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Seah B, Espnes GA, Hong WT, Wang W. Salutogenic Healthy Ageing Programme Embracement (SHAPE)- an upstream health resource intervention for older adults living alone and with their spouses only: complex intervention development and pilot randomized controlled trial. BMC Geriatr 2022; 22:932. [PMID: 36460959 PMCID: PMC9719210 DOI: 10.1186/s12877-022-03605-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 11/09/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND In view of age-related health concerns and resource vulnerabilities challenging older adults to age in place, upstream health resource interventions can inform older adults about the availability, accessibility, and utility of resources and equip them with better coping behaviours to maintain health and independence. This paper described the development process and evaluated the feasibility of an upstream health resource intervention, titled Salutogenic Healthy Ageing Programme Embracement (SHAPE), for older adults living alone or with spouses only. METHODS A pilot randomised controlled trial design was adopted. SHAPE was designed to equip older adults with resource information and personal conviction to cope with stressors of healthy aging. This 12-week intervention comprised 12 weekly structured group sessions, at least two individual home visits and a resource book. Both the intervention and control groups received usual care provided in the community. Feasibility of SHAPE intervention was evaluated using recruitment rate, intervention adherence, data collection completion rate, satisfaction survey and post-intervention interview. Outcome measures (sense of coherence, health-promoting lifestyle behaviours, quality of life, self-efficacy, and self-rated health) were assessed at baseline and post-intervention. Paired t-tests were used to examine within-group changes in outcome measures. Content analysis was used to analysed qualitative data. RESULTS Thirty-four participants were recruited and randomised. While recruitment rate was low (8.9%), intervention adherence (93.75%) and data collection completion (100%) were high. Participants expressed high satisfaction towards SHAPE intervention and found it useful. Participants experienced mindset growth towards personal and ageing experiences, and they were more proactive in adopting healthful behaviours. Although the programme was tailored according to needs of older adults, it required refinement. Intention-to-treat analysis showed significant increase in overall health-promoting lifestyle behaviours, health responsibility, physical activity, spiritual growth, and stress management among intervention participants. However, they reported a significant drop in autonomy post-intervention. CONCLUSION Findings of this pilot trial suggested that with protocol modifications, SHAPE can be a feasible and beneficial health resource intervention for older adults. Modifications on recruitment strategies, eligibility criteria, selection of outcome measures, training of resource facilitators and strong collaboration bonds with community partners would be needed to increase feasibility robustness and scientific rigor of this complex intervention. TRIAL REGISTRATION This study has been registered with clinicaltrials.gov on 10/05/2017. The trial registration number is NCT03147625.
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Affiliation(s)
- Betsy Seah
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Clinical Research Centre, Block MD11, Level 3, 10 Medical Drive, Singapore, 117597, Singapore. .,Health Concepts and Measurements-HealthierSG, 116B Rivervale Drive, #12-30, Singapore, 542116, Singapore.
| | - Geir Arild Espnes
- NTNU Center for Health Promotion Research, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Postbox 8905, Trondheim, N-7491, Norway
| | - Wee Tin Hong
- Health Concepts and Measurements-HealthierSG, 116B Rivervale Drive, #12-30, Singapore, 542116, Singapore
| | - Wenru Wang
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Clinical Research Centre, Block MD11, Level 3, 10 Medical Drive, Singapore, 117597, Singapore
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Dewsbury LS, Lim CK, Steiner GZ. The Efficacy of Ketogenic Therapies in the Clinical Management of People with Neurodegenerative Disease: A Systematic Review. Adv Nutr 2021; 12:1571-1593. [PMID: 33621313 PMCID: PMC8321843 DOI: 10.1093/advances/nmaa180] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 11/10/2020] [Accepted: 12/21/2020] [Indexed: 12/12/2022] Open
Abstract
Ketone bodies have potential disease-modifying activity that represent a novel therapeutic approach for neurodegenerative diseases (NDD). The aim of this systematic review was to summarize and evaluate the evidence for the application of ketogenic therapies (dietary or exogenous ketogenic agents) for NDD and provide recommendations for future research. Eight databases were electronically searched for articles reporting on controlled trials (≥4 wk duration) that induced ketosis or elevated serum ketone concentrations in people with NDD. Of 4498 records identified, 17 articles met the inclusion criteria with a total of 979 participants including studies on mild cognitive impairment (MCI; n = 6), multiple sclerosis (n = 4), Alzheimer's disease (n = 5), Parkinson's disease (n = 1), and MCI secondary to Parkinson's disease (n = 1). Of 17 studies, 7 were randomized double-blind placebo-controlled trials. Most studies used dietary interventions (n = 9), followed by medium-chain triglycerides (n = 7) and a fasting protocol (n = 1). Generally, trials were 6 wk in duration and assessed cognition as the primary outcome. Studies were heterogeneous in type and severity of NDD, interventions used, and outcomes assessed. Overall, 3/17 studies carried a low risk of bias. Based on available evidence, exogenous ketogenic agents may be more feasible than dietary interventions in NDD from a compliance and adherence perspective; more research is required to confirm this. Recommendations for future research include improving exogenous formulations to reduce adverse effects, exploring interindividual factors affecting response-to-treatment, and establishing a "minimum required dose" for clinically meaningful improvements in disease-specific symptoms, such as cognition or motor function.
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Affiliation(s)
- Lauren S Dewsbury
- NICM Health Research Institute, Western Sydney University, Penrith, New South Wales, Australia
| | - Chai K Lim
- Department of Biomedical Sciences, Faculty of Medicine Health and Human Sciences, Macquarie University, Macquarie Park, New South Wales, Australia
| | - Genevieve Z Steiner
- NICM Health Research Institute, Western Sydney University, Penrith, New South Wales, Australia
- Translational Health Research Institute (THRI), Western Sydney University, Penrith, New South Wales, Australia
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Harrison N, Brundle C, Heaven A, Clegg A. The cost of community research-recruiting community-dwelling participants to a feasibility primary care cluster randomised controlled trial. Trials 2021; 22:332. [PMID: 33964964 PMCID: PMC8106218 DOI: 10.1186/s13063-021-05297-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 04/26/2021] [Indexed: 11/10/2022] Open
Abstract
Background To support a robust evidence base for the organisation and provision of community-delivered health services for older people, clinical trials need to be designed to account for community-based participant recruitment. There is currently little reported information available on the time and cost of recruiting community-dwelling older people, which makes the completion of cost attribution documentation problematic when applying for research funding. Main body We aimed to establish the amount of researcher time it takes to recruit community-dwelling older people to a feasibility primary care cluster randomised controlled trial, including collecting baseline data. The trial was part of a programme of work investigating an intervention to improve the quality of life for older people with frailty. Two researchers conducting home visits to recruit and collect baseline data from participants recorded the time spent on travelling to and from the visit, at the visit itself and any associated administration. The median total researcher activity time per visit was 148 min. We discuss the various elements of recruitment and data collection activity and the factors that impacted the length of time taken, including location, individuals’ capacity and cognition, hearing and visual impairment and the desire for social contact. Conclusion Studies cannot reach their recruitment targets if they are unrealistically planned and resourced. We recommend that trials recruiting older people in the community allocate two and a half hours of researcher time per person, on average, for consent, baseline data collection, travel and administration. We acknowledge that a variety of different factors will mean that researcher activity will vary between different community-based trials. Our findings give a good starting point for timing calculations, and evidence on which to base the justification of research activity costings. Trial registration Personalised care planning for older people with frailty ISRCTN12363970. 08/11/2018.
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Affiliation(s)
- Nicola Harrison
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Caroline Brundle
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK.
