A systematic review of the efficiency of recruitment to stroke rehabilitation randomised controlled trials

Kris McGill, Catherine Sackley, Jon Godwin, Jodie McGarry, Marian C. Brady

Research output: Contribution to journalArticle

15 Downloads (Pure)

Abstract

Introduction: Randomised controlled trials (RCTs) that fail to meet their recruitment target risk increasing research waste. Acute stroke RCTs experience notable recruitment issues. The efficiency of recruitment to stroke rehabilitation RCTs has not been explored.
Aims and Objectives: To explore recruitment efficiency and the trial features associated with efficient recruitment to stroke rehabilitation RCTs.
Methods : A systematic review of stroke rehabilitation RCTs published between 2005 and 2015 identified in a search of the Cochrane Stroke Group (CSG) Trials Register from 35 electronic databases (e.g. Medline, CINAHL; EMBASE), clinical trial registers, and hand-searching. Inclusion criteria; stroke rehabilitation intervention, delivered by a member of the rehabilitation team, and clinically relevant environment. We extracted data on recruitment efficiency and trial features.
Results: We screened 12,939 titles, 1,270 abstracts and 788 full texts, before extracting data from 512 included RCTs (n=28,804 stroke survivor participants). This is the largest systematic review of recruitment to date. A third of stroke survivors screened consented to participate (median 34% (IQR 14-61), on average sites recruited 1.5 participants per site per month (IQR 0.71–3.22), and one in twenty (6% (IQR 0-13) dropped out during the RCT. Almost half (48%) of those screened in the community were recruited compared to hospital settings (27%). Similarly, almost half (47%) those screened at least six months after stroke participated, compared to stroke survivors within a month of stroke (23%). When one recruiter screened multiple sites, a median of one stroke survivor was recruited every two months compared to more than two per month when there was a dedicated recruiter per site. RCT recruitment was significantly faster per site, with fewer dropouts, for trials conducted in Asia (almost three stroke survivors monthly; 2% dropout) compared to European trials (approximately one stroke survivor monthly; 7% dropout)
Conclusions : One third of stroke survivors screened were randomised to rehabilitation RCTs at a rate of between 1 and 2 per month, per site. One in twenty did not complete the trial. Our findings will inform recruitment plans of future stroke rehabilitation RCTs. Limited reporting of recruitment details restricted the subgroup analysis performed.
Original languageEnglish
Article number68 (2020)
Number of pages12
JournalTrials
Volume21
DOIs
Publication statusPublished - 10 Jan 2020

Fingerprint

Randomized Controlled Trials
Stroke
Survivors
Stroke Rehabilitation
Rehabilitation
Clinical Trials
Databases
Research

Keywords

  • stroke
  • recruitment
  • rehabilitation
  • randomised controlled trials
  • systematic review
  • reporting standards

Cite this

@article{1602482e59e14f83bcea9c83b2d6aa69,
title = "A systematic review of the efficiency of recruitment to stroke rehabilitation randomised controlled trials",
abstract = "Introduction: Randomised controlled trials (RCTs) that fail to meet their recruitment target risk increasing research waste. Acute stroke RCTs experience notable recruitment issues. The efficiency of recruitment to stroke rehabilitation RCTs has not been explored.Aims and Objectives: To explore recruitment efficiency and the trial features associated with efficient recruitment to stroke rehabilitation RCTs.Methods : A systematic review of stroke rehabilitation RCTs published between 2005 and 2015 identified in a search of the Cochrane Stroke Group (CSG) Trials Register from 35 electronic databases (e.g. Medline, CINAHL; EMBASE), clinical trial registers, and hand-searching. Inclusion criteria; stroke rehabilitation intervention, delivered by a member of the rehabilitation team, and clinically relevant environment. We extracted data on recruitment efficiency and trial features.Results: We screened 12,939 titles, 1,270 abstracts and 788 full texts, before extracting data from 512 included RCTs (n=28,804 stroke survivor participants). This is the largest systematic review of recruitment to date. A third of stroke survivors screened consented to participate (median 34{\%} (IQR 14-61), on average sites recruited 1.5 participants per site per month (IQR 0.71–3.22), and one in twenty (6{\%} (IQR 0-13) dropped out during the RCT. Almost half (48{\%}) of those screened in the community were recruited compared to hospital settings (27{\%}). Similarly, almost half (47{\%}) those screened at least six months after stroke participated, compared to stroke survivors within a month of stroke (23{\%}). When one recruiter screened multiple sites, a median of one stroke survivor was recruited every two months compared to more than two per month when there was a dedicated recruiter per site. RCT recruitment was significantly faster per site, with fewer dropouts, for trials conducted in Asia (almost three stroke survivors monthly; 2{\%} dropout) compared to European trials (approximately one stroke survivor monthly; 7{\%} dropout) Conclusions : One third of stroke survivors screened were randomised to rehabilitation RCTs at a rate of between 1 and 2 per month, per site. One in twenty did not complete the trial. Our findings will inform recruitment plans of future stroke rehabilitation RCTs. Limited reporting of recruitment details restricted the subgroup analysis performed.",
keywords = "stroke, recruitment, rehabilitation, randomised controlled trials, systematic review, reporting standards",
author = "Kris McGill and Catherine Sackley and Jon Godwin and Jodie McGarry and Brady, {Marian C.}",
note = "Acceptance in SAN OA article",
year = "2020",
month = "1",
day = "10",
doi = "10.1186/s13063-019-3991-2",
language = "English",
volume = "21",

}

A systematic review of the efficiency of recruitment to stroke rehabilitation randomised controlled trials. / McGill, Kris; Sackley, Catherine; Godwin, Jon; McGarry, Jodie; Brady, Marian C.

