Carepartner Collaborative Integrated Therapy in Sub-Acute Stroke

亚急性中风的护理伙伴协作综合治疗

• 批准号: 9906277
• 负责人: Sarah R. Blanton
• 金额: $ 23.66万
• 依托单位: EMORY UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-04-03 至 2022-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9906277
• 关键词: Acute; Address; Caregivers; Caring; Chronic; Complement; Conflict (Psychology); Control Groups; Coupled; Data; Empathy; Family; Family member; Feasibility Studies; Fostering; Frustration; Future; Goals; Health; Health Technology; Home environment; Hour; Impairment; Individual; Intervention; Interview; Joints; Language; Lead; Mental Depression; Methods; Motivation; Online Systems; Outcome; Outpatients; Patients; Perceived quality of life; Perception; Personal Satisfaction; Persons; Phase; Physical Function; Pilot Projects; Problem Solving; Process; Qualitative Methods; Quality of life; Randomized; Randomized Controlled Trials; Recovery; Rehabilitation therapy; Research; Research Design; Research Priority; Residual state; Self Efficacy; Self Management; Site; Stress; Stroke; Structure; Testing; Therapeutic Intervention; Translations; United States; United States National Institutes of Health; Upper Extremity; Work; acute stroke; attentional control; base; chronic stroke; clinical practice; cohort; comparison intervention; constraint induced movement therapy; depressive symptoms; design; disability; efficacy testing; exhaust; experience; experimental group; functional independence; functional loss; improved; mortality risk; negative affect; novel; physical conditioning; post intervention; post stroke; programs; psychosocial; rehabilitation research; satisfaction; skills; stroke outcome; stroke recovery; stroke rehabilitation; stroke survivor; supportive environment; theories; therapy design; therapy development; trend; user-friendly

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.

抽象的 描述：中风是导致家庭护理伙伴 (CP) 严重、长期残疾的主要原因。 管理和支持可以改善中风幸存者 (SS) 的康复，但也可以增加 CP 的恢复； 抑郁、沮丧和怨恨，CP 经常感到不知所措和疲惫，而未得到满足的 CP。 需求对 SS 的康复产生负面影响并增加 CP 死亡风险。 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参与 CP。 家庭场景的示范性互动视频，CARE-CITE 指导 CP 协作 设定目标并与 SS 一起创造自主支持环境，以促进积极性和创造力 迄今为止，CARE-CITE 已在 SS 中进行了评估。 慢性中风并结合完善且结构化的强化上肢任务练习 该提案的具体目标是完善称为约束诱导运动疗法的干预措施。 并测试我们的移动、基于网络的自我管理干预措施，作为通常和习惯的上层管理的辅助手段 当 SS 处于门诊康复期和亚急性期（1-3 个月）时，中风后尽早进行肢体护理 恢复期以改善家庭 CP 和 SS 社会和身体健康结果 我们提出了两个建议。 年项目采用混合方法收敛设计，采用两组实验方法，分别进行 定量和定性分析，然后整合研究结果。我们将进行随机分组 (2:1) 36。 治疗（使用 CARE-CITE 的常规护理）或对照（不使用 CARE-CITE 的常规护理）的二元组 结构化CP参与）。干预后与接受CARE的CP进行面对面的半结构化访谈。 将对 CITE 进行分析以阐明定量结果。 以理论为基础、以家庭为中心的干预措施侧重于技能培养、改善家庭环境和解决问题 解决问题将改善 SS 身体机能和生活质量，同时减少 CP 负面结果：我们的目标。 长期目标是改善中风康复期间自我管理的共同责任，以及 随后通过技术支持的干预策略改善 CP 和 SS 结果。 该 R21 应用程序的目标是：(a) 评估亚急性中风期间在家中提供的移动 CARE-CITE 康复对 CP 和 SS 健康结果和生活质量的影响，(b) 检验移动 CARE- 的效果 CITE 关于与中风康复相关的家庭背景和过程，以及 (c) 使用定性方法 补充对目标 1 和 2 的过程和结果的影响的解释。 数据 这项研究将帮助我们了解支撑以家庭为中心的自我意识的机制。 改善中风恢复中的 SS 和 CP 结局的管理干预措施将是制定一项管理干预措施。 多中心随机对照试验，测试移动 CARE-CITE 在早期中风恢复中的功效。