Cognitive Rehabilitation for Gulf War Illness

描述(由申请人提供)： 海湾战争疾病是一种复杂的多症状疾病，其导致的残疾程度与癌症和慢性心力衰竭等其他重大疾病一样多。以前的临床试验(即认知行为疗法和分级运动)寻求通过增加活动来改善残疾，而不管症状如何。这些先前的GWI试验显示，疗效有限，依从性差。一种创新的治疗方法是针对GWI的一个特定组成部分，即解决问题的能力，已知与残疾有关。超过70%的海湾战争退伍军人(GWV)患有海湾战争退伍军人(GWV)，其解决问题的能力受损，预计与1.5倍的残疾风险有关。这种损害还与对医疗制度的坚持较差有关，这使得GWV难以管理GWI的其他方面。因此，对问题解决缺陷的康复是治疗像GWI这样的复杂综合征的关键目标。尽管如此，还没有既定的治疗方法来弥补GWV之间解决问题的不足。我们建议使用一种最先进的基于证据的认知康复方法--问题解决疗法来治疗GWI的问题解决缺陷。问题解决疗法教授患者克服影响问题解决的因素的技能。因为问题解决疗法教授患者解决现实生活中的问题的策略，它可以减少其他人群的残疾。这是认知康复疗法治疗重度颅脑损伤的首次试验。我们提出了一项电话提供的问题解决疗法与电话提供的健康教育的多点随机对照试验。我们将使用12个疗程的既定问题解决疗法干预，并采用结构化的五步顺序方法来教授问题解决。残疾将由世界卫生组织残疾评估附表2.0中反映残疾的两个方面：活动限制和参与限制的总体综合分数来衡量。为了增加……的代表性 在我们的样本中，我们将从三个退伍军人事务部招募258名GWV：新泽西州、纽约州北部和马萨诸塞州。

DESCRIPTION (provided by applicant): Gulf War illness (GWI) is a complex multi-symptom illness which causes as much disability as other major medical diseases such as cancer and chronic heart failure. Previous clinical trials (i.e. cognitive behavioral therapy and graded exercise) for GWI have sought to improve disability by increasing activity regardless of symptom presentation. These previous trials for GWI have shown limited efficacy and poor adherence. An innovative treatment approach is to target a specific component of GWI, namely problem-solving ability, known to be associated with disability. Impairment in problem-solving ability affects over 70% of Gulf War Veterans (GWV) with GWI and is prospectively related to 1.5 times greater risk of disability. This impairment is also related to poorer adherence to medical regimes, making it difficult for GWV to manage other aspects of GWI. Thus, rehabilitation of problem-solving deficits is a critical target to treat a complicated syndrome like GWI. Despite this, there are no established treatments to compensate for problem-solving deficits among GWV. We are proposing to treat the problem-solving deficits of GWI using a state-of-the-art evidence-based approach to cognitive rehabilitation, Problem-Solving Therapy. Problem-Solving Therapy teaches patients skills to overcome factors impacting problem-solving. Because Problem-Solving Therapy teaches patients strategies to address real-life problems it leads to reductions in disability in other populations. This is the first trial of cognitive rehabilitation therapy for GWI. We propose a mult-site randomized controlled trial of telephone-delivered Problem-Solving Therapy versus telephone-delivered Health Education. We will use a 12 session established Problem-Solving Therapy intervention with a structured five step sequential approach to teaching problem-solving. Disability will be measured by the overall composite score from the World Health Organization Disability Assessment Schedule 2.0 which reflects two dimensions of disability: activity limitations and participation restrictions. In order to increase the representativeness of our sample, we will recruit 258 GWV from three VA sites: New Jersey, upstate New York, and Massachusetts.