Optimizing a Telehealth Behavioral Intervention for Fatigue in People with Multiple Sclerosis

项目概要/摘要：Lindsey Knowles博士是一位心理学家和大学博士后研究员。 华盛顿（UW）和弗吉尼亚州普吉特海湾卫生保健系统（VAPSHCS）西雅图合作奖学金 多发性硬化症（MS）康复研究。她完全致力于成为一个独立的 一个受资助的研究者，他开发、优化和评估理论驱动的、可实施的干预措施， 改善慢性健康状况/残疾成人的症状、心理社会功能和生活质量。 博士诺尔斯是一个理想的候选人，这一领域的研究，因为她在观察和 压力和应对的干预研究以及康复研究中的高级奖学金培训。这 K23奖将提供基本的职业发展技能，以实现她的长期目标， 循证和可获得的治疗，以改善症状，功能和生活质量的人， 慢性健康状况。拟议的项目将开发，完善和优化远程医疗认知 行为疗法（CBT）对MS患者疲劳的干预（PwMS）。调查结果将支持 随机对照试验，以评估MS疲劳的优化的基于CBT的干预。职业生涯 发展和培训计划：拟议的工作将在华盛顿大学进行，并利用资源 在康复医学和VAPSHCS MS卓越中心西部的UW部门。博士 Knowles杰出的导师团队包括Dawn Ehde博士（初级导师;远程医疗CBT和MS 专家）、Aaron Turner（MS行为干预专家）、琳达柯林斯[多阶段优化策略 （MOST）专家]和安娜克拉茨（定性研究专家）。诺尔斯博士的培训目标与她的研究 通过教学和实践培训制定职业规划：（1）干预优化和临床试验方法 通过MOST，（2）快速的定性研究方法，（3）熟练掌握语法和科学知识， 传播。研究计划：拟议的目标将解决与活跃的 CBT成分改善MS疲劳。这些知识将有助于优化MS疲劳的CBT 最大限度地提高效力和效率，从而改善执行情况和可及性。研究的目的是 (1)开发，试点测试，并完善PwMS（放松训练， 行为激活、认知疗法），以最大限度地提高可行性和可接受性;（2a）行为要素 分析（通过因子优化试验），以测试三种远程医疗CBT的主要和交互作用 用于改善疲劳PwMS中的疲劳和心理社会功能的组分（主要结局）;（2b） 评估三个远程保健CBT组成部分的假设的独特和共同机制的变化; (2c)通过3个月随访评价结局改善的持久性。组件将 如果它们满足任一主要结局的阈值效应量， 作为优化的一揽子干预措施，实现关键的实施目标（在初步研究中确定）。

Project Summary/Abstract: Lindsey Knowles, PhD is a psychologist and postdoctoral fellow in the University of Washington (UW) and VA Puget Sound Health Care System (VAPSHCS) Seattle Collaborative Fellowship in Multiple Sclerosis (MS) Rehabilitation Research. She is fully committed to becoming an independently funded investigator who develops, optimizes, and evaluates theory-driven, implementable interventions to improve symptoms, psychosocial function, and quality of life in adults with chronic health conditions/disability. Dr. Knowles is an ideal candidate for this field of research given her strong background in observational and intervention research on stress and coping and advanced fellowship training in rehabilitation research. This K23 award will provide foundational career development skills for achieving her long-term goal of optimizing evidence-based and accessible treatment for improving symptoms, function, and quality of life in people with chronic health conditions. The proposed project will develop, refine, and optimize a telehealth Cognitive Behavioral Therapy (CBT) intervention for fatigue in people with MS (PwMS). Findings will support a randomized controlled trial to evaluate the optimized CBT-based intervention for MS fatigue. Career Development and Training Plan: The proposed work will be carried out at the UW and utilize resources within the UW Department of Rehabilitation Medicine and VAPSHCS MS Center of Excellence West. Dr. Knowles’s distinguished mentorship team includes Drs. Dawn Ehde (Primary Mentor; telehealth CBT and MS expert), Aaron Turner (MS behavioral intervention expert), Linda Collins [Multiphase Optimization Strategy (MOST) expert], and Anna Kratz (qualitative research expert). Dr. Knowles’s training goals align her research and career plans via didactic and hands-on training in: (1) Intervention optimization and clinical trials methods via MOST, (2) Rapid qualitative research methods, and (3) Proficiency in grantsmanship and scientific dissemination. Research Plan: The proposed aims will address a gap in knowledge related to the active ingredients of CBT for improving MS fatigue. This knowledge will facilitate optimization of CBT for MS fatigue to maximize efficacy and efficiency, thereby improving implementation and accessibility. The study aims are to (1) Develop, pilot test, and refine three telehealth CBT components for fatigue in PwMS (Relaxation Training, Behavioral Activation, Cognitive Therapy) to maximize feasibility and acceptability; (2a) Conduct component analysis (via factorial optimization trial) to test the main and interactive effects of the three telehealth CBT components for improving fatigue and psychosocial function in fatigued PwMS (primary outcomes); (2b) Assess change in hypothesized unique and common mechanisms of the three telehealth CBT components; (2c) Evaluate the durability of outcome improvements through the 3-month follow-up. Components will be selected for an optimized intervention if they meet the threshold effect size for either primary outcome and meet the key implementation objective (defined in a preliminary study) as an optimized intervention package.