Web-based stroke education for patients and families

描述(申请人提供)：在美国，缺血性中风是疾病负担的主要来源。中风幸存者复发的风险很高，因此他们是二级预防的重要群体。然而，中风幸存者的知识差距，包括对中风早期预警迹象的了解不足，对康复的目的和目标了解不足，以及对个人危险因素缺乏认识，导致了与中风相关的可预防的发病率。在中风住院康复期间，解决这些知识差距的教育通常是不够的。对中风幸存者进行有效的教育计划可以通过促进康复、降低再次中风的风险和降低中风复发的发病率来改善中风预后。在第一阶段SBIR中，我们确定了为中风幸存者及其家人发展基于网络的教育的可行性。我们开发了一个原型来传授中风的基本知识，包括警告迹象、风险因素和常见风险因素之一(高血压)的管理。这个原型是一个基于网络的交互式教育程序，使用视频格式和动画，以及通过计算机技术进行自我评估和适应性学习，以解决认知缺陷。对25名中风患者和7名照顾者进行了这一原型的试点研究，大约一半的受试者使用基于网络的训练，而不是适应性学习，另一半的受试者使用适应性学习。该计划被广泛接受，与基线相比，所有受试者的中风相关知识都有了显着提高。在没有适应性学习的情况下，正确率在后测中的平均提高为2.0。当适应性学习部分被整合到基于网络的培训中时，在事后测试中正确答案的平均改善为5.1。第一阶段的原型可以在www.strokelearning.com上访问以进行审查。我们现在建议在第二阶段完成这个基于网络的计划的开发，以便它解决所有主要的可管理的风险因素，提供一般的中风知识，并提供对中风康复的理解。重要的是，这项计划将继续把重点放在改变患者的行为上，使他们能够降低进一步中风的风险，并从康复中更好地受益。该计划还将适应患者的知识水平和认知障碍。它将反复衡量患者和护理人员在知识方面的进步，这样做将加强在多个疗程中的学习。作为第二阶段的一部分，我们将测试这一计划在出院时改善患者和照顾者中风知识方面的有效性，并在200名中风患者及其家属的对照试验中监测出院后2周和6周风险相关行为(吸烟)的变化。该计划将向中风医疗提供者提供适销对路的产品，包括必须满足特定患者教育要求的康复医院、寻求中风专业认证的医院和疗养院。此外，希望改善中风预防工作(从而节省成本并提高患者护理质量)的保险公司可能是一个收入来源。中风是美国第三大死亡原因和主要残疾原因，每年困扰着70万至100万美国人，其中非洲裔美国人的风险尤其高。美国480万中风幸存者是中风复发的高危人群。事实上，与年龄匹配的正常人相比，他们患中风的风险高出15倍。这个应用程序的总体目标是开发一个基于网络的互动视频程序，在康复期间和以后改善中风幸存者和他们的照顾者的教育，以便识别个人风险因素，改变行为，最终减少重复中风的发生，降低与中风相关的总体发病率。

DESCRIPTION (provided by applicant): Ischemic stroke is a major source of illness burden in the US. Stroke survivors are at high risk for recurrence and therefore they are an important group for secondary prevention. However, gaps in knowledge among stroke survivors, including inadequate knowledge of the early warning signs of stroke, inadequate understanding of the purpose and goals of rehabilitation, and lack of awareness of personal risk factors, lead to preventable stroke-related morbidity. Education to address these knowledge gaps is typically inadequate during inpatient rehabilitation for stroke. An effective program of education for stroke survivors could improve stroke outcomes by promoting rehabilitation, reducing the risk of another stroke and reducing morbidity of recurrent strokes. In the Phase I SBIR, we established the feasibility of developing a web-based education for stroke survivors and their families. We developed a prototype to impart basic knowledge about stroke, including warning signs, risk factors, and management of one of the common risk factors (hypertension). This prototype is an interactive web-based educational program, using video format and animation, as well as self-assessments and adaptive learning through computer technology to address cognitive deficits. A pilot study of this prototype with 25 stroke patients and 7 caregivers was conducted, with approximately half of the subjects using the Web-based training without adaptive learning, and the other half with adaptive learning. The program was well-accepted and stroke-related knowledge improved significantly compared to baseline for all subjects. Without the adaptive learning, the mean improvement in correct answers on pre-post testing was 2.0. When the adaptive learning component was integrated into the Web-based training, the mean improvement in correct answers on pre-post testing was 5.1. The Phase I prototype can be accessed for review at www.strokelearning.com. We now propose in Phase II to complete the development of this web-based program, so that it addresses all of the main manageable risk factors, provides general stroke knowledge, and provides an understanding of stroke rehabilitation. Importantly, this program will maintain a focus on changing patients' behavior, empowering them to reduce their risk for further strokes and benefit more optimally from rehabilitation. The program will also adapt to patients' level of knowledge and cognitive impairments. It will iteratively measure gains in knowledge by patients and caregivers and in doing so will reinforce learning over multiple sessions. As part of Phase II, we will test the efficacy of this program in improving patient and caregiver stroke knowledge at the time of discharge, and monitor change in risk- related behavior (smoking) at 2 and 6 weeks post-discharge in a controlled trial of 200 stroke patients and family members. This program will be a marketable product to providers of medical treatment for stroke, including rehabilitation hospitals which must meet specific patient education requirements, hospitals which are seeking stroke specialty certification and nursing homes. Additionally, insurance companies that wish to improve stroke prevention efforts (and thus save costs as well as improve patients' quality of care) may be a source of revenue. Stroke, the 3rd leading cause of death and a leading cause of disability in the US afflicts between 700,000 and one million Americans annually, with African-Americans at particularly high risk. The 4.8 million stroke survivors in the US represent a large at-risk group for a recurrence of stroke. In fact, they are at 15 times greater risk of stroke compared to age-matched normals. The overall goal of this application is to develop a web-based interactive video program that would improve the education of stroke survivors and their caregivers while in rehabilitation and beyond, in order to identify personal risk factors, modify behavior, and ultimately reduce the occurrence of repeat strokes and reduction of overall stroke-related morbidity.