| | - Anne Heaven
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Andrew Clegg
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK.,Academic Unit of Ageing and Stroke Research, University of Leeds, Leeds, UK
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Bruce J, Hossain A, Lall R, Withers EJ, Finnegan S, Underwood M, Ji C, Bojke C, Longo R, Hulme C, Hennings S, Sheridan R, Westacott K, Ralhan S, Martin F, Davison J, Shaw F, Skelton DA, Treml J, Willett K, Lamb SE. Fall prevention interventions in primary care to reduce fractures and falls in people aged 70 years and over: the PreFIT three-arm cluster RCT. Health Technol Assess 2021; 25:1-114. [PMID: 34075875 DOI: 10.3310/hta25340] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Falls and fractures are a major problem. OBJECTIVES To investigate the clinical effectiveness and cost-effectiveness of alternative falls prevention interventions. DESIGN Three-arm, pragmatic, cluster randomised controlled trial with parallel economic analysis. The unit of randomisation was the general practice. SETTING Primary care. PARTICIPANTS People aged ≥ 70 years. INTERVENTIONS All practices posted an advice leaflet to each participant. Practices randomised to active intervention arms (exercise and multifactorial falls prevention) screened participants for falls risk using a postal questionnaire. Active treatments were delivered to participants at higher risk of falling. MAIN OUTCOME MEASURES The primary outcome was fracture rate over 18 months, captured from Hospital Episode Statistics, general practice records and self-report. Secondary outcomes were falls rate, health-related quality of life, mortality, frailty and health service resource use. Economic evaluation was expressed in terms of incremental cost per quality-adjusted life-year and incremental net monetary benefit. RESULTS Between 2011 and 2014, we randomised 63 general practices (9803 participants): 21 practices (3223 participants) to advice only, 21 practices (3279 participants) to exercise and 21 practices (3301 participants) to multifactorial falls prevention. In the active intervention arms, 5779 out of 6580 (87.8%) participants responded to the postal fall risk screener, of whom 2153 (37.3%) were classed as being at higher risk of falling and invited for treatment. The rate of intervention uptake was 65% (697 out of 1079) in the exercise arm and 71% (762 out of 1074) in the multifactorial falls prevention arm. Overall, 379 out of 9803 (3.9%) participants sustained a fracture. There was no difference in the fracture rate between the advice and exercise arms (rate ratio 1.20, 95% confidence interval 0.91 to 1.59) or between the advice and multifactorial falls prevention arms (rate ratio 1.30, 95% confidence interval 0.99 to 1.71). There was no difference in falls rate over 18 months (exercise arm: rate ratio 0.99, 95% confidence interval 0.86 to 1.14; multifactorial falls prevention arm: rate ratio 1.13, 95% confidence interval 0.98 to 1.30). A lower rate of falls was observed in the exercise arm at 8 months (rate ratio 0.78, 95% confidence interval 0.64 to 0.96), but not at other time points. There were 289 (2.9%) deaths, with no differences by treatment arm. There was no evidence of effects in prespecified subgroup comparisons, nor in nested intention-to-treat analyses that considered only those at higher risk of falling. Exercise provided the highest expected quality-adjusted life-years (1.120), followed by advice and multifactorial falls prevention, with 1.106 and 1.114 quality-adjusted life-years, respectively. NHS costs associated with exercise (£3720) were lower than the costs of advice (£3737) or of multifactorial falls prevention (£3941). Although incremental differences between treatment arms were small, exercise dominated advice, which in turn dominated multifactorial falls prevention. The incremental net monetary benefit of exercise relative to treatment valued at £30,000 per quality-adjusted life-year is modest, at £191, and for multifactorial falls prevention is £613. Exercise is the most cost-effective treatment. No serious adverse events were reported. LIMITATIONS The rate of fractures was lower than anticipated. CONCLUSIONS Screen-and-treat falls prevention strategies in primary care did not reduce fractures. Exercise resulted in a short-term reduction in falls and was cost-effective. FUTURE WORK Exercise is the most promising intervention for primary care. Work is needed to ensure adequate uptake and sustained effects. TRIAL REGISTRATION Current Controlled Trials ISRCTN71002650. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 34. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Julie Bruce
- Warwick Clinical Trials Unit, Division of Health Sciences, University of Warwick, Coventry, UK
| | - Anower Hossain
- Warwick Clinical Trials Unit, Division of Health Sciences, University of Warwick, Coventry, UK.,Institute of Statistical Research and Training, University of Dhaka, Dhaka, Bangladesh
| | - Ranjit Lall
- Warwick Clinical Trials Unit, Division of Health Sciences, University of Warwick, Coventry, UK
| | - Emma J Withers
- Warwick Clinical Trials Unit, Division of Health Sciences, University of Warwick, Coventry, UK
| | - Susanne Finnegan
- Warwick Clinical Trials Unit, Division of Health Sciences, University of Warwick, Coventry, UK
| | - Martin Underwood
- Warwick Clinical Trials Unit, Division of Health Sciences, University of Warwick, Coventry, UK
| | - Chen Ji
- Warwick Clinical Trials Unit, Division of Health Sciences, University of Warwick, Coventry, UK
| | - Chris Bojke
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Roberta Longo
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Claire Hulme
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Susie Hennings
- Warwick Clinical Trials Unit, Division of Health Sciences, University of Warwick, Coventry, UK
| | - Ray Sheridan
- General Medicine/Care of the Elderly, Royal Devon and Exeter Hospital, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Katharine Westacott
- Elderly Care Department, Warwick Hospital, South Warwickshire NHS Foundation Trust, Warwick, UK
| | - Shvaita Ralhan
- Gerontology Department, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Finbarr Martin
- St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - John Davison
- Falls and Syncope Service, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Fiona Shaw
- Falls and Syncope Service, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Dawn A Skelton
- Centre for Living, School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Jonathan Treml
- Geriatric Medicine, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Keith Willett
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Sarah E Lamb
- Warwick Clinical Trials Unit, Division of Health Sciences, University of Warwick, Coventry, UK.,College of Medicine and Health, University of Exeter, Exeter, UK.,Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
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Brandt J, Buchholz A, Henry-Barron B, Vizthum D, Avramopoulos D, Cervenka MC. Preliminary Report on the Feasibility and Efficacy of the Modified Atkins Diet for Treatment of Mild Cognitive Impairment and Early Alzheimer's Disease. J Alzheimers Dis 2020; 68:969-981. [PMID: 30856112 DOI: 10.3233/jad-180995] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Ketone bodies, the products of fat metabolism, are a source of energy for the brain and are available even when glucose supplies are inadequate (such as with severe carbohydrate deprivation) or its metabolism is faulty (as it is in Alzheimer's disease). This phase I/II randomized clinical trial examined the feasibility of using a modified Atkins diet (MAD) to induce ketogenesis in persons with mild cognitive impairment (MCI) or early AD, and the effect of this diet on memory and other clinical outcomes. In the first 2.5 years of active recruitment, only 27 eligible and willing patients enrolled. After extensive assessment and education, they and their study partners were randomly assigned for 12 weeks to either the MAD or the National Institute on Aging (NIA) recommended diet for seniors. As of April 2018, 9 patients in the MAD arm and 5 in the NIA arm have completed the trial. In spite of extensive teaching, coaching, and monitoring, adherence to both diets was only fair. Among those in the MAD arm who generated at least trace amounts of urinary ketones, there was a large (effect size = 0.53) and statistically significant (p = 0.03) increase in Memory Composite Score between the baseline and week-6 assessment. MAD participants also reported increased energy between baseline and week-6 assessment. Despite challenges to implementing this trial, resulting in a small sample, our preliminary data suggest that the generation of even trace ketones might enhance episodic memory and patient-reported vitality in very early AD.
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Affiliation(s)
- Jason Brandt
- Department of Psychiatry & Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Alison Buchholz
- Department of Psychiatry & Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Bobbie Henry-Barron
- Institute for Clinical and Translational Research, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Diane Vizthum
- Institute for Clinical and Translational Research, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Dimitrios Avramopoulos
- Department of Psychiatry & Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Institute of Genetic Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mackenzie C Cervenka
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
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6
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McCrum LA, Watson S, McGowan L, McGuinness B, Cardwell C, Clarke M, Woodside JV, McKenna G. Development and feasibility of a tailored habit-based dietary intervention coupled with natural tooth replacement on the nutritional status of older patients. Pilot Feasibility Stud 2020; 6:120. [PMID: 32855815 PMCID: PMC7446197 DOI: 10.1186/s40814-020-00654-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 07/30/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Older adults suffering partial tooth loss may need additional intervention strategies other than natural tooth replacement alone to improve their nutritional status. This study aimed to design and develop a habit-based tailored dietary intervention and to assess the feasibility and acceptability of the intervention, in conjunction with natural tooth replacement, amongst partially dentate older adults. METHODS The design and development of the dietary intervention (phase 1) consisted of analysis of the target population's dietary intake and qualitative research through focus groups with community-dwelling older adults (aged 65 years and over). The dietary intervention consisted of forming three healthy dietary habits around fruits and vegetables, wholegrains and healthy proteins. Feasibility of the intervention was then tested amongst older adults who had recently completed dental treatment for natural tooth replacement in a small non-randomised single arm study (phase 2). The principal feasibility outcome was the usability and acceptability of the intervention which was measured using evaluation questionnaires and by conducting post-intervention semi-structured interviews. Supporting outcomes consisted of feasibility of screening procedures, recruitment strategies and retention/attrition rates as well as the participant's compliance to the intervention assessed through self-monitoring tracking sheets. RESULTS Twenty-one older adults (mean [SD] age 72.1 [10.4].) took part in one of four focus group discussions (phase 1). Twelve themes related to barriers (e.g. oral health, appetite) and facilitators (e.g. nutritional knowledge, retirement) of healthy eating guided intervention development, as did a further five themes when asked for direct intervention feedback. Nine older adult participants (mean [SD] age 72.5[9.7]) were recruited into the feasibility study (phase 2) where eight themes were identified from feedback interview discussions. The principal outcome measures identified intervention feasibility as participants considered the intervention acceptable and useable as both the evaluation questionnaire and qualitative interview results were overwhelmingly positive. As a supporting outcome measure, strong intervention compliance was also achieved. Screening procedures were accepted but additional recruitment strategies (e.g. incorporation of home study visits or recruitment via posters advertisement) may benefit future study enrolment and retention. CONCLUSION Phase 1 and phase 2 findings have allowed for an iterative, user-driven intervention to be developed and refined for a randomised control study to evaluate the intervention's effectiveness. TRIAL REGISTRATION ISRCTN66118345.
