Treatment Research Program Research Articles

The Pain Intervention & Digital Research Program: an operational report on combining digital research with outpatient chronic disease management.

Chronic pain affects up to 28% of U.S. adults, costing ∼$560 billion each year. Chronic pain is an instantiation of the perennial complexity of how to best assess and treat chronic diseases over time, especially in populations where age, medical comorbidities, and socioeconomic barriers may limit access to care. Chronic disease management poses a particular challenge for the healthcare system's transition from fee-for-service to value and risk-based reimbursement models. Remote, passive real-time data from smartphones could enable more timely interventions and simultaneously manage risk and promote better patient outcomes through predicting and preventing costly adverse outcomes; however, there is limited evidence whether remote monitoring is feasible, especially in the case of older patients with chronic pain. Here, we introduce the Pain Intervention and Digital Research (Pain-IDR) Program as a pilot initiative launched in 2022 that combines outpatient clinical care and digital health research. The Pain-IDR seeks to test whether functional status can be assessed passively, through a smartphone application, in older patients with chronic pain. We discuss two perspectives-a narrative approach that describes the clinical settings and rationale behind changes to the operational design, and a quantitative approach that measures patient recruitment, patient experience, and HERMES data characteristics. Since launch, we have had 77 participants with a mean age of 55.52, of which n = 38 have fully completed the 6 months of data collection necessitated to be considered in the study, with an active data collection rate of 51% and passive data rate of 78%. We further present preliminary operational strategies that we have adopted as we have learned to adapt the Pain-IDR to a productive clinical service. Overall, the Pain-IDR has successfully engaged older patients with chronic pain and presents useful insights for others seeking to implement digital phenotyping in other chronic disease settings.

초등학교 ADHD아동을 위한 중재적 개입 국내 연구 동향 및 질적 지표 분석

Objectives Domestic studies related to intervention programs for children with ADHD in elementary school are reviewed, and based on this, a direction for developing and applying effective intervention programs is sought.
 Methods In order to know the research trend of interventional intervention for children with ADHD in elementary school studied in Korea, research literature was searched and papers were selected, focusing on domestic academic journals studied from 2009 to December 2022. For this purpose, 41 selected studies were analyzed according to the thesis analysis framework, and the evidence-based intervention was reviewed by analyzing the qualitative indicators of group-subject studies and single-subject studies.
 Results As a result of the research analysis, the number of students in the lower grades (1 to 3) was higher than that in the upper grades (4 to 6), and it can be seen that there are many studies targeting boys. In previous studies, there was no detailed description of the intervention site and intervention environment. As for the intervention research program, many art activity-based intervention studies were provided, and analysis according to the dependent variable involved a number of studies on the cognitive and behavioral aspects of children with ADHD. As for the qualitative indicators of group targeting intervention research programs, there was a lack of studies that satisfied performance, operator's information technology, and comparative group's teaching skills. As for the qualitative indicators of single-subject intervention research programs, there were insufficient studies that satisfied the environmental description, description of measurement validity, baseline measurement of the dependent variable, and description of the baseline period.
 Conclusions The study suggests that intervention studies of children with primary school ADHD need to be designed to increase the reliability and validity of the studies, and to clarify the description of the subjects' intervention environment. Through the results of this study, studies reflecting this should be conducted in the future by considering the evidence-based analysis of the effectiveness and qualitative indicators of interventions for children with ADHD in elementary school.

Evaluating the psychometrics of the SSIS SEL in a socio‐economically diverse sample

AbstractThe increasing interest in implementing social‐emotional learning (SEL) interventions within schools calls for more reliable and valid assessment tools to measure the effectiveness of SEL programs. We investigated the factor structure and psychometric properties of the Social Skills Improvement System – Social‐Emotional Learning Edition (SSIS SEL) with a group of ethnically and socio‐economically diverse grade 3 students in Ontario, Canada (n = 427). The SSIS SEL is an age‐normed measure used for the evaluation of interventions and prevention initiatives. Data collected included both teacher‐report and student self‐report measures. The factor structure proposed by the scale developers was not replicated using this smaller single grade sample. However, the study demonstrates evidence of good construct and convergent validity supporting the novel factor structure. Results from this study suggest that more research on the SSIS SEL's application in real‐world intervention research programs is needed.

