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

拟议中的VA职业发展奖（CDA-1）旨在为退伍军人提供支持和指导

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.