Wide Spectrum Investigation of Stroke Outcome Disparities on Multiple Levels (WISSDOM)
Condition: Stroke Ischemic; Minority Health
MeSH terms: Stroke; Ischemic Stroke
Study type: Interventional

Summary: 
      This research project will evaluate the relationship between cardiovascular risk factors,
      degrees of physical and mental activity prior to the stroke, brain tissue integrity,
      post-stroke community participation and neurological recovery after the stroke. Investigators
      will recruit and study healthy and post stroke participants, gaining insight into the
      possible mechanisms that explain why the adverse risk profile, which is more commonly present
      in African-Americans than non-Hispanic Whites in the stroke belt, is translated into a less
      favorable recovery post stroke.
    

Detailed description: 
      Stroke is a common cause of disability, but not all subjects who survive a stroke are left
      with debilitating sequelae. The human brain is able to self-repair and adapt after injury
      through neuroplasticity, which is crucial for stroke recovery. At present, recovery cannot be
      completely predicted from clinical stroke variables. A promising theory suggests that the
      health status of the stroke host is as important as stroke severity for recovery. Within the
      neurological system, health is reflected by the integrity of the brain tissue and its
      neuronal environment, which provide the neuroplastic potential that is necessary for
      recovery. The potential for neuroplasticity is likely variable across individuals and
      possibly accounts for some of the differences in outcome that cannot be explained by other
      clinical factors.

      A better understanding of the relationship between stroke outcomes, host brain tissue
      integrity and recovery environment would have immense potential to address stroke related
      disabilities. The investigators are experts in research involving brain tissue integrity
      using neuroimaging and recovery environment using community based participation approaches
      involving nurse-guided community health workers (CHWs).

      This research project will evaluate the relationship between cardiovascular risk factors,
      degrees of physical and mental activity prior to the stroke, brain tissue integrity,
      post-stroke community participation and neurological recovery after the stroke. The
      investigators will recruit and study a biracial cohort, gaining insight into the possible
      mechanisms that explain why the adverse risk profile, which is more commonly present in
      African-Americans than non-Hispanic Whites in the stroke belt, is translated into a less
      favorable recovery post stroke. If a better understanding of the underlying reasons for this
      observation can be defined, an important first step toward eliminating this disparity can be
      achieved.
    

Intervention name(s): Community-based Intervention under Nurse Guidance after Stroke
Intervention type(s): Behavioral
Intervention description(s): CINGS is a 12-week nurse coordinated, Community Health Worker intervention structure. Intervention home visits will be conducted by the CHW and will include home-based training in self-care and self-management strategies alongside strategies to address risk of negative stroke outcomes that will be determined once these risk factors are identified and community-engaged approaches to their resolution derived. CHW efforts will be guided via televideo interactions with nurse coordinator. During home-visits, self-reported assessments will be collected via RedCap as well as assessments collected by the CHW and research nurse (weight, blood pressure, medication adherence). After baseline, participants randomized to the intervention group will have home visits, once a week for the first month, and biweekly for the other two months, conducted by the CHW. Additionally, there will be post-intervention follow-up assessments at 3, 6, and 12-month time intervals.
Other intervention name(s): CINGS
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Investigator, Outcomes Assessor)
Primary purpose: Supportive Care