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Anastasi JK, Capili B, Norton M, McMahon DJ, Marder K. Recruitment and retention of clinical trial participants: understanding motivations of patients with chronic pain and other populations. FRONTIERS IN PAIN RESEARCH 2024; 4:1330937. [PMID: 38606348 PMCID: PMC11006977 DOI: 10.3389/fpain.2023.1330937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 12/20/2023] [Indexed: 04/13/2024] Open
Abstract
This paper aims to present and discuss the issues, challenges, and strategies related to recruitment and retention in clinical trials involving participants with chronic pain. The randomized controlled clinical trial (RCT) is widely regarded as the gold standard for evaluating clinical interventions. However, it is crucial to acknowledge and address the challenges associated with recruiting and retaining participants. To prioritize the experience of the study population, targeted outreach strategies and a patient-centric approach are necessary. Researchers should consider incorporating recruitment and retention strategies during the study design phase. Implementing multi-pronged recruitment methods, leveraging relationships with community providers, and involving representatives of the patient population are helpful approaches. Effective communication and maintaining a professional environment are vital for optimizing engagement and supporting the successful execution of clinical trials involving participants with chronic pain.
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Affiliation(s)
- Joyce K. Anastasi
- Division of Special Studies in Symptom Management, New York University, New York, NY, United States
| | - Bernadette Capili
- Heilbrunn Family Center for Research Nursing, The Rockefeller University, New York, NY, United States
| | - Margaret Norton
- Division of Special Studies in Symptom Management, New York University, New York, NY, United States
- Department of Nursing, St. Joseph's University, Brooklyn, NY, United States
| | - Donald J. McMahon
- Division of Special Studies in Symptom Management, New York University, New York, NY, United States
| | - Karen Marder
- Irving Medical Center, Columbia University, New York, NY, United States
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Kennedy N, Nelson S, Jerome RN, Edwards TL, Stroud M, Wilkins CH, Harris PA. Recruitment and retention for chronic pain clinical trials: a narrative review. Pain Rep 2022; 7:e1007. [PMID: 38304397 PMCID: PMC10833632 DOI: 10.1097/pr9.0000000000001007] [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: 11/12/2021] [Revised: 03/22/2022] [Accepted: 04/02/2022] [Indexed: 11/25/2022] Open
Abstract
Opioid misuse is at a crisis level. In response to this epidemic, the National Institutes of Health has funded $945 million in research through the Helping to End Addiction Long-term (HEAL) Pain Management Initiative, including funding to the Vanderbilt Recruitment Innovation Center (RIC) to strategize methods to catalyze participant recruitment. The RIC, recognizing the challenges presented to clinical researchers in recruiting individuals experiencing pain, conducted a review of evidence in the literature on successful participant recruitment methods for chronic pain trials, in preparation for supporting the HEAL Pain trials. Study design as it affects recruitment was reviewed, with issues such as sufficient sample size, impact of placebo, pain symptom instability, and cohort characterization being identified as problems. Potential solutions found in the literature include targeted electronic health record phenotyping, use of alternative study designs, and greater clinician education and involvement. For retention, the literature reports successful strategies that include maintaining a supportive staff, allowing virtual study visits, and providing treatment flexibility within the trial. Community input on study design to identify potential obstacles to recruitment and retention was found to help investigators avoid pitfalls and enhance trust, especially when recruiting underrepresented minority populations. Our report concludes with a description of generalizable resources the RIC has developed or adapted to enhance recruitment and retention in the HEAL Pain studies. These resources include, among others, a Recruitment and Retention Plan Template, a Competing Trials Tool, and MyCap, a mobile research application that interfaces with Research Electronic Data Capture (REDCap).