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Affiliation(s)
- Leigh-Ann McCrum
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Institute of Clinical Science Block B, Belfast, BT12 6BJ UK
| | - Sinead Watson
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Institute of Clinical Science Block B, Belfast, BT12 6BJ UK
| | - Laura McGowan
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Institute of Clinical Science Block B, Belfast, BT12 6BJ UK
- Institute for Global Food Security, Queen’s University Belfast, Belfast, BT9 5BN UK
| | - Bernadette McGuinness
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Institute of Clinical Science Block B, Belfast, BT12 6BJ UK
| | - Christopher Cardwell
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Institute of Clinical Science Block B, Belfast, BT12 6BJ UK
| | - Mike Clarke
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Institute of Clinical Science Block B, Belfast, BT12 6BJ UK
| | - Jayne V. Woodside
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Institute of Clinical Science Block B, Belfast, BT12 6BJ UK
- Institute for Global Food Security, Queen’s University Belfast, Belfast, BT9 5BN UK
| | - Gerry McKenna
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Institute of Clinical Science Block B, Belfast, BT12 6BJ UK
- Centre for Dentistry, Queen’s University Belfast, Belfast, BT12 6BP UK
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Plante TB, Gleason KT, Miller HN, Charleston J, McArthur K, Himmelfarb CD, Lazo M, Ford DE, Miller ER, Appel LJ, Juraschek SP. Recruitment of trial participants through electronic medical record patient portal messaging: A pilot study. Clin Trials 2019; 17:30-38. [PMID: 31581836 DOI: 10.1177/1740774519873657] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND/AIM Cost-efficient methods are essential for successful participant recruitment in clinical trials. Patient portal messages are an emerging means of recruiting potentially eligible patients into trials. We assessed the response rate and complaint rate from direct-to-patient, targeted recruitment through patient portals of an electronic medical record for a clinical trial, and compared response rates by differences in message content. METHODS The Study to Understand Fall Reduction and Vitamin D in You (STURDY) trial is a National Institutes of Health-sponsored, community-based study of vitamin D supplementation for fall prevention in older adults conducted at Johns Hopkins. Potential participants were identified using the Epic electronic medical record at the Johns Hopkins Health System based on age (≥70 years), ZIP code (30-mile radius of study site), and prior activation of a patient portal account. We prepared a shorter message and a longer message. Both had basic information about study participation, but the longer message also contained information about the significance of the study and a personal invitation from the STURDY principal investigator. The Hopkins Institutional Review Board did not require prior consent from the patient or their providers. We calculated the response rate and tracked the number of complaints and requests for removal from future messages. We also determined response rate according to message content. RESULTS Of the 5.5 million individuals receiving care at the Johns Hopkins Health System, a sample of 6896 met our inclusion criteria and were sent one patient portal recruitment message between 6 April 2017 and 3 August 2017. Assessment of enrollment by this method ended on 1 December 2017. There were 116 patients who expressed interest in the study (response rate: 1.7%). Twelve (0.2%) recipients were randomized. There were two complaints (0.03%) and one request to unsubscribe from future recruitment messages (0.01%). Response rate was higher with the longer message than the shorter message (2.1% vs 1.2%; p = 0.005). CONCLUSION Patient portal messages inviting seniors to participate in a randomized controlled trial resulted in a response rate similar to commercial email marketing and resulted in very few complaints or opt-out requests. Furthermore, a longer message with more content enhanced response rate. Recruitment through patient portals might be an effective strategy to enroll trial participants.
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Affiliation(s)
- Timothy B Plante
- Department of Medicine, Larner College of Medicine, The University of Vermont, Burlington, VT, USA
| | - Kelly T Gleason
- Johns Hopkins University School of Nursing, Baltimore, MD, USA
| | - Hailey N Miller
- Johns Hopkins University School of Nursing, Baltimore, MD, USA
| | - Jeanne Charleston
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | | | - Mariana Lazo
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Daniel E Ford
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Edgar R Miller
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Lawrence J Appel
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Stephen P Juraschek
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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Chatters R, Newbould L, Sprange K, Hind D, Mountain G, Shortland K, Powell L, Gossage-Worrall R, Chater T, Keetharuth A, Lee E, Woods B. Recruitment of older adults to three preventative lifestyle improvement studies. Trials 2018; 19:121. [PMID: 29458392 PMCID: PMC5819193 DOI: 10.1186/s13063-018-2482-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 01/18/2018] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Recruiting isolated older adults to clinical trials is complex, time-consuming and difficult. Previous studies have suggested querying existing databases to identify appropriate potential participants. We aim to compare recruitment techniques (general practitioner (GP) mail-outs, community engagement and clinician referrals) used in three randomised controlled trial (RCT) studies assessing the feasibility or effectiveness of two preventative interventions in isolated older adults (the Lifestyle Matters and Putting Life In Years interventions). METHODS During the three studies (the Lifestyle Matters feasibility study, the Lifestyle Matters RCT, the Putting Life In Years RCT) data were collected about how participants were recruited. The number of letters sent by GP surgeries for each study was recorded. In the Lifestyle Matters RCT, we qualitatively interviewed participants and intervention facilitators at 6 months post randomisation to seek their thoughts on the recruitment process. RESULTS Referrals were planned to be the main source of recruitment in the Lifestyle Matters feasibility study, but due to a lack of engagement from district nurses, community engagement was the main source of recruitment. District nurse referrals and community engagement were also utilised in the Lifestyle Matters and Putting Life In Years RCTs; both mechanisms yielded few participants. GP mail-outs were the main source of recruitment in both the RCTs, but of those contacted, recruiting yield was low (< 3%). Facilitators of the Lifestyle Matters intervention questioned whether the most appropriate individuals had been recruited. Participants recommended that direct contact with health professionals would be the most beneficial way to recruit. CONCLUSIONS Recruitment to the Lifestyle Matters RCT did not mirror recruitment to the feasibility study of the same intervention. Direct district nurse referrals were not effective at recruiting participants. The majority of participants were recruited via GP mail-outs, which may have led to isolated individuals not being recruited to the trials. Further research is required into alternative recruitment techniques, including respondent-driven sampling plus mechanisms which will promote health care professionals to recruit vulnerable populations to research. TRIAL REGISTRATION International Standard Randomised Controlled Trial Registry, ID: ISRCTN28645428 (Putting Life In Years RCT). Registered on 11 April 2012; International Standard Randomised Controlled Trial Registry, ID: ISRCTN67209155 (Lifestyle Matters RCT). Registered on 22 March 2012; ClinicalTrials.gov , ID: NCT03054311 (Lifestyle Matters feasibility study). Registered retrospectively on 19 January 2017.
