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Principal Investigator: Lindsey Major Knowles
Organization: UNIVERSITY OF WASHINGTON
Fiscal Year: 2024
Award: $161,568
Funding agency: Eunice Kennedy Shriver National Institute of Child Health and Human Development
Project Summary/Abstract: Lindsey Knowles, PhD is a psychologist and postdoctoral fellow in the University
of Washington (UW) and VA Puget Sound Health Care System (VAPSHCS) Seattle Collaborative Fellowship
in Multiple Sclerosis (MS) Rehabilitation Research. She is fully committed to becoming an independently
funded investigator who develops, optimizes, and evaluates theory-driven, implementable interventions to
improve symptoms, psychosocial function, and quality of life in adults with chronic health conditions/disability.
Dr. Knowles is an ideal candidate for this field of research given her strong background in observational and
intervention research on stress and coping and advanced fellowship training in rehabilitation research. This
K23 award will provide foundational career development skills for achieving her long-term goal of optimizing
evidence-based and accessible treatment for improving symptoms, function, and quality of life in people with
chronic health conditions. The proposed project will develop, refine, and optimize a telehealth Cognitive
Behavioral Therapy (CBT) intervention for fatigue in people with MS (PwMS). Findings will support a
randomized controlled trial to evaluate the optimized CBT-based intervention for MS fatigue. Career
Development and Training Plan: The proposed work will be carried out at the UW and utilize resources
within the UW Department of Rehabilitation Medicine and VAPSHCS MS Center of Excellence West. Dr.
Knowles’s distinguished mentorship team includes Drs. Dawn Ehde (Primary Mentor; telehealth CBT and MS
expert), Aaron Turner (MS behavioral intervention expert), Linda Collins [Multiphase Optimization Strategy
(MOST) expert], and Anna Kratz (qualitative research expert). Dr. Knowles’s training goals align her research
and career plans via didactic and hands-on training in: (1) Intervention optimization and clinical trials methods
via MOST, (2) Rapid qualitative research methods, and (3) Proficiency in grantsmanship and scientific
dissemination. Research Plan: The proposed aims will address a gap in knowledge related to the active
ingredients of CBT for improving MS fatigue. This knowledge will facilitate optimization of CBT for MS fatigue
to maximize efficacy and efficiency, thereby improving implementation and accessibility. The study aims are to
(1) Develop, pilot test, and refine three telehealth CBT components for fatigue in PwMS (Relaxation Training,
Behavioral Activation, Cognitive Therapy) to maximize feasibility and acceptability; (2a) Conduct component
analysis (via factorial optimization trial) to test the main and interactive effects of the three telehealth CBT
components for improving fatigue and psychosocial function in fatigued PwMS (primary outcomes); (2b)
Assess change in hypothesized unique and common mechanisms of the three telehealth CBT components;
(2c) Evaluate the durability of outcome improvements through the 3-month follow-up. Components will be
selected for an optimized intervention if they meet the threshold effect size for either primary outcome and
meet the key implementation objective (defined in a preliminary study) as an optimized intervention package.
