The goal of this K23 award is to obtain the mentored training necessary for the candidate to have a smooth transition to become an independent investigator in the rehabilitation of persons with mild stroke. This proposal builds logically on te candidate's previously NIH-funded clinical research training and NIH-funded pre-doctoral training; however, the protected time and mentorship associated with this award are necessary to guarantee the candidate's independence. The candidate has a track record of grant funding and publications that have established him as an expert in the area of mild stroke. From his previous work and other published studies, it is clear that persons with mild stroke are at high risk of developing further chronic disease and even higher risk of dying from a second stroke. Self-management intervention has been proven to be an effective intervention to increase healthy behaviors, improve overall health status/health behaviors, decrease healthcare utilization/cost, and decrease depressive symptoms in several studies with people with a variety of chronic conditions; however, current treatment of mild stroke is mostly focused on the acute event with little emphasis on chronic disease. The critical next step and overall goal of the proposed research study will be to evaluate if self-management intervention will improve health outcomes for persons with mild stroke. A single-blinded pilot randomized controlled trial design will be used with individuals with mild stroke. At baseline all participants will complete an assessment battery and then be randomly assigned to either the intervention group or the usual-care group. The intervention group will receive the Chronic Disease Self-Management Program (CDSMP) and the usual-care group will receive hospital rehabilitation recommendations. Six months after the start of the intervention, both groups will be reassessed using a subset of the same assessment battery completed at baseline. A subgroup of participants will be asked to allow the investigators to have access to health insurance data to be used for a preliminary cost analysis. The long-term goal of this study is to improve function and quality of life for persons with mild stroke. This study will be a critical step in achieving tis long term goal and also the candidate's long term career goal to have a funded research program to develop and evaluate cognitive rehabilitation strategies that will improve function and quality of life for persons with mild stroke. In conjunction with this research project, the candidate has developed a rigorous career development plan in order to become technically proficient in clinical trial research methodology and cost-effectiveness analysis. Both the research project and career development plan associated with this award are designed to capitalize on the vast resources available to the candidate at his institution, Washington University in St. Louis. Washington University is a top research institution in the United States and the candidate has assembled a highly qualified multidisciplinary mentorship team to ensure he becomes an independent investigator by the end of the award period.
Individuals who have a mild stroke have a 44% risk of dying from a second stroke within 10 years which is in large part due to the cyclical relationship of chronic disease, poor health, and mild stroke which has gone largely unnoticed in the United States. Self-management intervention has been proven to be an effective intervention to increase healthy behaviors, improve overall health status, decrease healthcare utilization/cost, decrease depressive symptoms, and improve participation in people with a variety of chronic conditions; however, it has never be used with individuals with mild stroke. The critical next step and goal of the proposed study is to evaluate if self-management intervention will improve health outcomes for persons with mild stroke.