Engagement in the preschool classroom: Brief measures for use with children from ethno-racially diverse and low-income backgrounds

Children's behavioral engagement in preschool is a strong predictor of their academic achievement both concurrently and into the later school years across socioeconomic and ethnic groups (Chien et al., 2010; Fuhs et al., 2013; Hamre & Pianta, 2001; Kim & Suarez-Orozco, 2015; Ladd & Dinella, 2009). The present measurement development study was conducted within the context of a larger intervention research program in partnership with an urban Head Start program in the northeastern United States. Forty-one teachers and 456 children participated. Two new measures were developed and tested for use in preschool classrooms– a teacher rating scale and an independent observation instrument. Although many of the assessments that result from commonly employed systematic observation methods provide a detailed and nuanced description of children's engagement in the classroom, they often require intensive training and are costly to implement. The present study sought to provide the early childhood education field with two brief and more cost-effective measures. Findings revealed initial construct validity evidence for the two measures, which were found to be reliable and to relate modestly with one another as well as to an external criterion measure of children's science knowledge, which was the focus of the larger intervention. Findings also revealed significant relations between children's engagement and child and family demographic characteristics, perhaps attributable to the unique context of Head Start.

A Diagnostic Biomarker Model Associated with Immune Infiltration in Patients with Antibody-Mediated Rejection after Kidney Transplantation

Background: In spite of advances in development and application of immunosuppressive agents, the long-term survival of grafts still needs to be advanced caused by antibody-mediated rejection (ABMR). Many researchers have paid attention to this area. However, little was known about the role of genes and immune cells in the development of ABMR. Methods: In total, 2533 biopsy cases from four different cohorts were collected. Three Gene Expression Omnibus (GEO) datasets (GSE36059, GSE98320 and GSE12403) were used as the training set, and one GEO dataset and twenty biopsy samples from our center were used for validation. The potential diagnostic prediction value of the signature and immune profiles were also explored. Findings: The LASSO regression model and PPI network were performed to search candidate biomarkers. LAPTM5, GBP2, CCL5 and KLRD1 were obtained as diagnostic biomarkers (AUC = 0·934, 95% CI 0·923-0·943). Immune cell infiltration analysis revealed that γδ T cells which could secrete IL-17A were most related with four biomarkers. The infiltration of γδ T cells and IL-17A were significantly higher in ABMR group than that in ST group. Interpretation: We have identified and established a diagnostic model containing four transcripts as diagnostic biomarkers of ABMR following kidney transplantation. Several types of immune cells were inferred to be involved in the process of ABMR. Among these, γδ T cells were most related with four biomarkers, which may promote ABMR by producing IL-17A. Funding: This work was supported by the National Natural Science Foundation of China [grant numbers 82070769, 81900684, 81870512, 81770751, 81570676, 81470981, 81100532], Project of Jiangsu Province for Important Medical Talent [grant number ZDRCA2016025], the “333 High Level Talents Project” in Jiangsu Province [grant numbers BRA2017532, BRA2016514, BRA2015469], the Standardized Diagnosis and Treatment Research Program of Key Diseases in Jiangsu Province [grant number BE2016791], the Open Project Program of Health Department of Jiangsu Province [grant number JSY-2-2016-099], Jiangsu Province Natural Science Foundation Program [grant number BK20191063]. Declaration of Interest: None to declare. Ethical Approval: This study was approved by the local ethics committee of the First Affiliated Hospital of Nanjing Medical University (2016-SR-029).

Integrated COVID-19 Convalescent Plasma Treatment and Antibody Research Program at a Single Academic Medical Center

Background: Convalescent plasma is a potential therapy for COVID-19 Using existing resources at a single academic medical center, we established an integrated

A POTÊNCIA DO PROCESSO GRUPAL

Partindo de um programa de pesquisa intervenção psicossocial, o trabalho apresenta questionamentos e considerações sobre grupos comunitários e institucionais, objeto de ações de pesquisa e extensão do LAPIP - Laboratório de Pesquisa e Intervenção Psicossocial da UFSJ. As perspectivas de análises partem de autores que trabalham com a concepção dialética sobre grupos humanos e o processo grupal, como Ignácio Martín-Baró e Silvia Lane, e com as concepções de Grupo Operativo, de Enrique Pichón-Rivière e oficinas de grupo, de Lúcia Afonso. Nos grupos investigados/atendidos encontramos fenômenos grupais produtores de identidade e ativadores de consciência, além de uma insistência em se manterem como grupos, resistindo ao individualismo e ao isolamento social. Processos de coesão e identidades coletivas são produzidos em associação com mecanismos de solidariedade e afetividade. Presenciamos relações de poder mais igualitárias, implicando menos submissão e mais disposição para o trabalho educativo, com mais possibilidades de produção coletiva de conhecimentos.
 Palavras Chave: Grupo; Processo Grupal; Afetividade; Identidade Grupal; Inclusão Psicossocial.

