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

拟议的退伍军人事务部职业发展奖（CDA-1）旨在为退伍军人事务部的 加布里埃尔Scronce，成为一个成功的，独立的VA调查员，改善退伍军人的生活 中风幸存者Scronce博士获得了物理治疗博士和人体运动科学博士学位 在查佩尔山的北卡罗来纳州大学。她目前是拉尔夫H.约翰逊 VAMC和南卡罗来纳州医科大学的博士后学者， 博士罗真瑞PI的职业和研究培训目标受到她作为物理学家的经验的影响。 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 我认识到这些人的独特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来说，她的培训目标是为以下方面奠定基础： 心理社会因素和行为干预，以提高退伍军人对家庭锻炼计划的坚持性 (HEP)，提高定量，定性和混合方法研究的技能，提高临床 中风康复的试验设计和管理，并通过以下方式促进她的专业发展 奖学金、出版物、科学报告、指导和社区参与。的 CDA-1中的跨专业导师团队非常适合指导PI实现 她的训练目标。这CDA-1增加了新的导师博士Scronce博士从博士丽莎麦克蒂格在心理社会 因素/措施和行为干预，从Jillian Harvey博士在定性和混合方法 研究，并从Viswanathan Ramakrishnan博士在定量研究。在CDA-1中，Scronce博士将 继续接受徐博士的指导，并增加客观加速度测量法的培训，以跟踪HEP 坚持。Scronce博士在CDA-1中提出的研究解决了不充分的重要问题 中风幸存者坚持上肢（UE）HEP，这是一个限制康复和幸存者生活质量的问题。 有能力参与所期望的活动。这项研究的目的是解释如何修改 心理社会因素表现为退伍军人坚持HEP的障碍和促进因素 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，其中 中风后UE受损的退伍军人将被要求完成可修改的客观指标， 心理社会因素，完成HEP 7天，在此期间将客观监测依从性，以及 参加半结构化访谈，分享HEP依从性的障碍和促进因素。定量分析结果 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HEP的心理社会因素，障碍和促进因素之间的关系 坚持和客观的HEP坚持水平。长期目标是利用这项研究的结果， 一种新的强化行为干预，可以在康复访问中提供， 个体退伍军人的心理社会因素，以增加坚持HEP，最终改善UE恢复， 中风幸存者

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.