Examining the association between psychosocial factors and adherence to a home exercise program for upper extremity recovery in Veteran stroke survivors

拟议的退伍军人管理局职业发展奖(CDA-1)旨在为以下人员提供支持和指导 PI，Gabrielle Scronce博士，成为一名成功的独立退伍军人调查员，改善退伍军人的生活 中风幸存者。斯克朗斯博士获得了物理治疗博士学位和人体运动学博士学位 在北卡罗来纳大学教堂山分校。她目前是拉尔夫·H·约翰逊研究所的WOC研究员 VAMC和南卡罗来纳医科大学的博士后学者，在 罗振锡博士。PI的职业生涯和研究训练目标受到她作为体检人员的经验的影响 与退伍军人和现役军人一起工作的治疗师，因为这些互动使她能够 欣赏这些个人的独特优势和需求，但这些优势和需求没有得到充分的理解和解决 通过标准的物理治疗实践。具体地说，她的培训目标是为 提高退伍军人家庭锻炼依从性的心理社会因素和行为干预 (HEP)，提高定量、定性和混合方法研究的技能，提高临床熟练程度 中风康复的试验设计和管理，并通过 资质、出版物、科学报告、指导和社区参与。这个 CDA-1中的跨专业导师团队非常适合指导PI实现以下目标 她的训练目标。这一CDA-1增加了来自心理社会中的丽莎·麦克蒂格博士对斯克朗斯博士的新指导 因素/测量和行为干预，来自Jillian Harvey博士的定性和混合方法 研究，以及来自Viswanathan Ramakrishnan博士的定量研究。在CDA-1中，斯克朗斯博士将 继续接受徐博士的指导，并增加客观加速度计的培训以跟踪HEP 坚持不懈。Scronce博士在CDA-1中提出的研究解决了不充分的重要问题 卒中幸存者对上肢(UE)HEP的坚持，这是一个限制康复和幸存者的问题 随后能够参与所需的活动。这项研究的目的是解释如何修改 心理社会因素在退伍军人坚持HEP的障碍和促进者方面表现出来 中风幸存者。这一目标将通过采用混合方法设计的观察性研究来实现 中风后有UE损害的退伍军人将被要求完成可修改的客观测量 心理社会因素，完成为期7天的HEP，在此期间将客观监测依从性，以及 参与半结构化访谈，分享遵守HEP的障碍和促进者。定量研究结果 将心理社会因素与HEP依从性和半结构化访谈的定性结果联系起来 整合以阐明心理社会因素、障碍和促进者之间的关系 依从性和客观的HEP依从性水平。长期目标是利用这项研究的结果来开发 一种新的增强型行为干预，可以在康复访问中提供，并针对 退伍军人个体心理社会因素增加对HEP的依从性，最终促进UE在 中风老兵幸存者。

The proposed VA Career Development Award (CDA-1) is designed to provide support and mentorship for the PI, Dr. Gabrielle Scronce, to become a successful, independent VA investigator improving the lives of Veteran stroke survivors. Dr. Scronce obtained her Doctor of Physical Therapy and PhD in Human Movement Science at the University of North Carolina at Chapel Hill. She is currently a WOC researcher at the Ralph H. Johnson VAMC and a postdoctoral scholar at the Medical University of South Carolina under the primary mentorship of Dr. Na Jin Seo. The PI’s career and research training goals are influenced by her experience as a physical therapist working with Veterans and active duty service members, as these interactions have allowed her to appreciate the unique strengths and needs of these individuals that are insufficiently understood and addressed by standard physical therapy practice. Specifically, her training goals are to develop the foundation for psychosocial factors and behavioral interventions to improve Veterans’ adherence to home exercise programs (HEP), enhance skills in quantitative, qualitative, and mixed-methods research, develop proficiency in clinical trial design and management for stroke rehabilitation, and advance her professional development through grantsmanship, publications, scientific presentations, mentorship, and community engagement. The interprofessional team of mentors in this CDA-1 is well-suited to guide the PI as she works towards achieving her training goals. This CDA-1 adds new mentorship to Dr. Scronce from Dr. Lisa McTeague in psychosocial factors/measures and behavioral interventions, from Dr. Jillian Harvey in qualitative and mixed methods research, and from Dr. Viswanathan Ramakrishnan in quantitative research. In this CDA-1, Dr. Scronce will continue to receive mentorship from Dr. Seo with the addition of training in objective accelerometry to track HEP adherence. The study Dr. Scronce has proposed in this CDA-1 addresses the important problem of inadequate adherence to upper extremity (UE) HEP among stroke survivors, a problem that limits recovery and survivors’ subsequent ability to participate in desired activities. The objective of this study is to explain how modifiable psychosocial factors manifest themselves in terms of barriers and facilitators for HEP adherence among Veteran stroke survivors. This objective will be met through an observational study with mixed-methods design in which Veterans with UE impairment after stroke will be asked to complete objective measures of modifiable psychosocial factors, complete a HEP for 7 days during which adherence will be objectively monitored, and participate in semi-structured interviews to share barriers and facilitators to HEP adherence. Quantitative findings relating psychosocial factors with HEP adherence and qualitative findings from the semi-structured interview will be integrated to elucidate the relationship among psychosocial factors, barriers and facilitators for HEP adherence, and objective HEP adherence level. The long-term goal is to use the results of this study to develop a new enhanced behavioral intervention that can be delivered within a rehabilitation visit and that targets individual Veterans’ psychosocial factors to increase adherence to HEP, ultimately improving UE recovery in Veteran stroke survivors.