CLINICAL EFFECTIVENESS OF SELF MANAGEMENT INTERVENTION POST-MILD STROKE

描述（由申请人提供）：该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，成为轻度中风患者康复的独立调查员。该提案在逻辑上建立在候选人以前NIH资助的临床研究培训和NIH资助的博士前培训的基础上;然而，与该奖项相关的受保护的时间和指导对于保证候选人的独立性是必要的。候选人有一个跟踪记录的赠款资金和出版物，使他成为一个专家，在该地区的轻度中风。从他以前的工作和其他已发表的研究中，很明显，轻度中风的人患进一步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，降低医疗保健利用/成本，并减少抑郁症状的人与各种慢性疾病的几项研究;然而，目前的治疗轻度中风主要集中在急性事件，很少强调慢性疾病。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状况。将对轻度卒中患者进行单盲、初步随机对照试验设计。在基线时，所有参与者将完成一系列评估，然后随机分配到干预组或常规护理组。干预组将接受慢性病自我管理计划（CDSMP），常规护理组将接受医院康复建议。干预开始后6个月，将使用基线时完成的相同评估组合的子集对两组进行重新评估。将要求一个参与者小组允许研究人员访问用于初步成本分析的健康保险数据。本研究的长期目标是改善轻度卒中患者的功能和生活质量。这项研究将是实现长期目标的关键一步，也是候选人长期职业目标的关键一步，即获得资助的研究计划，以开发和评估认知康复策略，改善轻度中风患者的功能和生活质量。结合本研究项目，候选人制定了严格的职业发展计划，以便在技术上精通临床试验研究方法和成本效益分析。与该奖项相关的研究项目和职业发展计划都旨在利用候选人所在机构圣路易斯华盛顿大学的大量资源。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导师团队，以确保他在奖励期结束前成为独立研究员。

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.