Enhanced Problem-Solving Training (E-PST) to Improve Recovery from mTBI

增强问题解决训练 (E-PST) 以改善 mTBI 的恢复

• 批准号: 10023199
• 负责人: Paul R. King
• 金额: --
• 依托单位: VA WESTERN NEW YORK HEALTHCARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-10-01 至 2023-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10023199
• 关键词: Address; Area; Attention; Attention Concentration; Behavioral; Buffaloes; Caring; Chronic; Clinic; Clinical; Clinical Practice Guideline; Clinical Research; Cognition; Cognitive; Consult; Craniocerebral Trauma; Data; Decision Making; Development; Education; Elements; Ensure; Equipment and supply inventories; Evidence based intervention; Evidence based practice; Feedback; Fellowship; Freedom; Frustration; Future; General Practitioners; Goals; Grant; Health Personnel; Healthcare; Healthcare Systems; Home environment; Injury; Intervention; Interview; K-Series Research Career Programs; Manuals; Measures; Medical; Medical center; Mental Depression; Mental Health; Mental Health Services; Mental disorders; Mentorship; Monitor; New York; Outcome; Outcome Measure; Participant; Patient Self-Report; Positioning Attribute; Post-Traumatic Stress Disorders; Primary Health Care; Problem Solving; Protocols documentation; Provider; Psychologist; Published Comment; Randomized; Randomized Controlled Trials; Recording of previous events; Recovery; Rehabilitation therapy; Reporting; Research; Research Personnel; Research Proposals; Research Support; Research Training; Resources; Series; Services; Site; Symptoms; Testing; Time; Training; Veterans; War; Writing; arm; attentional control; base; brief intervention; career; clinical effect; cognitive ability; cognitive skill; cohort; comorbidity; design; efficacy trial; executive function; experience; improved; medically necessary care; meetings; mental health center; mild traumatic brain injury; neurobehavioral; operation; patient oriented; primary care services; primary outcome; programs; psychological distress; recruit; rehabilitation research; rehabilitation service; rehabilitative care; research and development; skills; skills training; symptom management; treatment as usual

Dr. Paul King (PI) is a Clinical Research Psychologist at the VA Center for Integrated Healthcare (CIH), and a graduate of a Department of Veterans Affairs (VA) Advanced Fellowship in Mental Illness Research and Treatment (MIRECC). His primary research area is post-deployment health care for Operation Enduring and Iraqi Freedom (OEF/OIF) Veterans in Primary Care-Mental Health Integration (PC-MHI) settings. The short- term objective for this Career Development Award-2 (CDA-2) proposal is to further Dr. King's development as a Rehabilitation Research and Development (RR&D) researcher by meeting specific training goals related to the design and execution of randomized controlled trials (RCTs), and further building skills in mental health (MH) rehabilitation. The career plan comprehensively addresses these goals via mentorship, formal coursework, and professional seminars. The combination of research support, mentorship, and training will provide opportunities for Dr. King to further develop skills, [prepare] him to function as an independent RR&D researcher, and build a Veteran-centered research portfolio in MH and mild traumatic brain injury (mTBI) rehabilitation. Long term, this research aims to improve the accessibility of skills-focused rehabilitative services; to enhance implementation of patient-centered, evidence-based practices (EBPs) for mTBI in VA; and to serve as a cornerstone for Dr. King's VA RR&D research career. Study activities will take place at the VA Western New York Healthcare System (VA WNYHS) at Buffalo, which is a full-service medical, MH, and substance treatment facility with an active research program. Primary care services are delivered on-site across 3 clinics, with licensed MH providers embedded in each. One of 2 CIH sites is located on the VA WNYHS campus (a second site is located at the Syracuse VA Medical Center). As a VA MH Center of Excellence dedicated to improving the care of Veterans via enhancing the integration of primary care and MH services, CIH is home to national experts in PC-MHI research and practice. The research goal of this CDA-2 proposal entitled “Enhanced Problem-Solving Training (E-PST) to Improve Recovery for mTBI” is to adapt and pilot test an enhanced version of Problem Solving Training for Primary Care (PST-PC) that can be delivered to Veterans with history of mTBI. This goal will be achieved by conducting 3 studies aimed at: 1) gathering stakeholder feedback on E-PST protocol adaptation through interviews with subject matter experts (SMEs) in PST, rehabilitation, and PC-MHI; 2) [examining the acceptability, feasibility, and preliminary clinical effect] of E-PST by conducting an open trial with [10-12] Veterans with history of mTBI; and 3) conducting a pilot RCT of E-PST compared to [an attention] control (n = 19 per arm). Study 1 (Aim 1) will employ a modified Delphi approach to gather SME feedback on the adaptation and refinement of the E-PST treatment manual. The resulting manual will guide the intervention that is delivered in the open trial in Study 2 (Aim 2). Participants in the open trial will complete the adapted 4-6 session E-PST protocol, and provide self-report and interview data at each session on various aspects of the treatment. These data will ensure that relevant Veteran stakeholder feedback is incorporated prior to initiating the pilot RCT in Study 3 (Aim 3). The purpose of the pilot RCT is threefold: a) to estimate a preliminary effect size (ES) for the primary outcome measure; b) to determine the feasibility of [the assessment plan]; and c) to establish the feasibility of recruitment and retention in order to guide the design of a future multisite efficacy trial. All participants in Studies 2-3 will continue with primary care treatment as usual (TAU) for any necessary medical management of symptoms. Data derived from this CDA-2 will be essential in planning a future RR&D Merit proposal designed to formally test E-PST's efficacy.