Women With Schizophrenia Only Half as Likely to Receive Mammograms

Women With Schizophrenia Only Half as Likely to Receive Mammograms

Addressing the impact of opioids on women and children

Women and children bear a substantial part of the burden of opioid overuse in the United States. Opioid use during pregnancy can lead to neonatal opioid withdrawal syndrome, and both the mothers and babies may be at higher risk of opioid use and its consequences later in the life course, setting up intergenerational cycles of opioid overuse. As part of the HEAL (Helping to End Addiction Long-term) Initiative of the National Institutes of Health, the Eunice Kennedy Shriver National Institute of Child Health and Human Development, and the Environmental influences on Child Health Outcomes program are together launching observational and intervention research programs to interrupt these cycles, beginning with opportunities in pregnancy and the newborn period. The Eunice Kennedy Shriver National Institute of Child Health and Human Development has also launched programs to find alternatives to opioids for painful conditions in women of reproductive age, including a range of gynecologic conditions. These coordinated efforts promise to help turn the tide against the opioid crisis by providing the necessary evidence to improve care for women and children affected by these substances.

The Legacy for Children™ Randomized Control Trial: Effects on Cognition Through Third Grade for Young Children Experiencing Poverty.

In an effort to promote the health and developmental outcomes of children born into poverty, the Centers for Disease Control and Prevention (CDC) conceptualized and designed the Legacy for Children™ (Legacy) public health prevention model. This article examines the impact of Legacy on children's cognitive and language development (intelligence quotient [IQ], achievement, language skills, and early reading skills) using both standardized assessments and parent-reported indictors through third grade. Data were collected from 2001 to 2014 from 541 mother-child dyads who were recruited into the 2 concurrent randomized controlled trials of Legacy in Miami and Los Angels. Cognitive and/or language outcomes of children were assessed annually from age 2 to 5 years as well as during a follow-up visit in the third grade. Children experiencing Legacy at the Los Angeles site had significantly higher IQ and achievement scores at 2 and 6 years postintervention, equivalent to approximately one-third of an SD (4 IQ points). IQ results persisted over time, and the difference between intervention and comparison groups on achievement scores widened. There were no significant differences in cognitive outcomes in the Miami sample. There were no significant differences in language outcomes for either site. Legacy shows evidence of effectiveness as an intervention to prevent cognitive delays among children living in poverty. The mixed findings across sites may not only reflect the impact of heterogeneous risk profiles noted by other intervention research programs but also warrant additional study.

In Case You Haven't Heard

Last week, first lady Melania Trump traveled to Lynchburg, Virginia, to attend an Opioid Town Hall inside Liberty University's basketball arena. Health and Human Services Secretary Alex Azar and Homeland Security Secretary Kirstjen Nielsen accompanied the first lady to Lynchburg. Trump emphasized there is no shame in asking for help. Most recently, she traveled to Philadelphia, learning more about Jefferson University Hospital's Maternal Addiction Treatment Education and Research (MATER) program for mothers and children affected by opioids. “As a mother and as first lady, I want to do everything I can to expose the serious dangers of opioid and drug addiction and provide opportunities for youth to become leaders in ending this crisis,” Trump said. She warned the college students at Liberty about alcohol and drugs but said she didn't want to “lecture” them, but rather tell them what she had learned. “I have learned that you have a responsibility to yourself, and also to those around you who may be struggling. While you may never personally become addicted, the chances of you knowing someone who struggles with it are very high,” Trump said. “And if you or someone you know needs help, you need to be brave enough to ask, or strong enough to stand with them as they fight through the disease. You need to be educated enough to know the signs of addiction, and also secure enough to talk about it, and keep talking about it until help arrives.”

