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Natarajan P, Menounos S, Harris L, Monuja M, Gorelik A, Karjalainen T, Buchbinder R, Harris IA, Naylor JM, Adie S. Participant recruitment and attrition in surgical randomised trials with placebo controls versus non-operative controls: a meta-epidemiological study and meta-analysis. BMJ Open 2024; 14:e080258. [PMID: 38637129 PMCID: PMC11029374 DOI: 10.1136/bmjopen-2023-080258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 03/22/2024] [Indexed: 04/20/2024] Open
Abstract
OBJECTIVE To compare differences in recruitment and attrition between placebo control randomised trials of surgery, and trials of the same surgical interventions and conditions that used non-operative (non-placebo) controls. DESIGN Meta-epidemiological study. DATA SOURCES Randomised controlled trials were identified from an electronic search of MEDLINE, EMBASE and Cochrane Central Register of Controlled Trials from their inception date to 21 November 2018. STUDY SELECTION Placebo control trials evaluating efficacy of any surgical intervention and non-operative control trials of the same surgical intervention were included in this study. 25 730 records were retrieved from our systemic search, identifying 61 placebo control and 38 non-operative control trials for inclusion in analysis. OUTCOME MEASURES Primary outcome measures were recruitment and attrition. These were assessed in terms of recruitment rate (number of participants enrolled, as a proportion of those eligible) and overall attrition rate (composite of dropout, loss to follow-up and cross-overs, expressed as proportion of total sample size). Secondary outcome measures included participant cross-over rate, dropout and loss to follow-up. RESULTS Unadjusted pooled recruitment and attrition rates were similar between placebo and non-operative control trials. Study characteristics were not significantly different apart from time to primary timepoint which was shorter in studies with placebo controls (365 vs 274 days, p=0.006). After adjusting for covariates (follow-up duration and number of timepoints), the attrition rate of placebo control trials was almost twice as high compared with non-operative controlled-trials (incident rate ratio (IRR) (95% CI) 1.8 (1.1 to 3.0), p=0.032). The incorporation of one additional follow-up timepoint (regardless of follow-up duration) was associated with reduced attrition in placebo control surgical trials (IRR (95% CI) 0.64 (0.52 to 0.79), p<0.001). CONCLUSIONS Placebo control trials of surgery have similar recruitment issues but higher attrition compared with non-operative (non-placebo) control trials. Study design should incorporate strategies such as increased timepoints for given follow-up duration to mitigate losses to follow-up and dropout. PROSPERO REGISTRATION NUMBER CRD42019117364.
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Affiliation(s)
- Pragadesh Natarajan
- St George and Sutherland Clinical Campuses, School of Clinical Medicine, UNSW Medicine & Health, Sydney, New South Wales, Australia
| | - Spiro Menounos
- St George and Sutherland Clinical Campuses, School of Clinical Medicine, UNSW Medicine & Health, Sydney, New South Wales, Australia
| | - Laura Harris
- St George and Sutherland Clinical Campuses, School of Clinical Medicine, UNSW Medicine & Health, Sydney, New South Wales, Australia
- St George and Sutherland Centre for Clinical Orthopaedic Research Limited, (SCORe), Kogarah, New South Wales, Australia
| | - Masiath Monuja
- St George and Sutherland Clinical Campuses, School of Clinical Medicine, UNSW Medicine & Health, Sydney, New South Wales, Australia
- St George and Sutherland Centre for Clinical Orthopaedic Research Limited, (SCORe), Kogarah, New South Wales, Australia
| | - Alexandra Gorelik
- Department of Medicine, Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Musculoskeletal Health and Wiser Health Care Units, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Teemu Karjalainen
- Department of Musculoskeletal Diseases, Tampere University Hospital, Tampere, Finland
| | - Rachelle Buchbinder
- Musculoskeletal Health and Wiser Health Care Units, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Ian A Harris
