REHABILITATION OUTCOMES RESEARCH CENTER ASSOCIATE INVESTIGATOR AWARD

Project Background

The goals of the Associate Investigator Award are to provide research training for scientists with little or no research experience. Dr. Boylstein graduated with a PhD in sociology in December of 2002 and meets the qualifications for this award. He will fully supported in reaching his training goals by the wealth of resource and expertise available in the RORC.

Project Objectives

To establish a research program on stroke recovery, focused on functional status changes and outcomes of newly emerging rehabilitation therapies; to Develop a strong team of co-investigators to obtain funding for a study on stroke recover, and to disseminate research finding to improve clinical practice and rehabilitation services for veterans.

Project Methods

The research program that Dr. Boylstein will develop is based on the new disunity paradigm that has emerged in the last two decades that view disability not simply as a condition that characterized the person with limited functioning, but as the product of interaction between the person and their surroundings. Dr. Boylstein seeks to develop a balanced approach by linking qualitative and quantitative data as a valuable lens for analyzing complexities of living with disabilities.

Project Findings

Dr. Boylstein is involved in the creation of stroke recovery trajectories for non-Hispanic white, Puerto Rican Hispanic, and African American veterans. This work is part of the proposed outcome of Dr. Rittman’s ongoing research project, "Culturally Sensitive Models of Stroke Recovery and Caregiving After Discharge Home." Specifically, his ongoing role in this project is the establishment of a recovery typology for each of the three ethnic groups related to civic integration during the first two years home after stroke. He has completed this typology for each ethnic group at the one and six month post discharge period and is currently continuing the analysis at twelve months post discharge. There is additional data at the 18-month, and 24-month time points. The trajectories are designed in such a way that quantitative data related to functional changes, social activities, and depression are linked to the qualitative typologies the research team constructs. This method of data triangulation is both innovative and important for the overall mission of VA research. Findings will provide clinicians with a trajectory of recovery post stroke that can lead to targeted interventions to assist them with improving the quality of life of veterans who return to the community. Dr. Rittman plans a one year no-cost extension of the project so that the data analysis can be concluded by the end of 2006. Dr. Boylstein plans to submit two manuscripts from his analysis in the second year of the AI extension.

Project Status

Dr. Boylstein has begun collecting pilot data on a newly emerging rehabilitation therapy involving locomotor training at the Brooks Rehabilitation Center in Jacksonville, FL. He is conducting qualitative interviews with research participants, and making weekly observations of the training sessions. This project is nearing completion. Dr. Boylstein is currently analyzing pilot data using a coding structure for the ethnographic field notes and in-depth patient interviews. His goal is to use qualitative data to develop an outcome expectations/self-efficacy measure sensitive to LT. The specific aims of the pilot project are: 1) to develop measures sensitive to participants’ changes in fatigue, self-efficacy, and physical functioning during LT, 2) provide research based information on patient experiences during LT to assist therapists in tailoring their expectations of functional change to be more closely aligned with the perceptions and expectations of consumers participating in LT, and 3) define the impact of LT on family and community participation of consumers post-therapy. These goals will continue to evolve as he completes the pilot study. However, he has narrowed his goals to using qualitative data to identify items that can be used to develop a measure of outcome expectations/self-efficacy during LT.

Project Impact

Through this program Dr. Boylstein has developed the skills necessary to conduct research in the field of stroke rehabilitation for veterans and for the population at large. He is starting his own research project, and collecting pilot data for a larger, funded project. The ultimate goal of his research is to present results that enable therapists, patients, and other community members to work together in developing a rehabilitation plan that is meaningful for the patient and is best suited for the patient’s short and long term recovery objectives.