Gut Microbial Carbohydrate Metabolism Hinders Weight Loss in Overweight Adults Undergoing Lifestyle Intervention With a Volumetric Diet

The rising incidence of obesity requires the reevaluation of our current therapeutic strategies to optimize patient outcomes. The objective of this study was to determine whether compositional and functional characteristics of the gut microbiota in adults predict responses to a comprehensive lifestyle intervention program in overweight and obese adults. We recruited 26 participants from the Mayo Clinic Obesity Treatment Research Program between August 6, 2013, and September 12, 2013, to participate in a lifestyle intervention program for weight loss. Adults aged 18 to 65 years with a body mass index of 27 to 39.9 kg/m2 and able to provide informed consent were included in the study. Fecal stool samples were obtained at baseline and after 3 months. Loss of at least 5% of baseline weight after 3 months was defined as success. Clinical characteristics and gut microbial composition and function were compared between those who achieved at least 5% and those who achieved less than 5% weight loss. After 3 months, 9 of 26 participants lost at least 5% of their weight. The mean weight loss was 7.89 kg (95% CI, 6.46-9.32 kg) in the success group and 1.51 kg (95% CI, 0.52-2.49 kg) in the less than 5% weight loss group. An increased abundance of Phascolarctobacterium was associated with success. In contrast, an increased abundance of Dialister and of genes encoding gut microbial carbohydrate-active enzymes was associated with failure to lose 5% body weight. A gut microbiota with increased capability for carbohydrate metabolism appears to be associated with decreased weight loss in overweight and obese patients undergoing a lifestyle intervention program.

Development, Feasibility, and Refinement of a Toxic Stress Prevention Research Program

Innovative interventions accessible to at-risk populations to prevent the intergenerational cycle of toxic stress are needed. This paper describes the iterative development of a community-based intervention, 2Gen Thrive, which was designed to prevent toxic stress and promote resilience by improving caregiver capacity to respond to children’s emotional, behavioral, and developmental needs. 2Gen Thrive leverages the collaboration between a Children’s Hospital and an Early Head Start/Head Start education center to help low-income, minority families thrive in the context of risk factors for toxic stress. In this paper, we focus on the process of developing, piloting, and refining our 2Gen Thrive preventive intervention research program, which has been developed following a community-based participatory research (CBPR) approach. The primary objective was to pilot test two prevention interventions we adapted for use in this target population: Classroom Theraplay, a classroom-wide intervention designed to prevent toxic stress among children exposed to adversity by fostering nurturing relationships with their teachers; and Dialectical Behavior Therapy Skills Training for Parents (DBT4P), a group intervention developed to bolster parental responsiveness by teaching Dialectical Behavioral Therapy (DBT) mindfulness and emotion regulation skills. We evaluated qualitative and process data as well as quantitative data from standardized instruments, including The Classroom Assessment Scoring System (CLASS), Patient Health Questionnaire (PHQ-9), Difficulties in Emotion Regulation Scale (DERS), and Parenting Stress Index (PSI/SF). Results demonstrate the feasibility, acceptability, and appropriateness of these preventive interventions delivered in the early education setting, and of conducting intervention research using a CBPR approach.

Training of Mexican elders as health promoters: a qualitative study.

The purpose of the study was to analyze the repercussion of a training program in gerontological health promotion addressed to senior citizens in a rural area in Mexico. The impact of the program was examined at two levels: first, with regard to the development of specific practices relating to primary health care and to the actual implementation of community health programs and, second, through the interpretive analysis of bodily inscriptions in the participants. Results gave evidence of a gradual empowering process among the elderly health promoters who consistently developed a position of responsibility and autonomy regarding the control of their lives and, at the same time, an increasingly open critical attitude with regard to the social role ascribed to them by the community. Furthermore, the knowledge, sense of and meanings that operated on the significant practices of the participants were consistently determined by the extent of their social capital and habitus. It was important to note that the intervention research program did not lead to permanent changes in the participants' habitus, whereas their main effects were associated to a greater consolidation of social support networks and to the acquisition of a salient position in their community given the symbolic cultural capital that represented having obtained an official certification. To conclude, a diversity of outcomes was evident in the participants as a result of the intervention program, depending on their personal biographies, social and cultural capitals, and on their particular positions within their community.

Methodology of a multispecialty outpatient Obesity Treatment Research Program.