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Affiliation(s)
- Robin Chatters
- School of Health and Related Research, The University of Sheffield, Regent Court, Regent Street, Sheffield, S1 4DA UK
| | - Louise Newbould
- Research Fellow Mental Health and Addiction Research Group Department of Health Sciences ARRC Building University of York, Heslington, York YO10 5DD UK
| | - Kirsty Sprange
- Faculty of Medicine and Health Sciences, Queen’s Medical Centre, Nottingham, NG7 2UH UK
| | - Daniel Hind
- School of Health and Related Research, The University of Sheffield, Regent Court, Regent Street, Sheffield, S1 4DA UK
| | - Gail Mountain
- School of Health and Related Research, The University of Sheffield, Regent Court, Regent Street, Sheffield, S1 4DA UK
| | - Katy Shortland
- Sheffield NIHR Clinical Research Facility, O Floor, Royal Hallamshire Hospital, Glossop Road, Sheffield, S10 2JF UK
| | - Lauren Powell
- School of Health and Related Research, The University of Sheffield, Regent Court, Regent Street, Sheffield, S1 4DA UK
| | - Rebecca Gossage-Worrall
- School of Health and Related Research, The University of Sheffield, Regent Court, Regent Street, Sheffield, S1 4DA UK
| | - Tim Chater
- School of Health and Related Research, The University of Sheffield, Regent Court, Regent Street, Sheffield, S1 4DA UK
| | - Anju Keetharuth
- School of Health and Related Research, The University of Sheffield, Regent Court, Regent Street, Sheffield, S1 4DA UK
| | - Ellen Lee
- School of Health and Related Research, The University of Sheffield, Regent Court, Regent Street, Sheffield, S1 4DA UK
| | - Bob Woods
- DSDC Wales, Bangor University, Normal Site, Bangor, LL57 2PZ UK
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Wacher NH, Reyes-Sánchez M, Vargas-Sánchez HR, Gamiochipi-Cano M, Rascón-Pacheco RA, Gómez-Díaz RA, Doubova SV, Valladares-Salgado A, Sánchez-Becerra MC, Méndez-Padrón A, Valdez-González LA, Mondragón-González R, Cruz M, Salinas-Martinez AM, Garza-Sagástegui MG, Hernández-Rubí J, González-Hermosillo A, Borja-Aburto VH. Stepwise strategies to successfully recruit diabetes patients in a large research study in Mexican population. Prim Care Diabetes 2017; 11:297-304. [PMID: 28343902 DOI: 10.1016/j.pcd.2017.02.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 02/24/2017] [Accepted: 02/26/2017] [Indexed: 11/24/2022]
Abstract
AIMS Describe stepwise strategies (electronic chart review, patient preselection, call-center, personnel dedicated to recruitment) for the successful recruitment of >5000 type 2 diabetes patients in four months. METHODS Twenty-five family medicine clinics from Mexico City and the State of Mexico participated: 13 usual care, 6 specialized diabetes care and 6 chronic disease care. Appointments were scheduled from 11/3/2015 to 3/31/2016. Phone calls were generated automatically from an electronic database. A telephone questionnaire verified inclusion criteria, and scheduled an appointment, with a daily report of appointments, patient attendance, acceptance rate, and questionnaire completeness. Another recruitment log reviewed samples collected. Absolute number (percentage) of patients are reported. Means and standard deviations were estimated for continuous variables, χ2 test and independent "t" tests were used. OR and 95% CI were estimated. RESULTS 14,358 appointments were scheduled, 9146 (63.7%) attended their appointment: 5710 (62.4%) fulfilled inclusion criteria and 5244 agreed to participate (91.8% acceptance). Those accepting participation were more likely women, younger and with longer disease duration (p<0.05). The cost of the call-center service was $3,010,000.00 Mexican pesos (∼$31.70 USD per recruited patient). CONCLUSIONS Stepwise strategies recruit a high number of patients in a short time. Call centers offer a low cost per patient.
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Affiliation(s)
- Niels H Wacher
- Unidad de Investigación en Epidemiología Clínica, UMAE Hospital de Especialidades, Centro Médico Siglo XXI, IMSS, Mexico City, Mexico.
| | - Mario Reyes-Sánchez
- División de Medicina Familiar, Unidad de Atención Primaria, IMSS, Mexico City, Mexico
| | | | - Mireya Gamiochipi-Cano
- Unidad de Investigación en Epidemiología Clínica, UMAE Hospital de Especialidades, Centro Médico Siglo XXI, IMSS, Mexico City, Mexico
| | | | - Rita A Gómez-Díaz
- Unidad de Investigación en Epidemiología Clínica, UMAE Hospital de Especialidades, Centro Médico Siglo XXI, IMSS, Mexico City, Mexico
| | - Svetlana V Doubova
- Unidad de Investigación en Epidemiología y Servicios de Salud, Centro Médico Siglo XXI, IMSS, Mexico City, Mexico
| | - Adán Valladares-Salgado
- Unidad de Investigación Médica en Bioquímica, UMAE Hospital de Especialidades, Centro Médico Siglo XXI, IMSS, Mexico City, Mexico
| | - Martha Catalina Sánchez-Becerra
- Unidad de Investigación Médica en Bioquímica, UMAE Hospital de Especialidades, Centro Médico Siglo XXI, IMSS, Mexico City, Mexico
| | - Araceli Méndez-Padrón
- Unidad de Investigación Médica en Bioquímica, UMAE Hospital de Especialidades, Centro Médico Siglo XXI, IMSS, Mexico City, Mexico
| | - Leticia A Valdez-González
- Unidad de Investigación en Epidemiología Clínica, UMAE Hospital de Especialidades, Centro Médico Siglo XXI, IMSS, Mexico City, Mexico
| | - Rafael Mondragón-González
- Unidad de Investigación en Epidemiología Clínica, UMAE Hospital de Especialidades, Centro Médico Siglo XXI, IMSS, Mexico City, Mexico
| | - Miguel Cruz
- Unidad de Investigación Médica en Bioquímica, UMAE Hospital de Especialidades, Centro Médico Siglo XXI, IMSS, Mexico City, Mexico
| | | | | | - Jaime Hernández-Rubí
- Departamento de Ingeniería en Sistemas Computacionales y Automatización, Instituto de Investigaciones en Matemáticas Aplicadas y en Sistemas, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Arturo González-Hermosillo
- Departamento de Ingeniería en Sistemas Computacionales y Automatización, Instituto de Investigaciones en Matemáticas Aplicadas y en Sistemas, Universidad Nacional Autónoma de México, Mexico City, Mexico
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Toddenroth D, Sivagnanasundaram J, Prokosch HU, Ganslandt T. Concept and implementation of a study dashboard module for a continuous monitoring of trial recruitment and documentation. J Biomed Inform 2016; 64:222-231. [PMID: 27769890 DOI: 10.1016/j.jbi.2016.10.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 08/14/2016] [Accepted: 10/17/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND The difficulty of managing patient recruitment and documentation for clinical trials prompts a demand for instruments for closely monitoring these critical but unpredictable processes. Increasingly adopted Electronic Data Capture (EDC) applications provide novel opportunities to reutilize stored information for an efficient management of traceable trial workflows. In related clinical and administrative settings, so-called digital dashboards that continuously visualize time-dependent parameters have recently met a growing acceptance. To investigate the technical feasibility of a study dashboard for monitoring the progress of patient recruitment and trial documentation, we set out to develop a propositional prototype in the form of a separate software module. METHODS After narrowing down functional requirements in semi-structured interviews with study coordinators, we analyzed available interfaces of a locally deployed EDC application, and designed the prototypical study dashboard based on previous findings. The module thereby leveraged a standardized export format in order to extract and import relevant trial data into a clinical data warehouse. Web-based reporting tools then facilitated the definition of diverse views, including diagrams of the progress of patient accrual and form completion at different granularity levels. To estimate the utility of the dashboard and its compatibility with current workflows, we interviewed study coordinators after a demonstration of sample outputs from ongoing trials. RESULTS The employed tools promoted a rapid development. Displays of the implemented dashboard are organized around an entry page that integrates key metrics for available studies, and which links to more detailed information such as study-specific enrollment per center. The interviewed experts commented that the included graphical summaries appeared suitable for detecting that something was generally amiss, although practical remedies would mostly depend on additional information such as access to the original patient-specific data. The dependency on a separate application was seen as a downside. Interestingly, the prospective users warned that in some situations knowledge of specific accrual statistics might undermine blinding in a subtle yet intricate fashion, so ignorance of certain patient features was seen as sometimes preferable for reproducibility. DISCUSSION Our proposed study dashboard graphically recaps key progress indicators of patient accrual and trial documentation. The modular implementation illustrates the technical feasibility of the approach. The use of a study dashboard might introduce certain technical requirements as well as subtle interpretative complexities, which may have to be weighed against potential efficiency gains.
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Affiliation(s)
- Dennis Toddenroth
- Chair of Medical Informatics, Friedrich-Alexander-University Erlangen-Nuremberg, Wetterkreuz 13, 91058 Erlangen-Tennenlohe, Germany.
| | - Janakan Sivagnanasundaram
- Chair of Medical Informatics, Friedrich-Alexander-University Erlangen-Nuremberg, Wetterkreuz 13, 91058 Erlangen-Tennenlohe, Germany.
| | - Hans-Ulrich Prokosch
- Chair of Medical Informatics, Friedrich-Alexander-University Erlangen-Nuremberg, Wetterkreuz 13, 91058 Erlangen-Tennenlohe, Germany; Medical Center for Communication and Information Technology, University Hospital Erlangen-Nuremberg, Glückstr. 11, 91054 Erlangen, Germany.
| | - Thomas Ganslandt
- Medical Center for Communication and Information Technology, University Hospital Erlangen-Nuremberg, Glückstr. 11, 91054 Erlangen, Germany.