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Affiliation(s)
- Nan Kennedy
- Vanderbilt Institute for Clinical and Translational Research, Nashville, TN, USA
| | - Sarah Nelson
- Vanderbilt Institute for Clinical and Translational Research, Nashville, TN, USA
| | - Rebecca N. Jerome
- Vanderbilt Institute for Clinical and Translational Research, Nashville, TN, USA
| | - Terri L. Edwards
- Vanderbilt Institute for Clinical and Translational Research, Nashville, TN, USA
| | - Mary Stroud
- Vanderbilt Institute for Clinical and Translational Research, Nashville, TN, USA
| | - Consuelo H. Wilkins
- Vanderbilt Institute for Clinical and Translational Research, Nashville, TN, USA
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Internal Medicine, Meharry Medical College, Nashville, TN, USA
- Office of Health Equity, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Paul A. Harris
- Vanderbilt Institute for Clinical and Translational Research, Nashville, TN, USA
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
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Treweek S, Pitkethly M, Cook J, Fraser C, Mitchell E, Sullivan F, Jackson C, Taskila TK, Gardner H. Strategies to improve recruitment to randomised trials. Cochrane Database Syst Rev 2018; 2:MR000013. [PMID: 29468635 PMCID: PMC7078793 DOI: 10.1002/14651858.mr000013.pub6] [Citation(s) in RCA: 225] [Impact Index Per Article: 37.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Recruiting participants to trials can be extremely difficult. Identifying strategies that improve trial recruitment would benefit both trialists and health research. OBJECTIVES To quantify the effects of strategies for improving recruitment of participants to randomised trials. A secondary objective is to assess the evidence for the effect of the research setting (e.g. primary care versus secondary care) on recruitment. SEARCH METHODS We searched the Cochrane Methodology Review Group Specialised Register (CMR) in the Cochrane Library (July 2012, searched 11 February 2015); MEDLINE and MEDLINE In Process (OVID) (1946 to 10 February 2015); Embase (OVID) (1996 to 2015 Week 06); Science Citation Index & Social Science Citation Index (ISI) (2009 to 11 February 2015) and ERIC (EBSCO) (2009 to 11 February 2015). SELECTION CRITERIA Randomised and quasi-randomised trials of methods to increase recruitment to randomised trials. This includes non-healthcare studies and studies recruiting to hypothetical trials. We excluded studies aiming to increase response rates to questionnaires or trial retention and those evaluating incentives and disincentives for clinicians to recruit participants. DATA COLLECTION AND ANALYSIS We extracted data on: the method evaluated; country in which the study was carried out; nature of the population; nature of the study setting; nature of the study to be recruited into; randomisation or quasi-randomisation method; and numbers and proportions in each intervention group. We used a risk difference to estimate the absolute improvement and the 95% confidence interval (CI) to describe the effect in individual trials. We assessed heterogeneity between trial results. We used GRADE to judge the certainty we had in the evidence coming from each comparison. MAIN RESULTS We identified 68 eligible trials (24 new to this update) with more than 74,000 participants. There were 63 studies involving interventions aimed directly at trial participants, while five evaluated interventions aimed at people recruiting participants. All studies were in health care.We found 72 comparisons, but just three are supported by high-certainty evidence according to GRADE.1. Open trials rather than blinded, placebo trials. The absolute improvement was 10% (95% CI 7% to 13%).2. Telephone reminders to people who do not respond to a postal invitation. The absolute improvement was 6% (95% CI 3% to 9%). This result applies to trials that have low underlying recruitment. We are less certain for trials that start out with moderately good recruitment (i.e. over 10%).3. Using a particular, bespoke, user-testing approach to develop participant information leaflets. This method involved spending a lot of time working with the target population for recruitment to decide on the content, format and appearance of the participant information leaflet. This made little or no difference to recruitment: absolute improvement was 1% (95% CI -1% to 3%).We had moderate-certainty evidence for eight other comparisons; our confidence was reduced for most of these because the results came from a single study. Three of the methods were changes to trial management, three were changes to how potential participants received information, one was aimed at recruiters, and the last was a test of financial incentives. All of these comparisons would benefit from other researchers replicating the evaluation. There were no evaluations in paediatric trials.We had much less confidence in the other 61 comparisons because the studies had design flaws, were single studies, had very uncertain results or were hypothetical (mock) trials rather than real ones. AUTHORS' CONCLUSIONS The literature on interventions to improve recruitment to trials has plenty of variety but little depth. Only 3 of 72 comparisons are supported by high-certainty evidence according to GRADE: having an open trial and using telephone reminders to non-responders to postal interventions both increase recruitment; a specialised way of developing participant information leaflets had little or no effect. The methodology research community should improve the evidence base by replicating evaluations of existing strategies, rather than developing and testing new ones.
