Carepartner Collaborative Integrated Therapy in Sub-Acute Stroke

摘要 描述：中风是导致严重、长期残疾的主要原因。家庭护理伙伴（CP） 管理和支持可以改善卒中幸存者（SS）的恢复，但也可以增加CP的 抑郁沮丧和怨恨CP经常感到不知所措和疲惫不堪，而未满足的CP 需求对SS的康复产生负面影响，并增加CP的死亡风险。我们已经开发出一种 以理论为基础，以家庭为中心的干预，护理伙伴协作综合治疗（CARE-CITE） 设计用于在家庭环境中进行SS上肢功能任务练习时积极吸引CP。使用 示范性和互动视频的家庭场景在家里，CARE-CITE指导合作伙伴在合作 目标设定和创造一个自主的支持环境，以促进动力和创造力 解决上肢自我管理的问题。到目前为止，CARE-CITE已经在SS中进行了评估， 慢性中风，再加上一个完善的和结构化的强化上肢任务的做法 一种叫做强制性运动疗法的干预措施。这项建议的具体目标是， 并测试我们的移动的，基于网络的自我管理干预作为一种辅助手段， 当SS处于门诊康复期和亚急性期（1-3个月）时，卒中后更早进行肢体护理 恢复期，以改善家庭CP和SS的心理社会和身体健康的结果。我们建议的两个 一年的项目使用混合方法收敛设计与两组实验方法， 进行定量和定性分析，然后综合分析结果。我们将随机分组（2：1）36 与治疗（常规和习惯护理与CARE-CITE）或对照（常规和习惯护理与CARE-CITE）的二元组 结构化CP参与）。干预后与接受CARE的CP进行面对面半结构化访谈- 将对CITE进行分析，以阐明定量结果。支持这项研究的前提是， 以理论为基础，以家庭为中心的干预，重点是技能建设，改善家庭环境， 解决将改善SS的身体功能和生活质量，同时减少CP的负面结果。目标：我们的 长期目标是改善中风恢复期间自我管理的共同责任， 随后通过技术支持的干预战略改善社区方案和社会支持的结果。的 该R21应用的目的是：（a）评价亚急性卒中期间在家中提供的移动的CARE-CITE 康复对CP和SS健康结果和生活质量的影响，（B）检查移动的护理的效果- 引用与中风康复有关的家庭背景和过程，以及（c）使用定性方法 以补充对目标1和2的进程和成果的影响的解释。数据 这项研究将帮助我们了解以家庭为中心的自我的机制， 管理干预，以改善卒中恢复期SS和CP结局。下一步将是开发一个 一项多中心随机对照试验，旨在测试移动的CARE-CITE在卒中早期恢复中的疗效。

Abstract DESCRIPTION: Stroke is a leading cause of serious, long-term disability. Family carepartner (CP) management and support can improve stroke survivor (SS) recovery; but can also increased the CP’s depression, frustration, and resentment. CPs frequently feel overwhelmed and exhausted, while unmet CP needs negatively affect the rehabilitation of the SS and increase CP risk of mortality. We have developed a theory-based, family-centered intervention, Carepartner Collaborative Integrated Therapy (CARE-CITE) designed to positively engage CPs during SS upper extremity functional task practice in the home setting. Using exemplary and interactive videos of family scenarios in the home, CARE-CITE guides the CP in collaborative goal setting and creating an autonomy supportive environment with the SS to promote motivation and creative problem solving in upper extremity self-management. To date, CARE-CITE has been evaluated in SS with chronic stroke and coupled with a well-established and structured intensive upper extremity task practice intervention called constraint-induced movement therapy. The specific objective of this proposal is to refine and test our mobile, web-based self-management intervention as an adjunct to usual and customary upper extremity care sooner after stroke when SS are in outpatient rehabilitation and in the sub-acute (1-3 months) recovery period to improve family CP and SS psychosocial and physical health outcomes. Our proposed two year project uses a mixed methods convergent design with a two-group experimental approach with separate quantitative and qualitative analyses followed by integration of findings. We will block randomize (2:1) 36 dyads to treatment (usual and customary care with CARE-CITE) or control (usual and customary care without structured CP involvement). In-person semi-structured interviews post intervention with CPs receiving CARE- CITE will be analyzed to illuminate quantitative results. The premise underpinning this research is that a theory-based, family-centered intervention focused on skill building, improved family context, and problem- solving will improve SS physical function and quality of life while reducing CP negative outcomes. AIMS: Our long-term goal is to improve joint responsibilities for self-management during stroke recovery and subsequently improve CP and SS outcomes through technologically supported intervention strategies. The aims of this R21 application are: (a) to evaluate mobile CARE-CITE delivered at home during subacute stroke rehabilitation on both CP and SS health outcomes and quality of life, (b) to examine the effect of mobile CARE- CITE on the family context and processes related to stroke rehabilitation, and (c) Use qualitative methods to complement the interpretation of effects on processes and outcomes from Aims 1 and 2. Data from this study will help us gain an understanding of mechanisms that underpin family-centered self- management interventions to improve SS and CP outcomes in stroke recovery. Next steps will be to develop a multi-site randomized controlled trial to test the efficacy of mobile CARE-CITE in early stroke recovery.