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Abstract
BACKGROUND Depressive illness is common in old age. Prevalence in the community of case level depression is around 15% and milder forms of depression are more common. It causes significant distress and disability. The number of people over the age of 60 years is expected to double by 2050 and so interventions for this often long-term and recurrent condition are increasingly important. The causes of late-life depression differ from depression in younger adults and so it is appropriate to study it separately.This is an update of a Cochrane review first published in 2012. OBJECTIVES To examine the efficacy of antidepressants and psychological therapies in preventing the relapse and recurrence of depression in older people. SEARCH METHODS We performed a search of the Cochrane Common Mental Disorders Group's specialised register (the CCMDCTR) to 13 July 2015. The CCMDCTR includes relevant randomised controlled trials (RCTs) from the following bibliographic databases: The Cochrane Library (all years), MEDLINE (1950 to date), EMBASE (1974 to date), and PsycINFO (1967 to date). We also conducted a cited reference search on 13 July 2015 of the Web of Science for citations of primary reports of included studies. SELECTION CRITERIA Both review authors independently selected studies. We included RCTs involving people aged 60 years and over successfully treated for an episode of depression and randomised to receive continuation and maintenance treatment with antidepressants, psychological therapies, or a combination. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data. The primary outcome for benefit was recurrence rate of depression (reaching a cut-off on any depression rating scale) at 12 months and the primary outcome for harm was drop-outs at 12 months. Secondary outcomes included relapse/recurrence rates at other time points, global impression of change, social functioning, and deaths. We performed meta-analysis using risk ratio (RR) for dichotomous outcomes and mean difference (MD) for continuous outcomes, with 95% confidence intervals (CI). MAIN RESULTS This update identified no further trials. Seven studies from the previous review met the inclusion criteria (803 participants). Six compared antidepressant medication with placebo; two involved psychological therapies. There was marked heterogeneity between the studies.Comparing antidepressants with placebo on the primary outcome for benefit, there was a statistically significant difference favouring antidepressants in reducing recurrence compared with placebo at 12 months with a GRADE rating of low for quality of evidence (three RCTs, n = 247, RR 0.67, 95% CI 0.54 to 0.82; number needed to treat for an additional beneficial outcome (NNTB) 5). Comparing antidepressants with placebo on the primary outcome for harms, there was no difference in drop-out rates at 12 months' follow-up, with a GRADE rating of low.There was no significant difference between psychological treatment and antidepressant in recurrence rates at 12 months (one RCT, n = 53) or between combination treatment and antidepressant alone at 12 months. AUTHORS' CONCLUSIONS This updated Cochrane review supports the findings of the original 2012 review. The long-term benefits and harm of continuing antidepressant medication in the prevention of recurrence of depression in older people are not clear and no firm treatment recommendations can be made on the basis of this review. Continuing antidepressant medication for 12 months appears to be helpful with no increased harms; however, this was based on only three small studies, relatively few participants, use of a range of antidepressant classes, and clinically heterogeneous populations. Comparisons at other time points did not reach statistical significance.Data on psychological therapies and combined treatments were too limited to draw any conclusions on benefits and harms.The quality of the evidence used in reaching these conclusions was low and the review does not, therefore, offer clear guidance to clinicians and patients on best practice and matching interventions to particular patient characteristics.Of note, we identified no new studies that evaluated pharmacological or psychological interventions in the continuation and maintenance treatment of depression in older people. We are aware of studies conducted since the previous review that included both older people and adults under the age of 65 years, but these fall outside of the remit of this review. We believe that there remains a need for studies solely recruiting older people, particularly the 'older old' with comorbid medical problems. However, these studies are likely to be challenging to conduct and may not, so far, have been prioritised by funders.
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Affiliation(s)
- Philip Wilkinson
- University of Oxford, Warneford HospitalDepartment of PsychiatryOxfordUKOX3 7JX
- Fulbrook Centre, Churchill HospitalOxford Health NHS Foundation TrustOxfordUKOX3 7JU
| | - Zehanah Izmeth
- John Radcliffe HospitalOxford University Hospitals NHS Foundation TrustOxfordUK
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12
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Copeland RJ, Horspool K, Humphreys L, Scott E. Recruiting to a large-scale physical activity randomised controlled trial - experiences with the gift of hindsight. Trials 2016; 17:104. [PMID: 26908117 PMCID: PMC4765210 DOI: 10.1186/s13063-016-1229-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Accepted: 02/11/2016] [Indexed: 11/10/2022] Open
Abstract
Background Recruitment issues continue to impact a large number of trials. Sharing recruitment information is vital to supporting researchers to accurately predict recruitment and to manage the risk of poor recruitment during study design and implementation. The purpose of this article is to build on the knowledge available to researchers on recruiting to community-based trials. Methods A critical commentary of the recruitment challenges encountered during the Booster Study, a randomised controlled trial in which researchers investigated the effectiveness of a motivational interviewing style intervention on the maintenance of physical activity. An overview of recruitment is provided, as well as strategies employed to recruit prospective participants and possible barriers to recruitment. Results Two hundred eighty-two people, 47 % of the original target, were recruited through mail-outs, with secondary recruitment pathways yielding no additional participants. The research team encountered problems with recontacting interested participants and providing study materials in non-English languages. A lower response rate to the mail-out and a greater number of non-contactable participants in the full study than in the pilot study resulted in a smaller pool of eligible participants from the brief intervention eligible for recruitment into the randomised controlled trial. Conclusions Despite using widely accepted recruitment strategies and incorporating new recruitment tactics in response to challenges, the Booster Study investigators failed to randomise a sufficient number of participants. Recruitment in trials of community-based behavioural interventions may have different challenges than trials based on clinical or primary care pathways. Specific challenges posed by the complexity of the study design and problems with staffing and resources were exacerbated by the need to revise upwards the number of mailed invitations as a result of the pilot study. Researchers should ensure study design facilitates recruitment and consider the implications of changing recruitment on the operational aspects of the trial. Where possible, the impact of new strategies should be measured, and recruitment successes and challenges should be shared with those planning similar studies. ISRCTN56495859 (registered on 12 February 2009); NCT00836459 (registered on 3 February 2009).
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Affiliation(s)
- Robert J Copeland
- Centre for Sport and Exercise Science, Sheffield Hallam University, Collegiate Campus, Sheffield, S10 2BP, UK.
| | - Kimberley Horspool
- School of Health and Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK.
| | - Liam Humphreys
- Centre for Sport and Exercise Science, Sheffield Hallam University, Collegiate Campus, Sheffield, S10 2BP, UK.
| | - Emma Scott
- Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK.
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Samus QM, Amjad H, Johnston D, Black BS, Bartels SJ, Lyketsos CG. A Multipronged, Adaptive Approach for the Recruitment of Diverse Community-Residing Elders with Memory Impairment: The MIND at Home Experience. Am J Geriatr Psychiatry 2015; 23:698-708. [PMID: 25771267 PMCID: PMC5226267 DOI: 10.1016/j.jagp.2015.01.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Revised: 01/21/2015] [Accepted: 01/27/2015] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To provide a critical review of a multipronged recruitment approach used to identify, recruit, and enroll a diverse community-based sample of persons with memory disorders into an 18-month randomized, controlled dementia care coordination trial. METHODS Descriptive analysis of a recruitment approach comprised five strategies: community liaison ("gatekeepers") method, letters sent from trusted community organizations, display and distribution of study materials in the community, research registries, and general community outreach and engagement activities. Participants were 55 community organizations and 63 staff of community organizations in Baltimore, Maryland. Participant referral sources, eligibility, enrollment status, demographics, and loss to follow-up were tracked in a relational access database. RESULTS In total, 1,275 referrals were received and 303 socioeconomically, cognitively, and racially diverse community-dwelling persons with cognitive disorders were enrolled. Most referrals came from letters sent from community organizations directly to clients on the study's behalf (39%) and referrals from community liaison organizations (29%). African American/black enrollees were most likely to come from community liaison organizations. CONCLUSION A multipronged, adaptive approach led to the successful recruitment of diverse community-residing elders with memory impairment for an intervention trial. Key factors for success included using a range of evidence-supported outreach strategies, forming key strategic community partnerships, seeking regular stakeholder input through all research phases, and obtaining "buy-in" from community stakeholders by aligning study objectives with perceived unmet community needs.
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Affiliation(s)
- Quincy M Samus
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins Bayview, School of Medicine, The Johns Hopkins University, Baltimore, MD.
| | - Halima Amjad
- Department of Gerontology and Geriatric Medicine, Johns Hopkins Bayview, School of Medicine, The Johns Hopkins University, Baltimore, MD
| | - Deirdre Johnston
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins Bayview, School of Medicine, The Johns Hopkins University, Baltimore, MD
| | - Betty S Black
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins Bayview, School of Medicine, The Johns Hopkins University, Baltimore, MD
| | - Stephen J Bartels
- Dartmouth Centers for Health and Aging, Community & Family Medicine, The Dartmouth Medical School, Lebanon, NH
| | - Constantine G Lyketsos
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins Bayview, School of Medicine, The Johns Hopkins University, Baltimore, MD
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Piantadosi C, Chapman IM, Naganathan V, Hunter P, Cameron ID, Visvanathan R. Recruiting older people at nutritional risk for clinical trials: what have we learned? BMC Res Notes 2015; 8:151. [PMID: 25884358 PMCID: PMC4415225 DOI: 10.1186/s13104-015-1113-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Accepted: 03/31/2015] [Indexed: 11/10/2022] Open
Abstract
Background The difficulty of recruiting older people to clinical trials is well described, but there is limited information about effective ways to screen and recruit older people into trials, and the reasons for their reluctance to enrol. This paper examines recruitment efforts for a community-based health intervention study that targeted older adults. Methods One year randomized control trial. Undernourished men and women, aged ≥ 65 years and living independently in the community were recruited in three Australian states. Participants were allocated to either oral testosterone undecanoate and high calorie oral nutritional supplement or placebo medication and low calorie oral nutritional supplementation. Hospital admissions, functional status, nutritional health, muscle strength, and other variables were assessed. Results 4023 potential participants were identified and 767 were screened by a variety of methods: hospital note screening, referrals from geriatric health services, advertising and media segments/appearances. 53 participants (7% of total screened) were recruited. The majority of potentially eligible participants declined participation in the trial after reading the information sheet. Media was the more successful method of recruiting, whereas contacting people identified by screening a large number of hospital records was not successful in recruiting any participants. Conclusion Recruitment of frail and older participants is difficult and multiple strategies are required to facilitate participation. Trial registration Australian Clinical Trial Registry: ACTRN 12610000356066 date registered 4/5/2010
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Affiliation(s)
- Cynthia Piantadosi
- Discipline of Medicine, University of Adelaide, Adelaide, SA, 5000, Australia.