Paul King博士（PI）是VA综合医疗保健中心（CIH）的临床研究心理学家， 毕业于退伍军人事务部（VA）精神疾病研究高级奖学金， 治疗（MIRECC）。他的主要研究领域是持久行动的部署后医疗保健， 伊拉克自由（OEF/OIF）退伍军人在初级保健-心理健康一体化（PC-MHI）设置。短- 本职业发展奖-2（CDA-2）提案的长期目标是促进金博士的发展， 康复研究与发展（RR & D）研究员，通过满足与以下相关的特定培训目标 随机对照试验（RCT）的设计和执行，并进一步培养心理健康技能 (MH)康复活动.职业计划通过导师制、正式的 课程和专业研讨会。研究支持、指导和培训的结合将 为金博士提供进一步发展技能的机会，[准备]他作为一个独立的R & D 研究人员，并建立一个退伍军人为中心的研究组合MH和轻度创伤性脑损伤（mTBI） 康复活动.从长远来看，这项研究旨在改善以技能为重点的康复服务的可及性。 服务;加强实施以患者为中心，以证据为基础的做法（EBP）的mTBI在VA; 并作为金博士VA RR & D研究生涯的基石。 研究活动将在位于布法罗的VA Western纽约医疗保健系统（VA WNYHS）进行， 这是一个全方位服务的医疗，MH，和物质治疗设施与一个积极的研究计划。初级 护理服务在3个诊所现场提供，每个诊所都有持牌的卫生保健提供者。2个中的一个 CIH网站位于弗吉尼亚州WNYHS校园（第二个网站位于锡拉丘兹弗吉尼亚州医疗中心）。 作为一个卓越的VA MH中心，致力于通过加强整合， 在初级保健和MH服务方面，CIH是PC-MHI研究和实践方面的国家专家的家园。 该CDA-2提案的研究目标题为"增强问题解决培训（E-PST），以提高 mTBI的恢复"是为了适应和试点测试小学问题解决培训的增强版本， 护理（PST-PC），可以提供给退伍军人与mTBI的历史。这一目标将通过 开展3项研究，旨在：1）收集利益相关者对E-PST协议适应性的反馈， 与PST、康复和PC-MHI领域的主题专家（SME）进行访谈; 2）[检查 E-PST的可接受性、可行性和初步临床效果]，进行开放试验[10 - 12] 有mTBI病史的退伍军人;和3）与[注意力]对照相比，进行E-PST的试点RCT（n = 10）。 每组19个）。研究1（目标1）将采用修改后的德尔菲方法收集SME对 调整和完善E-PST治疗手册。由此产生的手册将指导干预行动， 在研究2（目标2）的开放试验中交付。开放试验的参与者将完成改编的4 - 6 会议E-PST协议，并提供自我报告和采访数据，在每个会议的各个方面， 治疗这些数据将确保在启动前纳入相关的退伍军人利益相关者反馈 研究3中的先导RCT（目标3）。试验性随机对照试验的目的有三个方面：a）估计初步效果 主要结局指标的大小（ES）; B）确定[评估计划]的可行性;以及c） 确定招募和保留的可行性，以指导未来多中心功效的设计 审判研究2 - 3中的所有受试者将继续接受常规初级保健治疗（TAU）， 症状的医疗管理。从CDA-2中获得的数据对于规划未来的经常性资源和发展至关重要 Merit提案旨在正式测试E-PST的功效。