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Affiliation(s)
- Shaun Treweek
- University of AberdeenHealth Services Research UnitForesterhillAberdeenUKAB25 2ZD
| | - Marie Pitkethly
- University of DundeeNRS Primary Care NetworkThe Mackenzie BuildingKirsty Semple WayDundeeTaysideUKDD2 4BF
| | - Jonathan Cook
- University of OxfordNDORMSCentre for Statistics in MedicineNuffield Orthoapedic Centre, Windmill RdOxfordScotlandUKAB25 2ZD
| | - Cynthia Fraser
- University of AberdeenHealth Services Research UnitForesterhillAberdeenUKAB25 2ZD
| | - Elizabeth Mitchell
- Hull York Medical SchoolHertford BuildingUniversity of HullHullUKHU6 7RX
| | - Frank Sullivan
- University of St AndrewsDivision of Population & Behavioural ScienceNorth HaughUniversity of St AndrewsSt AndrewsUKKY16 9TF
| | - Catherine Jackson
- University of Central LancashireHarrington BuildingHA123PrestonUKPR1 2HE
| | - Tyna K Taskila
- The Work FoundationCentre for Workforce Effectiveness21 Palmer StreetLondonUKSW1V 3PF
| | - Heidi Gardner
- University of AberdeenHealth Services Research UnitForesterhillAberdeenUKAB25 2ZD
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Groeneweg R, van Assen L, Kropman H, Leopold H, Mulder J, Smits-Engelsman BCM, Ostelo RWJG, Oostendorp RAB, van Tulder MW. Manual therapy compared with physical therapy in patients with non-specific neck pain: a randomized controlled trial. Chiropr Man Therap 2017; 25:12. [PMID: 28465824 PMCID: PMC5408403 DOI: 10.1186/s12998-017-0141-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Accepted: 04/05/2017] [Indexed: 12/16/2022] Open
Abstract
Background Manual therapy according to the School of Manual Therapy Utrecht (MTU) is a specific type of passive manual joint mobilization. MTU has not yet been systematically compared to other manual therapies and physical therapy. In this study the effectiveness of MTU is compared to physical therapy, particularly active exercise therapy (PT) in patients with non-specific neck pain. Methods Patients neck pain, aged between 18–70 years, were included in a pragmatic randomized controlled trial with a one-year follow-up. Primary outcome measures were global perceived effect and functioning (Neck Disability Index), the secondary outcome was pain intensity (Numeric Rating Scale for Pain). Outcomes were measured at 3, 7, 13, 26 and 52 weeks. Multilevel analyses (intention-to-treat) were the primary analyses for overall between-group differences. Additional to the primary and secondary outcomes the number of treatment sessions of the MTU group and PT group was analyzed. Data were collected from September 2008 to February 2011. Results A total of 181 patients were included. Multilevel analyses showed no statistically significant overall differences at one year between the MTU and PT groups on any of the primary and secondary outcomes. The MTU group showed significantly lower treatment sessions compared to the PT group (respectively 3.1 vs. 5.9 after 7 weeks; 6.1 vs. 10.0 after 52 weeks). Conclusions Patients with neck pain improved in both groups without statistical significantly or clinically relevant differences between the MTU and PT groups during one-year follow-up. Trial registration ClinicalTrials.gov Identifier: NCT00713843.