| | - Ian M Chapman
- Discipline of Medicine, University of Adelaide, Adelaide, SA, 5000, Australia.
| | - Vasi Naganathan
- Centre for Education and Research on Ageing, University of Sydney, Concord Hospital, Concord, NSW, 2139, Australia.
| | - Peter Hunter
- Alfred Health, Caulfield Hospital, 260, Caulfield, VIC, 3162, Australia.
| | - Ian D Cameron
- John Walsh Centre for Rehabilitation Research, Sydney Medical School, University of Sydney, Sydney, NSW, 2065, Australia.
| | - Renuka Visvanathan
- Discipline of Medicine, University of Adelaide, Adelaide, SA, 5000, Australia. .,Adelaide Geriatrics Training and Research with Aged Care (GTRAC) Centre, School of Medicine, University of Adelaide, Paradise, SA, 5075, Australia. .,Aged and Extended Care Services, The Queen Elizabeth Hospital, Woodville South, SA, 5011, Australia.
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Hind D, Mountain G, Gossage-Worrall R, Walters SJ, Duncan R, Newbould L, Rex S, Jones C, Bowling A, Cattan M, Cairns A, Cooper C, Goyder E, Edwards RT. Putting Life in Years (PLINY): a randomised controlled trial and mixed-methods process evaluation of a telephone friendship intervention to improve mental well-being in independently living older people. PUBLIC HEALTH RESEARCH 2014. [DOI: 10.3310/phr02070] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundSocial isolation in older adults is associated with morbidity. Evaluating interventions to promote social engagement is a research priority.MethodsA parallel-group randomised controlled trial was planned to evaluate whether telephone friendship (TF) improves the well-being of independently living older people. An internal pilot aimed to recruit 68 participants by 30 September 2012, with 80% retained at 6 months. Randomisation was web based and only analysts were blind to allocation. A service provider was contracted to train 10 volunteer facilitators by 1 April 2012 and 10 more by 1 September 2012. Participants were aged > 74 years with good cognitive function and living independently in an urban community. The intervention arm of the trial consisted of manualised TF with standardised training: (1) one-to-one befriending (10- to 20-minute calls once per week for up to 6 weeks made by volunteer facilitators) followed by (2) TF groups of six participants (1-hour teleconferences once per week for 12 weeks facilitated by the same volunteer). Friendship groups aimed to enhance social support and increase opportunities for social interaction to maintain well-being. This was compared with usual health and social care provision. The primary clinical outcome was the Short Form questionnaire-36 items (SF-36) mental health dimension score at 6 months post randomisation. Qualitative research assessing intervention acceptability (participants) and implementation issues (facilitators) and an intervention fidelity assessment were also carried out. Intervention implementation was documented through e-mails, meeting minutes and field notes. Acceptability was assessed through framework analysis of semistructured interviews. Two researchers coded audio recordings of telephone discussions for fidelity using a specially designed checklist.ResultsIn total, 157 people were randomised to the TF group (n = 78) or the control group (n = 79). Pilot recruitment and retention targets were met. Ten volunteers were trained by 1 September 2012; after volunteer attrition, three out of the 10 volunteers delivered the group intervention. In total, 50 out of the 78 TF participants did not receive the intervention and the trial was closed early. A total of 56 people contributed primary outcome data from the TF (n = 26) and control (n = 30) arms. The mean difference in SF-36 mental health score was 9.5 (95% confidence interval 4.5 to 14.5) after adjusting for age, sex and baseline score. Participants who were interviewed (n = 19) generally declared that the intervention was acceptable. Participant dissatisfaction with closure of the groups was reported (n = 4). Dissatisfaction focused on lack of face-to-face contact and shared interests or attitudes. Larger groups experienced better cohesion. Interviewed volunteers (n = 3) expressed a lack of clarity about procedures, anxieties about managing group dynamics and a lack of confidence in the training and in their management and found scheduling calls challenging. Training was 91–95% adherent with the checklist (39 items; three groups). Intervention fidelity ranged from 30.2% to 52.1% (28–41 items; three groups, three time points), indicating that groups were not facilitated in line with training, namely with regard to the setting of ground rules, the maintenance of confidentiality and facilitating contact between participants.ConclusionsAlthough the trial was unsuccessful for a range of logistical reasons, the experience gained is of value for the design and conduct of future trials. Participant recruitment and retention were feasible. Small voluntary sector organisations may be unable to recruit, train and retain adequate numbers of volunteers to implement new services at scale over a short time scale. Such risks might be mitigated by multicentre trials using multiple providers and specialists to recruit and manage volunteers.Trial registrationCurrent Controlled Trials ISRCTN28645428.FundingThis project was funded by the NIHR Public Health Research programme and will be published in full inPublic Health Research; Vol. 2, No. 7. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Daniel Hind
- Sheffield Clinical Trials Research Unit, University of Sheffield, Sheffield, UK
| | - Gail Mountain
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | | | - Stephen J Walters
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Rosie Duncan
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Louise Newbould
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Saleema Rex
- Sheffield Clinical Trials Research Unit, University of Sheffield, Sheffield, UK
| | - Carys Jones
- Institute of Medical and Social Care Research, Bangor University, Bangor, UK
| | - Ann Bowling
- Facility of Health Sciences, University of Southampton, Southampton, UK
| | - Mima Cattan
- Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
| | | | - Cindy Cooper
- Sheffield Clinical Trials Research Unit, University of Sheffield, Sheffield, UK
| | - Elizabeth Goyder
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
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Ricci NA, Aratani MC, Caovilla HH, Ganança FF. Challenges in conducting a randomized clinical trial of older people with chronic dizziness: before, during and after vestibular rehabilitation. Contemp Clin Trials 2014; 40:26-34. [PMID: 25460341 DOI: 10.1016/j.cct.2014.11.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Revised: 10/31/2014] [Accepted: 11/01/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE This study aims to describe the process of conducting a randomized clinical trial of elderly with chronic dizziness subjected to vestibular rehabilitation (VR) and to verify its effectiveness on dizziness intensity. METHODS Older adults (≥65 years) with chronic dizziness from vestibular disorders referred to VR were enrolled to the trial. The control group (n=40) was submitted to the Cawthorne & Cooksey protocol and the experimental group (n=42) to the modified Cawthorne & Cooksey protocol which included multiple components. Protocols were performed during individual 50-minute sessions, twice-weekly, for eight weeks. Main measures were: recruitment data (refusal and eligibility), baseline characteristics, dropout rate, session attendance, protocol adherence, adverse effects, exercise adaptation and follow-up events. The Visual Analog Scale (VAS) was used to measure dizziness intensity. RESULTS 144 elderly were referred to VR, 26.4% declined to participate and 16.7% were ineligible. There were 51 session non-attendances, with disease being the most frequent reason. Regardless of VR protocol, VAS dizziness intensity diminished along sessions (p<0.001). 88.6% of the participants reported improvement after treatment, and 22.9% mentioned an increase in dizziness on follow-up. Home exercises were no longer being performed by 21.4% of the subjects after 3 months from discharge. The final dropout rate was 14.6%. There were no differences between VR protocols on recruitment, dropout, session's attendance, adherence to protocol and treatment effects. CONCLUSIONS Our results revealed many challenges in conducting a rehabilitation trial with an elderly sample. The VR protocols showed to be feasible and suitable to reduce dizziness in older adults.
