (1-3 months) recovery period to improve family CP and SS psychosocial and physical health outcomes. Our proposed two year project uses a mixed methods convergent design with a two-group experimental approach with separate quantitative and qualitative analyses followed by integration of findings. We will block randomize (2:1) 36 dyads to treatment (usual and customary care with CARE-CITE) or control (usual and customary care without structured CP involvement). In-person semi-structured interviews post intervention with CPs receiving CARE- CITE will be analyzed to illuminate quantitative results. The premise underpinning this research is that a theory-based, family-centered intervention focused on skill building, improved family context, and problem- solving will improve SS physical function and quality of life while reducing CP negative outcomes. AIMS: Our long-term goal is to improve joint responsibilities for self-management during stroke recovery and subsequently improve CP and SS outcomes through technologically supported intervention strategies. The aims of this R21 application are: (a) to evaluate mobile CARE-CITE delivered at home during subacute stroke rehabilitation on both CP and SS health outcomes and quality of life, (b) to examine the effect of mobile CARE- CITE on the family context and processes related to stroke rehabilitation, and (c) Use qualitative methods to complement the interpretation of effects on processes and outcomes from Aims 1 and 2. Data from this study will help us gain an understanding of mechanisms that underpin family-centered self- management interventions to improve SS and CP outcomes in stroke recovery. Next steps will be to develop a multi-site randomized controlled trial to test the efficacy of mobile CARE-CITE in early stroke recovery.

摘要 描述：中风是导致长期严重残疾的主要原因。家庭照料者(CP) 管理和支持可以改善卒中幸存者(SS)的恢复，但也可以增加CP 沮丧、沮丧和怨恨。CP经常感到不知所措和疲惫，而未满足的CP 需求对SS的康复产生负面影响，并增加CP死亡的风险。我们已经开发出一种 以理论为基础、以家庭为中心的干预、护理伙伴协作综合治疗(CARE-CITE) 目的是在家庭环境中积极参与SS上肢功能任务练习中的CPS。vbl.使用 家庭场景的示范和互动视频，CARE-CITE在协作中指导CP 设定目标，并与SS一起创造一个支持自主的环境，以促进动力和创造力 上肢自我管理中的问题解决。到目前为止，CARE-CITE已经在SS中进行了评估， 慢性中风，再加上良好的、有组织的强化上肢任务练习 干预被称为强制诱导运动疗法。这项提议的具体目标是完善 并测试我们的移动、基于网络的自我管理干预，作为通常和习惯上的辅助工具 中风后较早的肢体护理，SS在门诊康复和亚急性期(1-3个月) 恢复期以改善家庭CP和SS的心理社会和身体健康结果。我们建议的两个 一年项目采用混合方法收敛设计，采用两组实验方法，分别 进行定量和定性分析，然后综合调查结果。我们将区块随机化(2：1)36 治疗(有护理的常规护理和习惯护理--引用)或对照(没有护理的常规护理和常规护理)的二元性 结构化CP参与)。接受护理的CPS干预后的面对面半结构化访谈- 将对CITE进行分析，以说明量化结果。支持这项研究的前提是 以理论为基础、以家庭为中心的干预，侧重于技能培养、改善家庭环境和问题- 解决问题将改善SS的身体功能和生活质量，同时减少CP的负面后果。目标：我们的 长期目标是改善中风康复和康复期间的自我管理的共同责任 随后，通过技术支持的干预策略改善CP和SS的结局。这个 此R21应用程序的目标是：(A)评估亚急性中风期间在家中提供的移动护理 康复对CP和SS的健康结果和生活质量的影响；(B)检查流动护理的效果- 列举与中风康复有关的家庭背景和进程，以及(C)使用定性方法 补充对目标1和目标2对过程和结果的影响的解释。 这项研究将帮助我们理解以家庭为中心的自我意识的形成机制 管理干预以改善卒中康复中SS和CP的结局。下一步将是开发一种 多点随机对照试验测试移动护理在中风早期康复中的疗效。