Abstract

The aim of this project is to use epidemiologic methods in a randomized clinical trial to test the effects of a psychosocial intervention to improve functional ability in elderly stroke patients. The proposed intervention is designed to mobilize the social networks of stroke patients, comprised for the most part of family and close friends, to provide effective emotional and instrumental support and increase the patient's sense of self-efficacy regarding ability to regain function. This intervention is tailored specifically to the needs of individual stroke patients, their families and support systems and is designed to occur in 15 meetings over a 6 month period. Stroke patients (n=290) from the 2 major hospitals in New Haven will be randomly allocated to the psychosocial intervention (PSI) and usual care (UC) groups. Primary endpoints are assessed at 3 and 6 months and are based on self-reports and performance-based assessments of functional ability. Several longitudinal epidemiological studies have reported that social support influences recovery of functional ability both in terms of physical functioning and psychological adjustment in stroke patients. Furthermore a number of observational cohort studies have indicated that lack of social support is related to increased mortality, especially case- fatality. Finally, several recent intervention studies have shown that psychosocial interventions have led to improved psychosocial adjustment in stroke patients and longer survival in patients with other chronic illness. Important components of these interventions have been focused on improving or providing support to patients with chronic illness and improving family functioning. To date, no interventions have focused specifically on the outcome we consider to be a critical one - improvement in physical functioning.
Our aim i s to employ rigorous clinical trial methodology to test the effectiveness of a psychosocial intervention to improve functioning in elderly stroke patients.

  Funding Agency

Agency
National Institute of Health (NIH)
Institute
National Institute of Neurological Disorders and Stroke (NINDS)
Type
Research Project (R01)
Project #
7R01NS032324-02
Application #
2270418
Study Section
Behavioral Medicine Study Section (BEM)
Project Start
1995-09-20
Project End
1999-06-30
Budget Start
1995-09-20
Budget End
1996-06-30
Support Year
2
Fiscal Year
1995
Total Cost
Indirect Cost

  Institution

Name
Harvard University
Department
Administration
Type
Schools of Public Health
DUNS #
082359691
City
Boston
State
MA
Country
United States
Zip Code
02115

  Publications

Glymour, M Maria; Weuve, Jennifer; Fay, Martha E et al. (2008) Social ties and cognitive recovery after stroke: does social integration promote cognitive resilience? Neuroepidemiology 31:10-20
Glymour, M Maria; Berkman, Lisa F; Ertel, Karen A et al. (2007) Lesion characteristics, NIH stroke scale, and functional recovery after stroke. Am J Phys Med Rehabil 86:725-33
Glass, Thomas A; Berkman, Lisa F; Hiltunen, Elizabeth F et al. (2004) The Families In Recovery From Stroke Trial (FIRST): primary study results. Psychosom Med 66:889-97
Ay, Hakan; Oliveira-Filho, Jamary; Buonanno, Ferdinando S et al. (2002) 'Footprints' of transient ischemic attacks: a diffusion-weighted MRI study. Cerebrovasc Dis 14:177-86
Kothari, R; Hall, K; Brott, T et al. (1997) Early stroke recognition: developing an out-of-hospital NIH Stroke Scale. Acad Emerg Med 4:986-90
Tomsick, T; Brott, T; Barsan, W et al. (1996) Prognostic value of the hyperdense middle cerebral artery sign and stroke scale score before ultraearly thrombolytic therapy. AJNR Am J Neuroradiol 17:79-85
Barsan, W G; Brott, T G; Broderick, J P et al. (1994) Urgent therapy for acute stroke. Effects of a stroke trial on untreated patients. Stroke 25:2132-7
Levy, D E; Brott, T G; Haley Jr, E C et al. (1994) Factors related to intracranial hematoma formation in patients receiving tissue-type plasminogen activator for acute ischemic stroke. Stroke 25:291-7
Broderick, J; Brott, T; Barsan, W et al. (1993) Blood pressure during the first minutes of focal cerebral ischemia. Ann Emerg Med 22:1438-43
Tomsick, T; Brott, T; Barsan, W et al. (1992) Thrombus localization with emergency cerebral CT. AJNR Am J Neuroradiol 13:257-63

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