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Affiliation(s)
- Natalia A Ricci
- Department of Otorhinolaryngology and Head & Neck Surgery, Division of Otoneurology, Federal University of São Paulo (UNIFESP), São Paulo, Brazil; Masters and Doctoral Programs in Physical Therapy, City University of São Paulo (UNICID), São Paulo, Brazil.
| | - Mayra C Aratani
- Department of Otorhinolaryngology and Head & Neck Surgery, Division of Otoneurology, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Heloísa H Caovilla
- Department of Otorhinolaryngology and Head & Neck Surgery, Division of Otoneurology, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Fernando F Ganança
- Department of Otorhinolaryngology and Head & Neck Surgery, Division of Otoneurology, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
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Price E, Artz AS, Barnhart H, Sapp S, Chelune G, Ershler WB, Walston JD, Gordeuk VR, Berger NA, Reuben D, Prchal J, Rao SV, Roy CN, Supiano MA, Schrier SL, Cohen HJ. A prospective randomized wait list control trial of intravenous iron sucrose in older adults with unexplained anemia and serum ferritin 20-200 ng/mL. Blood Cells Mol Dis 2014; 53:221-30. [PMID: 25065855 DOI: 10.1016/j.bcmd.2014.06.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Accepted: 06/30/2014] [Indexed: 10/25/2022]
Abstract
Anemia is common in older persons and is associated with substantial morbidity and mortality. One third of anemic older adults have unexplained anemia of the elderly (UAE). We carried out a randomized, wait list control trial in outpatients with UAE and serum ferritin levels between 20 and 200 ng/mL. Intravenous iron sucrose was given as a 200-mg weekly dose for 5 weeks either immediately after enrollment (immediate intervention group) or following a 12-week wait list period (wait list control group). The primary outcome measure was changed in 6-minute walk test (6MWT) distances from baseline to 12 weeks between the two groups. Hematologic, physical, cognitive, and quality of life parameters were also assessed. The study was terminated early after 19 subjects enrolled. The distance walked in the 6MWT increased a mean 8.05±55.48 m in the immediate intervention group and decreased a mean 11.45±49.46 m in the wait list control group (p=0.443). The hemoglobin increased a mean 0.39±0.46 g/dL in the immediate intervention group and declined a mean 0.39±0.85 g/dL in the wait list control group (p=0.026). Thus, a subgroup of adults with UAE may respond to intravenous iron. Enrollment of subjects into this type of study remains challenging.
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Affiliation(s)
- Elizabeth Price
- Division of Pulmonary and Critical Care Medicine, 300 Pasteur Drive, Room H3143, MC 5236 Stanford, CA 94305, USA.
| | - Andrew S Artz
- University of Chicago, 5841 S Maryland Ave., Chicago, IL 60637, USA.
| | - Huiman Barnhart
- Duke Clinical Research Institute, PO Box 17969, Durham, NC 27715, USA.
| | - Shelly Sapp
- Duke University Medical Center, Durham, NC 27710, USA.
| | - Gordon Chelune
- Center for Alzheimer's Care, Imaging and Research, University of Utah, Dept. of Neurology, 650 Komas Drive, Salt Lake City, UT 84108, USA.
| | - William B Ershler
- Institute for Advanced Studies in Aging, 6400 Arlington Blvd., Falls Church, VA 22042, USA.
| | - Jeremy D Walston
- Johns Hopkins University School of Medicine, 5501 Hopkins Bayview Circle, Baltimore, MD 21224, USA.
| | - Victor R Gordeuk
- University of Illinois at Chicago, Clinical Science North Bldg., 820S Wood St., Chicago, IL 60612, USA.
| | - Nathan A Berger
- Case Western Reserve University, 10900 Euclid Ave., Cleveland, OH 44106, USA.
| | - David Reuben
- University of California, Los Angeles Medical Center, 10945 Le Conte Ave., Los Angeles, CA 90095, USA.
| | - Josef Prchal
- University of Utah School of Medicine, 30 North 1900 East, Salt Lake City, UT 84132, USA.
| | - Sunil V Rao
- Duke University Medical Center, Durham VA Medical Center, 508 Fulton Street, Durham, NC 27705, USA.
| | - Cindy N Roy
- Johns Hopkins University School of Medicine, 5501 Hopkins Bayview Circle, Baltimore, MD 21224, USA.
| | - Mark A Supiano
- University of Utah School of Medicine, 30 North 1900 East, Salt Lake City, UT 84132, USA.
| | | | - Harvey Jay Cohen
- Duke University Medical Center, Center for the Study of Aging, Box 3003, Durham, NC 27710, USA.
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Smorenburg AJ, Oosterman BJ, Grobbee DE, Bonten MJ, Roes KC. Effects of recruitment strategies and demographic factors on inclusion in a large scale vaccination trial in adults 65 years and older. Vaccine 2014; 32:2989-94. [DOI: 10.1016/j.vaccine.2014.03.081] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2012] [Revised: 02/25/2014] [Accepted: 03/26/2014] [Indexed: 11/15/2022]
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Mara LSD, Valente Filho JM, Ribeiro EP, Ulbrich AZ, Lineburger AA, Angarten V, Sties SW, Pacheco JA, Carvalho TD. Exercício intenso e suplementação de testosterona em portadores de insuficiência cardíaca. REV BRAS MED ESPORTE 2014. [DOI: 10.1590/1517-86922014200201600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUÇÃO: O sono é um estado natural e recorrente, no qual acontecem processos neurobiológicos importantes. A má qualidade do sono está diretamente A insuficiência cardíaca (IC) é uma síndrome com alterações neuroendócrinas, limitações funcionais associadas à baixa qualidade de vida. Há pouco conhecimento dos efeitos do exercício físico de alta intensidade e terapia de suplementação de testosterona (TST) em portadores de IC e hipotestosteronemia.OBJETIVO: Avaliar os efeitos do exercício de alta intensidade associado a TST na qualidade de vida e potência aeróbia destes pacientes.MÉTODOS: Dezenove pacientes portadores de IC (idade media, 58 ± 10 anos; fração de ejeção, 34 ± 8%) foram randomizados para o grupo exercício de alta intensidade (controle; n=9) e exercício de alta intensidade com suplementação hormonal (intervenção; n=10). Os Pacientes exercitaram-se (40 minutos, 90% do consumo máximo de oxigênio) três vezes semanalmente durante 12 semanas. O grupo intervenção recebeu testosterona na primeira e sexta semanas. Antes e após o período de estudo foram obtidas medidas da capacidade funcional e escores do Minnesota Living with Heart Failure Questionnaire.RESULTADOS: No intragrupo controle e intervenção, respectivamente, houve aumento do pico de consumo de oxigênio (12% vs. 15%; p CONCLUSÃO: Exercício de alta intensidade melhora a capacidade funcional e escores da QV após 12 semanas de tratamento.
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20
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Implementing a Prospective Study of Women Seeking Abortion in the United States: Understanding and Overcoming Barriers to Recruitment. Womens Health Issues 2014; 24:e115-23. [DOI: 10.1016/j.whi.2013.10.004] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Revised: 10/17/2013] [Accepted: 10/18/2013] [Indexed: 11/30/2022]
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21
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McLean C, Kerse N, Moyes SA, Ng T, Lin SYS, Peri K. Recruiting older people for research through general practice: the Brief Risk Identification Geriatric Health Tool trial. Australas J Ageing 2013; 33:257-63. [PMID: 24520915 DOI: 10.1111/ajag.12058] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIM To describe successful methods of recruitment and identify practice characteristics related to increased recruitment of older people for a randomised controlled trial. METHODS General practices in three regions of New Zealand and community-dwelling patients aged 75+ were recruited for the Brief Risk Identification Geriatric Health Tool trial. General practitioners (GPs) were faxed invitations with telephone follow-up. Reply-paid cards with telephone follow-up were used to invite older people. GP and practice characteristics were examined in relationship to recruitment rate. RESULTS During 2007-2008, 158 of 438 GPs (36%) in 60 of 116 practices approached (52%) were recruited. Regional variation was marked and 3893 of 8308 invited (49%) older people were recruited. The GP's length of time at the practice and training in New Zealand was associated with recruitment success. CONCLUSIONS Despite variability in practice recruitment, a reasonably large and representative sample of older people was recruited through general practices.
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Affiliation(s)
- Christine McLean
- Department of General Practice and Primary Health Care, School of Population Health, University of Auckland, Auckland, New Zealand
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22
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Marsh AP, Lovato LC, Glynn NW, Kennedy K, Castro C, Domanchuk K, McDavitt E, Rodate R, Marsiske M, McGloin J, Groessl EJ, Pahor M, Guralnik JM. Lifestyle interventions and independence for elders study: recruitment and baseline characteristics. J Gerontol A Biol Sci Med Sci 2013; 68:1549-58. [PMID: 23716501 DOI: 10.1093/gerona/glt064] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Recruitment of older adults into long-term clinical trials involving behavioral interventions is a significant challenge. The Lifestyle Interventions and Independence for Elders (LIFE) Study is a Phase 3 multicenter randomized controlled multisite trial, designed to compare the effects of a moderate-intensity physical activity program with a successful aging health education program on the incidence of major mobility disability (the inability to walk 400 m) in sedentary adults aged 70-89 years, who were at high risk for mobility disability (scoring ≤ 9 on the Short Physical Performance Battery) at baseline. METHODS Recruitment methods, yields, efficiency, and costs are described together with a summary of participant baseline characteristics. Yields were examined across levels of sex, race and ethnicity, and Short Physical Performance Battery, as well as by site. RESULTS The 21-month recruiting period resulted in 14,812 telephone screens; 1,635 participants were randomized (67.2% women, 21.0% minorities, 44.7% with Short Physical Performance Battery scores ≤ 7). Of the telephone-screened participants, 37.6% were excluded primarily because of regular participation in physical activity, health exclusions, or self-reported mobility disability. Direct mailing was the most productive recruitment strategy (59.5% of randomized participants). Recruitment costs were $840 per randomized participant. Yields differed by sex and Short Physical Performance Battery. We accrued 11% more participant follow-up time than expected during the recruitment period as a result of the accelerated recruitment rate. CONCLUSIONS The LIFE Study achieved all recruitment benchmarks. Bulk mailing is an efficient method for recruiting high-risk community-dwelling older persons (including minorities), from diverse geographic areas for this long-term behavioral trial.
