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 (SES) 较低的个体更容易中风，3 个月后更容易残疾， SES 较低的人不太可能独立行走，很难坚持医生的治疗。指南的原因是 1) 残疾程度的增加使患者没有资格或无法耐受治疗，以及 2) 获得优质护理的机会较差，即缺乏前往治疗的交通减少社会经济地位低的中风后差异。在过去的 5 年里，我们需要投资开发新的工具，使治疗变得更容易。多年来，PI 一直在开发 Startle 辅助康复疗法 (START)，这是一种远程支持的低成本改善中风患者上肢治疗结果的治疗，特别是患有中风的患者重度至中度中风是应用令人震惊的声音刺激（通过耳机）。增加练习的强度，特别是在重症患者群体中，START 是辅助性的，这意味着它。不会取代临床实践，而是增强当前的循证治疗目标：我们。寻求确定 START 是否可用于增强上肢的功能相关运动。初步数据：因中风而患有重度至中度残疾的个人完成了远程交付的、为期 3 天的使用 START Box 和 Blocks 进行对象操作的培训，这是培训期间的目标。与对照 (+3.3%) 相比，在 START 下 (+47.1%)，修改后的功能范围显示出大幅增加。与对照（+1.1%）相比，START 下的损伤也有所增加（+8.9%）。 START（上肢-Fugl-Meyer：+8.6%）导致受试者报告的手臂功能增加这些结果表明 START 可以是数量（运动活动日志：+26.2%）和质量（+20.2%）。远程部署，可能被证明是一种有价值的辅助工具，可以增强上肢的功能性运动。我们建议对 58 名受试者组成的更大队列进行 1 期临床试验，并进行更长时间的 5 天训练目标是确定 START 可以 1) 增强上肢的功能运动，2) 产生影响生活质量的可持续变化：该提案意义重大，因为它测试了该工具有可能直接针对导致低社会经济地位个人护理差异的原因。美国 650 万名中风患者中有三分之一 (34%) 享受医疗补助或没有保险。我们最好的证据是：基于疗法（例如高强度、CIMT）和我们新兴的康复技术（例如 TMS、机器人）我们的少数族裔和社会经济地位较低的人群无法接触到《START》，因为它解决了不平等问题，因为它 1) 的目标是：患有严重残疾的个人，这对低社会经济地位和少数群体影响尤为严重，2) 能够消除交通运输，60% 的社会经济地位低的人认为交通运输是获得护理的障碍。如果成功，这项研究将为更大规模的试验奠定基础，以确定 1) START 的有效性纳入传统治疗以及患者的依从性、依从性和耐受性 - 特别是在低社会经济地位群体中。