In: Trials, Vol. 21, 68 (2020), 10.01.2020.

Research output: Contribution to journalArticle

TY - JOUR

T1 - A systematic review of the efficiency of recruitment to stroke rehabilitation randomised controlled trials

AU - McGill, Kris

AU - Sackley, Catherine

AU - Godwin, Jon

AU - McGarry, Jodie

AU - Brady, Marian C.

N1 - Acceptance in SAN OA article

PY - 2020/1/10

Y1 - 2020/1/10

N2 - Introduction: Randomised controlled trials (RCTs) that fail to meet their recruitment target risk increasing research waste. Acute stroke RCTs experience notable recruitment issues. The efficiency of recruitment to stroke rehabilitation RCTs has not been explored.Aims and Objectives: To explore recruitment efficiency and the trial features associated with efficient recruitment to stroke rehabilitation RCTs.Methods : A systematic review of stroke rehabilitation RCTs published between 2005 and 2015 identified in a search of the Cochrane Stroke Group (CSG) Trials Register from 35 electronic databases (e.g. Medline, CINAHL; EMBASE), clinical trial registers, and hand-searching. Inclusion criteria; stroke rehabilitation intervention, delivered by a member of the rehabilitation team, and clinically relevant environment. We extracted data on recruitment efficiency and trial features.Results: We screened 12,939 titles, 1,270 abstracts and 788 full texts, before extracting data from 512 included RCTs (n=28,804 stroke survivor participants). This is the largest systematic review of recruitment to date. A third of stroke survivors screened consented to participate (median 34% (IQR 14-61), on average sites recruited 1.5 participants per site per month (IQR 0.71–3.22), and one in twenty (6% (IQR 0-13) dropped out during the RCT. Almost half (48%) of those screened in the community were recruited compared to hospital settings (27%). Similarly, almost half (47%) those screened at least six months after stroke participated, compared to stroke survivors within a month of stroke (23%). When one recruiter screened multiple sites, a median of one stroke survivor was recruited every two months compared to more than two per month when there was a dedicated recruiter per site. RCT recruitment was significantly faster per site, with fewer dropouts, for trials conducted in Asia (almost three stroke survivors monthly; 2% dropout) compared to European trials (approximately one stroke survivor monthly; 7% dropout) Conclusions : One third of stroke survivors screened were randomised to rehabilitation RCTs at a rate of between 1 and 2 per month, per site. One in twenty did not complete the trial. Our findings will inform recruitment plans of future stroke rehabilitation RCTs. Limited reporting of recruitment details restricted the subgroup analysis performed.

AB - Introduction: Randomised controlled trials (RCTs) that fail to meet their recruitment target risk increasing research waste. Acute stroke RCTs experience notable recruitment issues. The efficiency of recruitment to stroke rehabilitation RCTs has not been explored.Aims and Objectives: To explore recruitment efficiency and the trial features associated with efficient recruitment to stroke rehabilitation RCTs.Methods : A systematic review of stroke rehabilitation RCTs published between 2005 and 2015 identified in a search of the Cochrane Stroke Group (CSG) Trials Register from 35 electronic databases (e.g. Medline, CINAHL; EMBASE), clinical trial registers, and hand-searching. Inclusion criteria; stroke rehabilitation intervention, delivered by a member of the rehabilitation team, and clinically relevant environment. We extracted data on recruitment efficiency and trial features.Results: We screened 12,939 titles, 1,270 abstracts and 788 full texts, before extracting data from 512 included RCTs (n=28,804 stroke survivor participants). This is the largest systematic review of recruitment to date. A third of stroke survivors screened consented to participate (median 34% (IQR 14-61), on average sites recruited 1.5 participants per site per month (IQR 0.71–3.22), and one in twenty (6% (IQR 0-13) dropped out during the RCT. Almost half (48%) of those screened in the community were recruited compared to hospital settings (27%). Similarly, almost half (47%) those screened at least six months after stroke participated, compared to stroke survivors within a month of stroke (23%). When one recruiter screened multiple sites, a median of one stroke survivor was recruited every two months compared to more than two per month when there was a dedicated recruiter per site. RCT recruitment was significantly faster per site, with fewer dropouts, for trials conducted in Asia (almost three stroke survivors monthly; 2% dropout) compared to European trials (approximately one stroke survivor monthly; 7% dropout) Conclusions : One third of stroke survivors screened were randomised to rehabilitation RCTs at a rate of between 1 and 2 per month, per site. One in twenty did not complete the trial. Our findings will inform recruitment plans of future stroke rehabilitation RCTs. Limited reporting of recruitment details restricted the subgroup analysis performed.

KW - stroke

KW - recruitment

KW - rehabilitation

KW - randomised controlled trials

KW - systematic review

KW - reporting standards

U2 - 10.1186/s13063-019-3991-2

DO - 10.1186/s13063-019-3991-2

M3 - Article

VL - 21

M1 - 68 (2020)

ER -