Ischemic stroke is a major source of illness burden in the US. Stroke survivors are at high risk for recurrence and therefore they are an important group for secondary prevention. However, gaps in knowledge among stroke survivors, including inadequate knowledge of the early warning signs of stroke, inadequate understanding of the purpose and goals of rehabilitation, and lack of awareness of personal risk factors, lead to preventable stroke-related morbidity. Education to address these knowledge gaps is typically inadequate during inpatient rehabilitation for stroke. An effective program of education for stroke survivors could improve stroke outcomes by promoting rehabilitation, reducing the risk of another stroke and reducing morbidity of recurrent strokes. In the Phase I SBIR, we established the feasibility of developing a web-based education for stroke survivors and their families. We developed a prototype to impart basic knowledge about stroke, including warning signs, risk factors, and management of one of the common risk factors (hypertension). This prototype is an interactive web-based educational program, using video format and animation, as well as self-assessments and adaptive learning through computer technology to address cognitive deficits. A pilot study of this prototype with 25 stroke patients and 7 caregivers was conducted, with approximately half of the subjects using the Web-based training without adaptive learning, and the other half with adaptive learning. The program was well-accepted and stroke-related knowledge improved significantly compared to baseline for all subjects. Without the adaptive learning, the mean improvement in correct answers on pre-post testing was 2.0. When the adaptive learning component was integrated into the Web-based training, the mean improvement in correct answers on pre-post testing was 5.1. The Phase I prototype can be accessed for review at www.strokelearning.com. We now propose in Phase II to complete the development of this web-based program, so that it addresses all of the main manageable risk factors, provides general stroke knowledge, and provides an understanding of stroke rehabilitation. Importantly, this program will maintain a focus on changing patients'behavior, empowering them to reduce their risk for further strokes and benefit more optimally from rehabilitation. The program will also adapt to patients'level of knowledge and cognitive impairments. It will iteratively measure gains in knowledge by patients and caregivers and in doing so will reinforce learning over multiple sessions. As part of Phase II, we will test the efficacy of this program in improving patient and caregiver stroke knowledge at the time of discharge, and monitor change in risk- related behavior (smoking) at 2 and 6 weeks post-discharge in a controlled trial of 200 stroke patients and family members. This program will be a marketable product to providers of medical treatment for stroke, including rehabilitation hospitals which must meet specific patient education requirements, hospitals which are seeking stroke specialty certification and nursing homes. Additionally, insurance companies that wish to improve stroke prevention efforts (and thus save costs as well as improve patients'quality of care) may be a source of revenue. Stroke, the 3rd leading cause of death and a leading cause of disability in the US afflicts between 700,000 and one million Americans annually, with African-Americans at particularly high risk. The 4.8 million stroke survivors in the US represent a large at-risk group for a recurrence of stroke. In fact, they are at 15 times greater risk of stroke compared to age-matched normals. The overall goal of this application is to develop a web-based interactive video program that would improve the education of stroke survivors and their caregivers while in rehabilitation and beyond, in order to identify personal risk factors, modify behavior, and ultimately reduce the occurrence of repeat strokes and reduction of overall stroke-related morbidity.
| Campbell, Grace B; Skidmore, Elizabeth R; Whyte, Ellen M et al. (2015) Overcoming practical challenges to conducting clinical research in the inpatient stroke rehabilitation setting. Top Stroke Rehabil 22:386-95 |
| Whyte, Ellen; Skidmore, Elizabeth; Aizenstein, Howard et al. (2011) Cognitive impairment in acquired brain injury: a predictor of rehabilitation outcomes and an opportunity for novel interventions. PM R 3:S45-51 |
