Defining Trajectories of Linguistic, Cognitive-Communicative and Quality of Life Outcomes in Aphasia

定义失语症的语言、认知交际和生活质量结果的轨迹

• 批准号: 10376798
• 负责人: Leora R Cherney
• 金额: $ 57.23万
• 依托单位: REHABILITATION INSTITUTE OF CHICAGO D/B/A SHIRLEY RYAN ABILITYLAB
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-04-10 至 2024-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10376798
• 关键词: Admission activity; Adult; Affect; Agreement; Aphasia; Biological Markers; Brain; Brain-Derived Neurotrophic Factor; Caregivers; Caring; Characteristics; Clinical; Clinical Treatment; Cognitive; Communication; Decision Making; Dose; Fibrinogen; Functional Magnetic Resonance Imaging; Genetic Markers; Genetic Polymorphism; Goals; Growth; Health; Health Care Costs; Heterogeneity; Hospitals; Individual; Inpatients; Language; Language Therapy; Length of Stay; Lesion; Life; Linguistics; Location; Longitudinal cohort study; Measurement; Measures; Methodology; Methods; Modeling; Monitor; Neurobiology; Neuronal Plasticity; Outcome; Outcome Measure; Outpatients; Participant; Pathology; Patient Outcomes Assessments; Patient Self-Report; Patient-Focused Outcomes; Patients; Performance; Persons; Predictive Factor; Prevalence; Productivity; Prospective Studies; Prospective cohort; Public Health; Quality of life; Recovery; Rehabilitation therapy; Rest; Sampling; Services; Severities; Speech Therapy; Standardization; Stroke; Survivors; System; Testing; Treatment Factor; Variant; Work; aphasia recovery; clinical practice; cohort; cost; design; functional gain; gene therapy; health related quality of life; improved; improved outcome; innovation; instrument; nervous system disorder; neuroimaging marker; patient oriented; post stroke; programs; prospective; recruit; rehabilitation service; response; service delivery; sound; stroke patient; stroke rehabilitation; stroke therapy; stroke-induced aphasia

Stroke imposes significant burdens on the health and quality of life of survivors and their caregivers, and presents a major public health issue in terms of healthcare costs and lost productivity. Aphasia adds to the cost of stroke- related care. Many stroke survivors with aphasia receive therapy in inpatient rehabilitation facilities. However, aphasia recovery is variable and there is limited evidence on the benefits of inpatient rehabilitation on outcomes. The objective of this study is to describe the trajectories of linguistic, cognitive-communicative, and health-related quality of life (QoL) outcomes following stroke in persons with aphasia during inpatient and outpatient rehabilita- tion to 18 months following stroke. A sampleof 300 consecutively-admitted stroke patients with aphasia recruited at three Midwestern rehabilitation hospitals will complete measures of linguistic and cognitive-communicative performance, and the Quality of Life in Neurological Disorders (Neuro-QoL) Measurement System instruments during rehabilitation and at 6-,12-, and 18- months post-stroke. We will model outcomes as individual and group trajectories, allowing us to develop individual predictions which could inform clinical planning and decision-mak- ing for new patients. The Specific Aims are to: Aim 1: Establish a prospective cohort of stroke patients with aphasia, and define their typical trajectory of lin- guistic, cognitive-communicative, and health-related QoL recovery at admission to and discharge from the IRF, and at 6, 12, and 18 months post onset. Aim 2: Identify factors that are associated with linguistic, cognitive-communicative, and health-related QoL out- comes from among the following: patient factors including demographic and clinical characteristics related to stroke and aphasia; treatment variables including inpatient and outpatient aphasia therapy characteristics and informal aphasia services; and biomarkers, including genetic and neuroimaging biomarkers. Aim 3: Evaluate the stability of the models of linguistic, cognitive-communicative, and health-related QoL out- comes recovery that are developed from Aims 1 and 2. This study is innovative in its use of (1) standardized assessments that measure not only linguistic outcomes but also communication and QoL outcomes; (2) patient-centered, self-report instruments such as Neuro-QoL to de- tect clinically important change through 18 months post-stroke; (3) individual growth curve analysis to describe recovery trajectories and examine associations between demographic, lesion, aphasia, genetic, and speech and language therapy characteristics; (4) biomarkers that have been implicated in promoting neuroplasticity; (5) rest- ing state functional magnetic resonance imaging to evaluate the association between network pathology and recovery from aphasia; (6) information on type, amount, and duration of aphasia treatment provided in clinical settings; and (7) information on informal aphasia services following discharge from formal therapy.

中风给幸存者及其护理人员的健康和生活质量带来了巨大的负担，并呈现出 就医疗保健成本和生产力损失而言，这是一个重大的公共卫生问题。失语症会增加中风的成本 相关护理。许多患有失语症的中风幸存者在住院康复机构接受治疗。然而， 失语症的恢复情况各不相同，并且关于住院康复对结果的益处的证据有限。 本研究的目的是描述语言、认知交际和健康相关的轨迹 住院和门诊康复期间失语症患者中风后的生活质量（QoL）结果 中风后 18 个月。招募了 300 名连续入院的中风失语症患者作为样本 中西部三家康复医院将完成语言和认知交流的测量 神经疾病 (Neuro-QoL) 测量系统仪器的表现和生活质量 康复期间以及中风后 6、12 和 18 个月。我们将模拟个人和团体的结果 轨迹，使我们能够开发个人预测，为临床规划和决策提供信息 寻找新患者。具体目标是： 目标 1：建立一个患有失语症的中风患者的前瞻性队列，并确定他们的典型言语轨迹。 入院和出院时语言、认知交流和健康相关的生活质量恢复， 以及发病后 6、12 和 18 个月。 目标 2：确定与语言、认知交流和健康相关的生活质量相关的因素 来自以下因素： 患者因素，包括与以下因素相关的人口统计学和临床​​特征 中风和失语症；治疗变量包括住院和门诊失语症治疗特征和 非正式失语症服务；和生物标志物，包括遗传和神经影像生物标志物。 目标 3：评估语言、认知交流和健康相关的生活质量输出模型的稳定性 恢复是从目标 1 和目标 2 发展而来的。 这项研究的创新之处在于它使用了（1）标准化评估，不仅衡量语言结果，还衡量语言结果。 还有沟通和生活质量结果； (2) 以患者为中心的自我报告工具，例如 Neuro-QoL，以消除 中风后 18 个月内发生临床重要变化； (3)个体生长曲线分析描述 恢复轨迹并检查人口统计学、病变、失语症、遗传和言语之间的关联 语言治疗的特点； (4) 与促进神经可塑性有关的生物标志物； （5）休息—— 状态功能磁共振成像来评估网络病理学与 从失语症中恢复； (6) 临床提供的失语症治疗类型、金额、持续时间等信息 设置; (7) 关于正式治疗出院后的非正式失语症服务的信息。