CLINICAL EFFECTIVENESS OF SELF MANAGEMENT INTERVENTION POST-MILD STROKE

描述（由申请人提供）：这个K23奖项的目标是获得必要的指导培训，使候选人能够顺利过渡到成为轻度中风患者康复的独立研究者。该提案建立在候选人之前nih资助的临床研究培训和nih资助的博士预科培训的逻辑基础上；然而，与该奖项相关的保护时间和指导是必要的，以保证候选人的独立性。该候选人拥有资助和发表文章的记录，这使他成为轻度中风领域的专家。从他以前的工作和其他已发表的研究来看，很明显，轻度中风的人发展成进一步的慢性疾病的风险很高，甚至死于第二次中风的风险更高。自我管理干预已被证明是一种有效的干预措施，以增加健康行为，改善整体健康状况/健康行为，降低医疗保健的利用/成本，并减少抑郁症状的各种慢性疾病的人。然而，目前对轻度中风的治疗主要集中在急性事件上，很少重视慢性疾病。拟议研究的关键下一步和总体目标将是评估自我管理干预是否会改善轻度中风患者的健康结果。对轻度脑卒中患者采用单盲先导随机对照试验设计。在基线时，所有参与者将完成一系列评估，然后被随机分配到干预组或常规护理组。干预组将接受慢性疾病自我管理计划（CDSMP），常规护理组将接受医院康复建议。干预开始6个月后，两组将使用基线时完成的相同评估组的子集进行重新评估。将要求一个参与者小组允许调查人员获得用于初步成本分析的医疗保险数据。这项研究的长期目标是改善轻度中风患者的功能和生活质量。这项研究将是实现这一长期目标的关键一步，也是候选人的长期职业目标，有一个资助的研究项目来开发和评估认知康复策略，这些策略将改善轻度中风患者的功能和生活质量。结合该研究项目，候选人制定了严格的职业发展计划，以便在临床试验研究方法和成本效益分析方面精通技术。与该奖项相关的研究项目和职业发展计划都是为了充分利用候选人所在机构圣路易斯华盛顿大学（Washington University in St. Louis）的大量资源。华盛顿大学是美国顶尖的研究机构，候选人组建了一支高素质的多学科指导团队，确保其在奖励期结束前成为独立研究者。

DESCRIPTION (provided by applicant): The goal of this K23 award is to obtain the mentored training necessary for the candidate to have a smooth transition to become an independent investigator in the rehabilitation of persons with mild stroke. This proposal builds logically on te candidate's previously NIH-funded clinical research training and NIH-funded pre-doctoral training; however, the protected time and mentorship associated with this award are necessary to guarantee the candidate's independence. The candidate has a track record of grant funding and publications that have established him as an expert in the area of mild stroke. From his previous work and other published studies, it is clear that persons with mild stroke are at high risk of developing further chronic disease and even higher risk of dying from a second stroke. Self-management intervention has been proven to be an effective intervention to increase healthy behaviors, improve overall health status/health behaviors, decrease healthcare utilization/cost, and decrease depressive symptoms in several studies with people with a variety of chronic conditions; however, current treatment of mild stroke is mostly focused on the acute event with little emphasis on chronic disease. The critical next step and overall goal of the proposed research study will be to evaluate if self-management intervention will improve health outcomes for persons with mild stroke. A single-blinded pilot randomized controlled trial design will be used with individuals with mild stroke. At baseline all participants will complete an assessment battery and then be randomly assigned to either the intervention group or the usual-care group. The intervention group will receive the Chronic Disease Self-Management Program (CDSMP) and the usual-care group will receive hospital rehabilitation recommendations. Six months after the start of the intervention, both groups will be reassessed using a subset of the same assessment battery completed at baseline. A subgroup of participants will be asked to allow the investigators to have access to health insurance data to be used for a preliminary cost analysis. The long-term goal of this study is to improve function and quality of life for persons with mild stroke. This study will be a critical step in achieving tis long term goal and also the candidate's long term career goal to have a funded research program to develop and evaluate cognitive rehabilitation strategies that will improve function and quality of life for persons with mild stroke. In conjunction with this research project, the candidate has developed a rigorous career development plan in order to become technically proficient in clinical trial research methodology and cost-effectiveness analysis. Both the research project and career development plan associated with this award are designed to capitalize on the vast resources available to the candidate at his institution, Washington University in St. Louis. Washington University is a top research institution in the United States and the candidate has assembled a highly qualified multidisciplinary mentorship team to ensure he becomes an independent investigator by the end of the award period.