Terms: <21+ years old><ANOVA><Active Follow-up><Adult><Adult Human><Affect><Analysis of Variance><Apoplexy><Behavior Conditioning Therapy><Behavior Modification><Behavior Therapy><Behavior Treatment><Behavioral><Behavioral Conditioning Therapy><Behavioral Model><Behavioral Modification><Behavioral Therapy><Behavioral Treatment><Brain Trauma><Brain Vascular Accident><Cancers><Case Series><Cerebral Stroke><Cerebrovascular Apoplexy><Cerebrovascular Stroke><Chronic><Clinical Trials><Cognition Therapy><Cognitive><Cognitive Psychotherapy><Cognitive Therapy><Cognitive treatment><Conditioning Therapy><Data><Disease><Disorder><Disseminated Sclerosis><Doctor of Philosophy><Emotional><Evidence based intervention><Exclusion><Fatigue><Fellowship><Funding><Future><Goals><Health><Health Care Systems><Healthcare Systems><Hour><Improve Access><Individual><Intervention><Intervention Strategies><Intervention Studies><Investigators><K23 Award><K23 Mechanism><K23 Program><Knowledge><Lack of Energy><Long COVID><Long COVID-19><Long coronavirus disease><Long coronavirus disease 2019><MS patient><MS treatment><Malignant Neoplasms><Malignant Tumor><Medical Rehabilitation><Mentored Patient-Oriented Research Career Development Award><Mentored Patient-Oriented Research Career Development Award (K23)><Mentors><Mentorship><Methods><Multiple Sclerosis><Observation in research><Outcome><Persons><Ph.D.><PhD><Physiatrics><Physiatry><Physical Medicine><Physiologic><Physiological><Population><Postdoc><Postdoctoral Fellow><Pre-Post Tests><Private Sector><Psychologist><QOL><Qualitative Research><Quality of life><R-Series Research Projects><R01 Mechanism><R01 Program><Randomized><Randomized, Controlled Trials><Reaction><Rehabilitation><Rehabilitation Medicine><Rehabilitation therapy><Relaxation><Relaxation Therapy><Reporting><Research><Research Associate><Research Grants><Research Methodology><Research Methods><Research Personnel><Research Project Grants><Research Projects><Research Resources><Researchers><Resources><Role><Scientific Advances and Accomplishments><Self Efficacy><Spinal Cord Trauma><Spinal Trauma><Spinal cord injured><Spinal cord injury><Stress><Stress and Coping><Stroke><Symptoms><Testing><Therapeutic Intervention><Training><Training Activity><Traumatic Brain Injury><Traumatic Myelopathy><United States><Universities><Variance Analyses><Washington><Work><Writing><acceptability and feasibility><active followup><adulthood><barriers to implementation><behavior intervention><behavioral health intervention><behavioral intervention><brain attack><career><career development><cerebral vascular accident><cerebrovascular accident><chronic COVID><chronic COVID-19><chronic novel coronavirus disease 2019><cognitive behavior intervention><cognitive behavior modification><cognitive behavior therapy><cognitive behavioral intervention><cognitive behavioral modification><cognitive behavioral therapy><cognitive behavioral treatment><coping with stress><daily functioning><design><designing><develop therapy><disability><disabling symptom><effective therapy><effective treatment><evidence base><experience><follow up><follow up assessment><follow-up><followed up><followup><followup assessment><implementation barriers><implementation challenges><implementation determinants><implementation facilitation><implementation factors><improve symptom><improved><improved outcome><insular sclerosis><intervention development><intervention effect><intervention refinement><intervention research><intervention therapy><interventional research><interventional strategy><interventional study><interventions research><long haul COVID><long haul COVID-19><long haul coronavirus disease><long haul coronavirus disease 2019><long-hauler COVID><long-hauler COVID-19><long-hauler coronavirus disease 2019><long-hauler syndrome><long-term COVID><long-term COVID-19><long-term coronavirus disease><long-term coronavirus disease 2019><longterm COVID><longterm COVID-19><longterm coronavirus disease><longterm coronavirus disease 2019><malignancy><multiphase optimization strategy><multiple sclerosis patient><multiple sclerosis therapy><multiple sclerosis treatment><neoplasm/cancer><participant engagement><patient engagement><patients with MS><patients with multiple sclerosis><people with Multiple sclerosis><persistent COVID-19><pilot test><post COVID syndrome><post COVID-19 syndrome><post acute COVID syndrome><post acute COVID-19><post acute COVID-19 syndrome><post acute SARS-CoV-2><post acute coronavirus disease 2019><post acute coronavirus disease 2019 syndrome><post acute coronavirus disease syndrome><post acute severe acute respiratory syndrome coronavirus 2><post coronavirus disease 2019 syndrome><post coronavirus disease syndrome><post intervention><post-acute phases of COVID-19><post-doc><post-doctoral><post-doctoral trainee><primary outcome><prolonged COVID-19 symptoms><prospective><psychosocial><randomisation><randomization><randomized control trial><randomly assigned><rehab research><rehab therapy><rehabilitation research><rehabilitative><rehabilitative therapy><relaxation training><research and methods><research associates><scientific accomplishments><scientific advances><skill acquisition><skill development><skills><social role><sound><stress-related coping><stroked><strokes><symptom improvement><symptomatic improvement><telehealth><theories><therapy development><training module><translational model><traumatic brain damage><treatment development>