Despite the large number of U.S. adults who overweight or obese, few providers have ready access to comprehensive lifestyle interventions, the cornerstone of medical obesity management. Our goal was to establish a research infrastructure embedded in a comprehensive lifestyle intervention treatment for obesity. The Obesity Treatment Research Program (OTRP) is a multi-specialty project at Mayo Clinic in Rochester, Minnesota designed to provide a high intensity, year-long, comprehensive lifestyle obesity treatment. The program includes a nutritional intervention designed to reduce energy intake, a physical activity program and a cognitive behavioral approach to increase the likelihood of long-term adherence. The behavioral intervention template incorporated the Diabetes Prevention Program and the Look AHEAD trial materials. The OTRP is consistent with national recommendations for the management of overweight and obesity in adults, but with embedded features designed to identify patient characteristics that might help predict outcomes, assure long-term follow up and support various research initiatives. Our goal was to develop approaches to understand whether there are patient characteristics that predict treatment outcomes.

Updated epidemiological assessment of amyotrophic lateral sclerosis in Wakayama Prefecture, Japan, using data from the Japanese specified disease treatment research program

Updated epidemiological assessment of amyotrophic lateral sclerosis in Wakayama Prefecture, Japan, using data from the Japanese specified disease treatment research program

Sleep continuity, architecture and quality among treatment-seeking cannabis users: An in-home, unattended polysomnographic study.

The objective of the study was to describe self-report and objectively measured sleep characteristics of adult treatment-seeking cannabis users. Study participants (n = 87) were adults who were screened for a 12-week outpatient cannabis treatment research program in Baltimore, MD. Participants completed objective and self-report measures of sleep quality. Data were analyzed for the sample overall and after stratifying by sex (54 men, 33 women). Participants were primarily urban, socioeconomically disadvantaged African Americans. Participants were frequent, heavy cannabis users; among a subset of participants assessed, 76.7% used cannabis on the day/night of the assessment. Participants had low rates of other substance abuse and of psychiatric comorbidities. Polysomnography indicated 19.5% of participants received the recommended 7 to 9 hr of sleep, with women averaging more sleep than men. One third (31.0%) had sleep latencies >30 min, one half spent >30 min awake after sleep onset, and more than one half of the sample (55.2%) had sleep efficiency scores of <85%. Most participants met criteria for subthreshold (36.8%) or clinical insomnia (25.3%) on the Insomnia Severity Index, 77.0% had scores of >5 on the Pittsburgh Sleep Quality Index. Most had average scores on the Dysfunctional Beliefs and Attitudes About Sleep (DBAS) questionnaire (M = 51.1, SD = 18.8) that were higher than average among clinical insomnia patients. Women had higher DBAS scores than men. Most participants exhibited characteristics of disordered sleep, and sex differences were observed on polysomnography and self-report measures. Findings extend prior research concerning the association between cannabis use and disordered sleep. Data presented in this article come from Clinical Trial NCT01685073. (PsycINFO Database Record

東京都の人工呼吸器装着中の孤発性筋萎縮性側索硬化症患者の 人工呼吸・栄養療法の導入状況と療養環境の変化 ―2006年度と2012年度の臨床調査個人票の比較を通して―

東京都の人工呼吸器装着中の孤発性筋萎縮性側索硬化症患者の 人工呼吸・栄養療法の導入状況と療養環境の変化 ―2006年度と2012年度の臨床調査個人票の比較を通して―

Abstract 89: Differences in Acute Stroke Care in Primary and Comprehensive Stroke Centers in Florida: An Analysis of the Florida-Puerto Rico Collaboration to Reduce Stroke Disparities (FL-PR CReSD) Study- the NINDS Stroke Prevention Intervention Research Program