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Affiliation(s)
- Anthony P Marsh
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC 27109-7868.
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Stout M, Tew GA, Doll H, Zwierska I, Woodroofe N, Channer KS, Saxton JM. Testosterone therapy during exercise rehabilitation in male patients with chronic heart failure who have low testosterone status: a double-blind randomized controlled feasibility study. Am Heart J 2012. [PMID: 23194490 DOI: 10.1016/j.ahj.2012.09.016] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND This study assessed the feasibility of a 12-week program of exercise, with and without intramuscular testosterone supplementation, in male patients with chronic heart failure (CHF) and low testosterone status and collected preliminary data for key health outcomes. METHODS Male patients with CHF (n = 41, age 67.2 years, range 51-84 years) with mean ± SD testosterone levels of 10.7 ± 2.6 nmol/L (309 ± 76 ng/dL) were randomly allocated to exercise with testosterone or placebo groups. Feasibility was assessed in terms of recruitment, intervention compliance, and attrition. Outcomes included an incremental shuttle walk test, peak oxygen uptake, muscular strength, echocardiographic measures, N-terminal pro-brain natriuretic peptide, inflammatory markers, depression (Beck Depression Inventory), and health-related quality of life (Minnesota Living with Heart Failure Questionnaire and Medical Outcomes Study Short-Form). RESULTS Attrition was 30% but with 100% compliance to exercise and injections in patients who completed the study. Similar improvements in shuttle walk test (18% vs 19%), body mass (-1.3 kg vs -1.0 kg), and hand grip strength (2.1 kg vs 2.5 kg) from baseline were observed in both groups. The exercise with testosterone group showed improvements from baseline in peak oxygen uptake (P < .01), Beck Depression Inventory (P < .05), leg strength (P < .05), and several Medical Outcomes Study Short-Form quality of life domains (P < .05), which were generally not apparent in the exercise with placebo group. Echocardiographic measures, N-terminal pro-brain natriuretic peptide, and inflammatory markers were mostly unchanged. CONCLUSIONS This study shows for the first time that testosterone supplementation during a program of exercise rehabilitation is feasible and can positively impact on a range of key health outcomes in elderly male patients with CHF who have a low testosterone status.
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Abstract
BACKGROUND Depressive illness in older people causes significant suffering and health service utilisation. Relapse and recurrence rates are high. OBJECTIVES To examine the efficacy of antidepressants and psychological therapies in preventing the relapse and recurrence of depression in older people. SEARCH METHODS Search of the Cochrane Depression, Anxiety and Neurosis Review Group's specialized register (the CCDANCTR) up to 22 June 2012. The CCDANCTR includes relevant randomised controlled trials from the following bibliographic databases: The Cochrane Library (all years), EMBASE, (1974 to date) MEDLINE (1950 to date) and PsycINFO (1967 to date). We handsearched relevant journals, contacted experts in the field and examined reference lists, conference proceedings and bibliographies. SELECTION CRITERIA Both review authors independently selected studies. We included randomised controlled trials (RCTs) involving people aged 60 and over successfully treated for an episode of depression and randomised to receive continuation and maintenance treatment with antidepressants, psychological therapies, or combination. DATA COLLECTION AND ANALYSIS Data were extracted independently by the two authors.The primary outcome was relapse/recurrence rate of depression (reaching a cut-off on any depression rating scale) at six-monthly intervals. Secondary outcomes included global impression of change, social functioning, and deaths. Meta-analysis was performed using risk ratio for dichotomous outcomes and mean differences (MD) for continuous outcomes, with 95% confidence intervals. MAIN RESULTS Seven studies met the inclusion criteria (803 participants). Six compared antidepressant medication with placebo; two involved psychological therapies. There was marked heterogeneity between the studies.Comparing antidepressants with placebo, at six months follow-up there was no significant difference. At 12 months follow-up there was a statistically significant difference favouring antidepressants in reducing recurrence compared with placebo (three RCTs, N = 247, RR = 0.67, 95% CI 0.55 to 0.82; NNTB = five). At 24 months there was no significant difference for antidepressants overall, however, for the subgroup of tricyclic antidepressants there was significant benefit (three RCTs, N = 169, RR = 0.70, 95% CI 0.50 to 0.99; NNTB = five). At 36 months there was no significant difference for antidepressants overall. There was no difference in treatment acceptability or death rates between antidepressant and placebo.There was no significant difference between psychological treatment and antidepressant in recurrence rates at 12, 24, and 36 months (one RCT, N = 53) or between combination and antidepressant alone.Overall, the included studies were at low risk of bias. AUTHORS' CONCLUSIONS The long-term benefits of continuing antidepressant medication in the prevention of recurrence of depression in older people are not clear and no firm treatment recommendations can be made on the basis of this review. Continuing antidepressant medication for 12 months appears to be helpful but this is based on only three small studies with relatively few participants using differing classes of antidepressants in clinically heterogeneous populations. Comparisons at other time points did not reach statistical significance. Data on psychological therapies and combined treatments are too limited to draw any conclusions.
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Forster SE, Powers HJ, Foulds GA, Flower DJ, Hopkinson K, Parker SG, Young TA, Saxton J, Pockley AG, Williams EA. Improvement in Nutritional Status Reduces the Clinical Impact of Infections in Older Adults. J Am Geriatr Soc 2012; 60:1645-54. [DOI: 10.1111/j.1532-5415.2012.04118.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
| | | | - Gemma A. Foulds
- Department of Oncology; University of Sheffield; Sheffield; UK
| | | | - Kay Hopkinson
- Department of Oncology; University of Sheffield; Sheffield; UK
| | - Stuart G. Parker
- School of Health and Related Research; University of Sheffield; Sheffield; UK
| | - Tracey A. Young
- School of Health and Related Research; University of Sheffield; Sheffield; UK
| | - John Saxton
- School of Allied Health Professionals; University of East Anglia; Norwich; UK
| | - Alan G. Pockley
- Department of Oncology; University of Sheffield; Sheffield; UK
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Crichton GE, Howe PRC, Buckley JD, Coates AM, Murphy KJ, Bryan J. Long-term dietary intervention trials: critical issues and challenges. Trials 2012; 13:111. [PMID: 22812577 PMCID: PMC3453508 DOI: 10.1186/1745-6215-13-111] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2012] [Accepted: 06/21/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There are many challenges involved in running randomised controlled dietary intervention trials that investigate health outcomes. The aim of this paper was to evaluate the recruitment process, retention of participants and challenges faced in our dairy intervention trial, and to provide strategies to combat the difficulties of running long-term dietary intervention trials. METHODS A 12-month, randomised, two-way crossover study was conducted in overweight adults with habitually low dairy food consumption to assess the effects of a high dairy intake (4 servings of reduced-fat dairy per day) compared with a low dairy intake (1 serving of reduced-fat dairy per day) on measures of cardiometabolic and cognitive health. On completion of the high dairy intake phase, each participant was interviewed about their experience in the trial and responses were used to evaluate the key issues for study participants. RESULTS Although the recruitment target was achieved, high rates of attrition (49.3%) and difficulties maintaining participant compliance (reported by 37.8% of participants) were major threats to the viability of the study. Factors that contributed to the high attrition included inability to comply with the dietary requirements of the study protocol (27.0%), health problems or medication changes (24.3%) and time commitment (10.8%). CONCLUSION Attrition and adherence to study requirements present challenges to trials requiring longer-term dietary change. Including a run-in period to further assess the motivation, commitment and availability of participants, maintaining regular contact with participants during control phases, minimising time commitment, providing flexibility with dietary requirements, facilitating positive experiences, and stringent monitoring of diet are some key recommendations for future dietary intervention trials. TRIAL REGISTRATION Australia and New Zealand Clinical Trials Registry (ACTRN 12608000538347).
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Affiliation(s)
- Georgina E Crichton
- Nutritional Physiology Research Centre, University of South Australia, Adelaide, South Australia, Australia.
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