Abstract DESCRIPTION: Stroke is a leading cause of serious, long-term disability. Family carepartner (CP) management and support can improve stroke survivor (SS) recovery; but can also increased the CP’s depression, frustration, and resentment. CPs frequently feel overwhelmed and exhausted, while unmet CP needs negatively affect the rehabilitation of the SS and increase CP risk of mortality. We have developed a theory-based, family-centered intervention, Carepartner Collaborative Integrated Therapy (CARE-CITE) designed to positively engage CPs during SS upper extremity functional task practice in the home setting. Using exemplary and interactive videos of family scenarios in the home, CARE-CITE guides the CP in collaborative goal setting and creating an autonomy supportive environment with the SS to promote motivation and creative problem solving in upper extremity self-management. To date, CARE-CITE has been evaluated in SS with chronic stroke and coupled with a well-established and structured intensive upper extremity task practice intervention called constraint-induced movement therapy. The specific objective of this proposal is to refine and test our mobile, web-based self-management intervention as an adjunct to usual and customary upper extremity care sooner after stroke when SS are in outpatient rehabilitation and in the sub-acute (1-3 months) recovery period to improve family CP and SS psychosocial and physical health outcomes. Our proposed two year project uses a mixed methods convergent design with a two-group experimental approach with separate quantitative and qualitative analyses followed by integration of findings. We will block randomize (2:1) 36 dyads to treatment (usual and customary care with CARE-CITE) or control (usual and customary care without structured CP involvement). In-person semi-structured interviews post intervention with CPs receiving CARE- CITE will be analyzed to illuminate quantitative results. The premise underpinning this research is that a theory-based, family-centered intervention focused on skill building, improved family context, and problem- solving will improve SS physical function and quality of life while reducing CP negative outcomes. AIMS: Our long-term goal is to improve joint responsibilities for self-management during stroke recovery and subsequently improve CP and SS outcomes through technologically supported intervention strategies. The aims of this R21 application are: (a) to evaluate mobile CARE-CITE delivered at home during subacute stroke rehabilitation on both CP and SS health outcomes and quality of life, (b) to examine the effect of mobile CARE- CITE on the family context and processes related to stroke rehabilitation, and (c) Use qualitative methods to complement the interpretation of effects on processes and outcomes from Aims 1 and 2. Data from this study will help us gain an understanding of mechanisms that underpin family-centered self- management interventions to improve SS and CP outcomes in stroke recovery. Next steps will be to develop a multi-site randomized controlled trial to test the efficacy of mobile CARE-CITE in early stroke recovery.

Project Narrative Stroke is a leading cause of long-term disability and to date, research has placed little emphasis on how to integrate carepartners (family members) into the rehabilitation process without increasing negative carepartner outcomes. We have developed and implemented a novel, web- based carepartner focused intervention (CARE-CITE) designed to foster problem solving and skill building while facilitating carepartner engagement during upper extremity functional activities in the home setting. The proposed research will evaluate the application of the CARE- CITE intervention paired with usual and customary care during the sub-acute stroke.