Addressing socioeconomic disparities in post-stroke disability through the development of an accessible, new tool

通过开发易于使用的新工具来解决中风后残疾的社会经济差异

基本信息

批准号：
10196586
负责人：
CLAIRE F. HONEYCUTT
金额：
$ 19.72万
依托单位：
ARIZONA STATE UNIVERSITY-TEMPE CAMPUS
依托单位国家：
美国
项目类别：
财政年份：
2021
资助国家：
美国
起止时间：
2021-04-26 至 2023-03-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10196586
关键词：
Acoustics Action Research Address Adherence Adjuvant Affect Auditory Caring Data Data Analytics Development Disabled Persons Doctor of Philosophy Dose Double-Blind Method Effectiveness Engineering Evidence based treatment Functional disorder Goals Guidelines Home Impairment Individual Life Limb structure Measures Medicaid Medicare/Medicaid Minority Minority Groups Modeling Motor Activity Movement Muscle Occupational Therapy Outcome Measure Outpatients Paresis Patient Care Patient Self-Report Patients Phase I Clinical Trials Physical therapy Physicians Population Positioning Attribute Public Health Quality of Care Quality of life Randomized Controlled Trials Rehabilitation therapy Reporting Risk Robotics Running Severities Stimulus Stroke Supervision System Testing Training Transportation Treatment Cost Uninsured Upper Extremity Veronica Work arm arm function arm paresis barrier to care clinical practice cohort compliance behavior cost disability disability leave evidence base evidence based guidelines functional independence improved low socioeconomic status novel patient population post stroke recruit rehabilitation technology remote delivery smartphone Application socioeconomic disparity spasticity statistics telehealth therapy outcome tool traditional therapy treatment disparity

项目摘要

Individuals with low socioeconomic status (SES) are more likely to have a stroke, more disabled at 3 months, and less likely to be independently ambulatory. Individuals with low SES struggle to adhere to physician guidelines because of 1) increased disability leaves patients ineligible or unable to tolerate therapy, and 2) poor access to quality care i.e., lack of transportation to therapy. To reduce post-stroke disparity in low SES groups, we need to invest in development of novel tools that make therapy more accessible. For the past 5 years, the PI has been developing Startle Adjuvant Rehabilitation Therapy (START), a tele-enabled, low-cost treatment to improve upper-extremity therapy outcomes in individuals with stroke – in particular individuals with severe-to-moderate stroke. START is the application of a startling, acoustic stimulus (via headphones) which increases the intensity of practice, particularly in severe patient populations. START is adjuvant, meaning it does not replace clinical practice but instead enhances current evidence-based treatments. Objective: we seek to determine if START can be used to enhance functionally relevant movement of the upper extremity. Preliminary data: Individuals with severe-to-moderate disability from a stroke completed a remotely delivered, 3-day training of object manipulation with START. Box and Blocks, which was targeted during training, demonstrated a large increase under START (+47.1%) compared to Control (+3.3%). Modified functional reach was also increased under START (+8.9%) compared to Control (+1.1%). Impairment also decreased under START (Upper-Extremity-Fugl-Meyer: +8.6%) resulting in subject-reported increase in arm function both in quantity (Motor Activity Log: +26.2%) and quality (+20.2%). These results indicate that START can be deployed remotely and may prove a valuable, adjuvant tool to enhance functional upper extremity movement. We propose to perform a Phase 1 clinical trial on a larger cohort of 58 subjects, with a longer, 5-day training with the goal of establishing that START can 1) enhance functional movement of the upper extremity and 2) generate sustainable changes that impact quality of life. Impact: This proposal is significant because it tests a tool that has the potential to directly target the causes leading to disparity of care for individuals with low SES. A third (34%) of 6.5 million people in the U.S. with stroke are on Medicaid or uninsured. Our best evidence- based therapies (e.g., high-intensity, CIMT) and our emerging rehabilitation technologies (e.g., TMS, robotics) are inaccessible to our minority and low SES populations. START addresses disparity because it 1) targets individuals with severe disability, which disproportionally affects low SES and minority groups, and 2) is tele- enabled eliminating transportation which 60% of individuals with low SES report as a barrier to care. If successful, this study will set the stage for larger trials to establish 1) the effectiveness of START to be incorporated into traditional therapy and as well as patient compliance, adherence, and tolerance – particularly in low SES groups.

社会经济地位低下（SES）的个人更有可能中风，在3个月时更残疾，而且不太可能是独立的卧床。 SES低的人努力遵守物理学指南由于1）残疾增加使患者没有资格或无法忍受治疗，而2）无法获得优质护理，即缺乏治疗的运输。降低低SES的中风后差异小组，我们需要投资开发新型工具，以使治疗更容易获得。在过去的5个多年来，PI一直在开发惊吓调整康复疗法（Start），这是一种电信，低成本的治疗以改善中风患者的高级治疗结果 - 特别是严重到中度的中风。开始是使用起始刺激的应用（通过耳机）增加了实践强度，特别是在严重的患者人群中。开始是调整的，这意味着它不能取代临床实践，而是增强了当前的基于证据的治疗方法。目标：我们寻求确定是否可以使用开始来增强上肢的功能相关运动。初步数据：中风严重到中度残疾的人完成了远程交付的人，一开始对物体操纵的3天培训。训练期间针对的框和块与对照相比（+3.3％），在开始时（+47.1％）显示出大量增加（+47.1％）。修改的功能范围与对照相比（+1.1％），在开始时也增加了（+8.9％）。损害也下降了启动（高超级 - 富麦 - 梅尔： +8.6％）导致主题报告的手臂功能增加数量（运动活动日志： +26.2％）和质量（ +20.2％）。这些结果表明开始可能是远程部署，可能会证明有价值的调整工具以增强功能上肢运动。我们建议对58名受试者的较大队列进行1期临床试验，并进行较长的5天培训以确定开始的目的是1）增强上肢的功能运动和2）产生影响生活质量的可持续变化。影响：该提案很重要，因为它测试了有可能直接针对原因的原因的工具，导致SES较低的个体的护理差异。在美国的650万人中，有三分之一（34％）的中风或没有保险。我们最好的证据 - 基于基于的疗法（例如，高强度，CIMT）和我们的新兴康复技术（例如，TMS，机器人技术）我们的少数民族和低人类种群无法访问。开始解决差异，因为它1）严重的残疾人，对低SE和少数群体的影响不成比例，2）是启用了消除运输，其中有60％的低SES报告是护理的障碍。如果成功，这项研究将为大型试验建立阶段1）开始的有效性纳入传统疗法以及患者的依从性，依从性和宽容性，尤其是在低SES组中。