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Affiliation(s)
- Ruud Groeneweg
- Radboud University Nijmegen Medical Centre, Scientific Institute for Quality of Health Care, Geert Grooteplein 21, 6525 EX Nijmegen, The Netherlands.,Department of Health Sciences, Faculty of Earth & Life Sciences, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute, De Boelelaan 1085, 1081 HV Amsterdam, The Netherlands.,Avans+, University of Applied Science, Heerbaan 14-40, 4817 NL Breda, The Netherlands
| | - Luite van Assen
- Radboud University Nijmegen Medical Centre, Scientific Institute for Quality of Health Care, Geert Grooteplein 21, 6525 EX Nijmegen, The Netherlands
| | - Hans Kropman
- Avans+, University of Applied Science, Heerbaan 14-40, 4817 NL Breda, The Netherlands
| | - Huco Leopold
- Avans+, University of Applied Science, Heerbaan 14-40, 4817 NL Breda, The Netherlands
| | - Jan Mulder
- Radboud University Nijmegen Medical Centre, Scientific Institute for Quality of Health Care, Geert Grooteplein 21, 6525 EX Nijmegen, The Netherlands
| | - Bouwien C M Smits-Engelsman
- Department of Health and Rehabilitation Sciences, University of Cape Town, Anzio Road 7935, Cape Town, South Africa
| | - Raymond W J G Ostelo
- Department of Health Sciences, Faculty of Earth & Life Sciences, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute, De Boelelaan 1085, 1081 HV Amsterdam, The Netherlands.,Department of Epidemiology and Biostatistics & EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands
| | - Rob A B Oostendorp
- Radboud University Nijmegen Medical Centre, Scientific Institute for Quality of Health Care, Geert Grooteplein 21, 6525 EX Nijmegen, The Netherlands.,Department of Manual Therapy, Vrije Universiteit Brussel, Faculty of Medicine and Pharmacy, Brussels, Belgium
| | - Maurits W van Tulder
- Department of Health Sciences, Faculty of Earth & Life Sciences, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute, De Boelelaan 1085, 1081 HV Amsterdam, The Netherlands
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van Hoeven LR, Janssen MP, Roes KCB, Koffijberg H. Aiming for a representative sample: Simulating random versus purposive strategies for hospital selection. BMC Med Res Methodol 2015; 15:90. [PMID: 26497748 PMCID: PMC4619525 DOI: 10.1186/s12874-015-0089-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Accepted: 10/19/2015] [Indexed: 12/05/2022] Open
Abstract
Background A ubiquitous issue in research is that of selecting a representative sample from the study population. While random sampling strategies are the gold standard, in practice, random sampling of participants is not always feasible nor necessarily the optimal choice. In our case, a selection must be made of 12 hospitals (out of 89 Dutch hospitals in total). With this selection of 12 hospitals, it should be possible to estimate blood use in the remaining hospitals as well. In this paper, we evaluate both random and purposive strategies for the case of estimating blood use in Dutch hospitals. Methods Available population-wide data on hospital blood use and number of hospital beds are used to simulate five sampling strategies: (1) select only the largest hospitals, (2) select the largest and the smallest hospitals (‘maximum variation’), (3) select hospitals randomly, (4) select hospitals from as many different geographic regions as possible, (5) select hospitals from only two regions. Simulations of each strategy result in different selections of hospitals, that are each used to estimate blood use in the remaining hospitals. The estimates are compared to the actual population values; the subsequent prediction errors are used to indicate the quality of the sampling strategy. Results The strategy leading to the lowest prediction error in the case study was maximum variation sampling, followed by random, regional variation and two-region sampling, with sampling the largest hospitals resulting in the worst performance. Maximum variation sampling led to a hospital level prediction error of 15 %, whereas random sampling led to a prediction error of 19 % (95 % CI 17 %-26 %). While lowering the sample size reduced the differences between maximum variation and the random strategies, increasing sample size to n = 18 did not change the ranking of the strategies and led to only slightly better predictions. Conclusions The optimal strategy for estimating blood use was maximum variation sampling. When proxy data are available, it is possible to evaluate random and purposive sampling strategies using simulations before the start of the study. The results enable researchers to make a more educated choice of an appropriate sampling strategy. Electronic supplementary material The online version of this article (doi:10.1186/s12874-015-0089-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Loan R van Hoeven
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Universiteitsweg 100, 3584 CG, Utrecht, The Netherlands. .,Sanquin Blood Supply, Transfusion Technology Assessment Department, Sanquin Research, Amsterdam, Universiteitsweg 100, 3584 CG, Utrecht, The Netherlands.