Introduction: Primary stroke center (PSC) and comprehensive stroke center (CSC) designation in Florida aims to improve delivery of care and outcomes for stroke patients. In line with the goals of the NINDS funded Florida-Puerto Rico Collaboration to Reduce Stroke Disparities (FL-PR CReSD) Study, we sought to compare ischemic stroke performance metrics by stroke center designation in participating Florida hospitals. Methods: We analyzed 74,623 cases with acute ischemic stroke from 26 CSC and 40 PSC from January 2010-April 2016. We described patient demographics, comorbidities and Get With The Guidelines-Stroke performance metrics of defect free care (compliance with 7 pre-defined performance core measures), door to CT time (DTCT) ≤25 mins and door to needle time (DTN) ≤60 mins. Results: Compared with PSC patients, CSC patients were younger (70 ± 15 vs. 71 ± 14 years, p&lt;.0001), more likely male (51% vs. 50%, p=.0008), more likely Hispanic (17% vs. 10%, p&lt;.0001) and Black (21% vs. 17%, p&lt;.0001), had more severe strokes (NIHSS median 5 (IQR 2-12) vs. 4 (IQR 1-9); NIHSS ≥16, 12% vs. 9%, p &lt;.0001), were more likely to have atrial fibrillation (19% vs. 17%, p&lt;.0001), and were more likely to arrive by EMS (55% vs. 46%, p&lt;.0001). CSC cases were more likely to have faster DTCT (44 vs. 48 mins, p=.0124 ; &lt; 25 mins 33% vs. 31%, p&lt;.0001). More patients in CSC received thrombolysis (12% vs. 9%, p&lt;.0001), with faster DTN (59 vs. 71 min, p &lt;.0001; ≤60 minutes 53% vs. 37%, p &lt;.0001). Patients in CSC had greater rates of defect free care (85% vs. 82.4%, p&lt;.0001). Blacks had longer median DTCT than Whites and Hispanics in both CSC (56 mins Blacks vs. 41 mins Whites and Hispanics) and PSC (60 mins Blacks, 44 mins Whites, 57 mins Hispanics). Blacks in CSC had longer median DTN (63 mins) than Whites (60 mins) and Hispanics (53 mins). Hispanics had longer median DTN (73 mins) in PSC than Blacks (70 mins) and Whites (70 mins). Conclusion: Patients treated in CSC, compared with those treated in PSC, received better defect-free care and had lower DTCT and DTN times. Race-ethnic disparities in performance metrics are still evident in both CSC and PSC. Identification of these disparities is important to design interventions to reduce disparities and improve stroke quality of care for all.

Abstract TP311: Does Age Affect Race/Ethnic Differences in Discharge Ambulation Status? Data From the Florida Puerto Collaboration to Reduce Stroke Disparities (FL-PR CReSD) Study - The NINDS Stroke Prevention Intervention Research Program

Background: Among stroke survivors, worse functional outcomes have been reported in race/ethnic minority groups. Race/ethnic differences in post-stroke independent ambulation may be evident early and largely influenced by age. Independent ambulation is defined as the ability to walk without supervision or assistance from another person. Discharge ambulation status may have implications for long term rehabilitation after stroke. We sought to determine the impact of age on race/ethnic differences in discharge ambulation status in the large NINDS-funded FL-PR CReSD Registry of Get With The Guidelines-Stroke (GWTG-S) data. Methods: Discharge ambulation status was analyzed for 51,859 acute ischemic stroke (AIS) survivors from 69 FL and 13 PR sites. Multivariate logistic regression models were used to test whether age modifies the relationship between race/ethnicity and independent ambulation at discharge (IAD). Stratified analyses were performed in 3 age groups: 18-64, 65-79, 80+. Models were adjusted for sex, vascular risk factors, independent ambulation status at admission and hospital characteristics. Results: IAD was achieved in 52%, of which 71% were non-Hispanic White (NHW), 13% NH Black (NHB), 12% FL Hispanic (FLH), and 4% PR Hispanic (PRH). IAD was most common in NHW (57%), followed by FLH (53%), NHB (47%), and PRH (40%). Older age was associated with lower odds of IAD (18-64: 68%, 65-79: 54%, 80+: 32%). After full adjustment, IAD was less likely in older [65-79 vs 18-64: OR 0.68, 95% CI 0.63-0.73; 80+: OR 0.35, 95% CI 0.32-0.39] and NHB vs. NHW patients [OR 0.85, 95% CI 0.78-0.92]. In age-stratified analyses, NHBs were less likely than NHWs to achieve IAD among those age 65-79 (47% vs. 57%) and 80+ (29% vs 34%) [OR 0.79, 95% CI 0.70-0.90; OR 0.76, 95% CI 0.65-0.88]. This association was not seen in the 18-64 age group (66% vs 69%), [OR 0.97, 95% CI 0.88-1.06]. Conclusions: About half of AIS survivors are unable to ambulate independently after stroke at discharge. Elderly NHB are less likely to IAD, though the disparity is not observed in working age adults. Post-stroke ambulation is a public health issue that substantially contributes to the economic burden of US healthcare. Further studies are warranted to identify causes of race/ethnic disparities in IAD.