| | - Mart P Janssen
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Universiteitsweg 100, 3584 CG, Utrecht, The Netherlands. .,Sanquin Blood Supply, Transfusion Technology Assessment Department, Sanquin Research, Amsterdam, Universiteitsweg 100, 3584 CG, Utrecht, The Netherlands.
| | - Kit C B Roes
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Universiteitsweg 100, 3584 CG, Utrecht, The Netherlands.
| | - Hendrik Koffijberg
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Universiteitsweg 100, 3584 CG, Utrecht, The Netherlands. .,Department of Health Technology & Services Research, MIRA Institute for biomedical technology and technical medicine, University of Twente, Drienerlolaan 5, 7522, NB, Enschede, The Netherlands.
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Sherman KJ, Cherkin DC, Wellman RD, Cook AJ, Hawkes RJ, Delaney K, Deyo RA. A randomized trial comparing yoga, stretching, and a self-care book for chronic low back pain. ACTA ACUST UNITED AC 2011; 171:2019-26. [PMID: 22025101 DOI: 10.1001/archinternmed.2011.524] [Citation(s) in RCA: 173] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Chronic low back pain is a common problem lacking highly effective treatment options. Small trials suggest that yoga may have benefits for this condition. This trial was designed to determine whether yoga is more effective than conventional stretching exercises or a self-care book for primary care patients with chronic low back pain. METHODS A total of 228 adults with chronic low back pain were randomized to 12 weekly classes of yoga (92 patients) or conventional stretching exercises (91 patients) or a self-care book (45 patients). Back-related functional status (modified Roland Disability Questionnaire, a 23-point scale) and bothersomeness of pain (an 11-point numerical scale) at 12 weeks were the primary outcomes. Outcomes were assessed at baseline, 6, 12, and 26 weeks by interviewers unaware of treatment group. RESULTS After adjustment for baseline values, 12-week outcomes for the yoga group were superior to those for the self-care group (mean difference for function, -2.5 [95% CI, -3.7 to -1.3]; P < .001; mean difference for symptoms, -1.1 [95% CI, -1.7 to -0.4]; P < .001). At 26 weeks, function for the yoga group remained superior (mean difference, -1.8 [95% CI, -3.1 to -0.5]; P < .001). Yoga was not superior to conventional stretching exercises at any time point. CONCLUSION Yoga classes were more effective than a self-care book, but not more effective than stretching classes, in improving function and reducing symptoms due to chronic low back pain, with benefits lasting at least several months. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00447668.
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Katz S, Dufficy H, John C. Keys to success with clinical trials. Gastroenterol Hepatol (N Y) 2011; 7:100-105. [PMID: 21475416 PMCID: PMC3061013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Affiliation(s)
- Seymour Katz
- Dr. Katz is Clinical Professor of Medicine at Albert Einstein College of Medicine in Bronx, New York; Attending Gastroenterologist at North Shore University Hospital and Long Island Jewish Health System in Manhasset, New York; and Attending Gastroenterologist at St. Francis Hospital in Roslyn, New York
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Whitebird RR, Bliss DZ, Savik K, Lowry A, Jung HJG. Comparing community and specialty provider-based recruitment in a randomized clinical trial: clinical trial in fecal incontinence. Res Nurs Health 2010; 33:500-11. [PMID: 21053384 DOI: 10.1002/nur.20408] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2010] [Indexed: 12/17/2022]
Abstract
Recruitment of participants to clinical trials remains a significant challenge, especially for research addressing topics of a sensitive nature such as fecal incontinence (FI). In the Fiber Study, a randomized controlled trial on symptom management for FI, we successfully enrolled 189 community-living adults through collaborations with specialty-based and community-based settings, each employing methods tailored to the organizational characteristics of their site. Results show that using the two settings increased racial and ethnic diversity of the sample and inclusion of informal caregivers. There were no differential effects on enrollment, final eligibility, or completion of protocol by site. Strategic collaborations with complementary sites can achieve sample recruitment goals for clinical trials on topics that are sensitive or known to be underreported.
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