- South West Sydney Clinical Campuses, School of Clinical Medicine, UNSW Medicine & Health, Sydney, New South Wales, Australia
| | - Justine M Naylor
- South West Sydney Clinical Campuses, School of Clinical Medicine, UNSW Medicine & Health, Sydney, New South Wales, Australia
| | - Sam Adie
- St George and Sutherland Clinical Campuses, School of Clinical Medicine, UNSW Medicine & Health, Sydney, New South Wales, Australia
- St George and Sutherland Centre for Clinical Orthopaedic Research Limited, (SCORe), Kogarah, New South Wales, Australia
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Shoham Y, Rosenberg L, Hickerson W, Goverman J, Iyer N, Barrera-Oro J, Lipovy B, Monstrey S, Blome-Eberwein S, Wibbenmeyer LA, Scharpenberg M, Singer AJ. Early Enzymatic Burn Debridement: Results of the DETECT Multicenter Randomized Controlled Trial. J Burn Care Res 2024; 45:297-307. [PMID: 37715999 DOI: 10.1093/jbcr/irad142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Indexed: 09/18/2023]
Abstract
Since 1970 surgeons have managed deep burns by surgical debridement and autografting. We tested the hypothesis that enzymatic debridement with NexoBrid would remove the eschar reducing surgery and achieve comparable long-term outcomes as standard of care (SOC). In this Phase 3 trial, we randomly assigned adults with deep burns (covering 3-30% of total body surface area [TBSA]) to NexoBrid, surgical or nonsurgical SOC, or placebo Gel Vehicle (GV) in a 3:3:1 ratio. The primary endpoint was complete eschar removal (ER) at the end of the debridement phase. Secondary outcomes were need for surgery, time to complete ER, and blood loss. Safety endpoints included wound closure and 12 and 24-months cosmesis on the Modified Vancouver Scar Scale. Patients were randomized to NexoBrid (n = 75), SOC (n = 75), and GV (n = 25). Complete ER was higher in the NexoBrid versus the GV group (93% vs 4%; P < .001). Surgical excision was lower in the NexoBrid vs the SOC group (4% vs 72%; P < .001). Median time to ER was 1.0 and 3.8 days for the NexoBrid and SOC respectively (P < .001). ER blood loss was lower in the NexoBrid than the SOC group (14 ± 512 mL vs 814 ± 1020 mL, respectively; P < .0001). MVSS scores at 12 and 24 months were noninferior in the NexoBrid versus SOC groups (3.7 ± 2.1 vs 5.0 ± 3.1 for the 12 months and 3.04 ± 2.2 vs 3.30 ± 2.76 for the 24 months). NexoBrid resulted in early complete ER in >90% of burn patients, reduced surgery and blood loss. NexoBrid was safe and well tolerated without deleterious effects on wound closure and scarring.
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Affiliation(s)
- Yaron Shoham
- Department of Plastic Surgery and Burn Unit, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheba 8400711, Israel
| | - Lior Rosenberg
- Department of Plastic Surgery and Burn Unit, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheba 8400711, Israel
| | - William Hickerson
- Department of Plastic Surgery, College of Medicine, University of Tennessee Health Science Center, Memphis, TN 38163, USA
- Department of Medicine, Firefighters Regional Burn Center, Regional One Health, Memphis, TN 38163, USA
| | - Jeremy Goverman
- Department of Surgery, Sumner Redstone Burn Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Narayan Iyer
- Burn and Blast Medical Countermeasures Program, Division of Chemical, Biological, Radiological/Nuclear Countermeasures (CBRN), Biomedical Advanced Research and Development Authority (BARDA), Administration for Preparedness and Response (ASPR) 20201, HHS
| | - Julio Barrera-Oro
- Burn and Blast Medical Countermeasures Program, Division of Chemical, Biological, Radiological/Nuclear Countermeasures (CBRN), Biomedical Advanced Research and Development Authority (BARDA), Administration for Preparedness and Response (ASPR) 20201, HHS
| | - Bretislav Lipovy
- Department of Burns and Plastic Surgery, University Hospital Brno, Faculty of Medicine, Masaryk University, Brno 60300, Czech Republic
| | - Stan Monstrey
- Department of Plastic and Reconstructive Surgery and Burn Center, University Hospital of Ghent, Ghent 9000, Belgium
| | | | - Lucy A Wibbenmeyer
- Department of Surgery, Carver College of Medicine, University of Iowa Health Care, Iowa City, IA 52242, USA
| | - Martin Scharpenberg
- Universität Bremen, Kompetenzzentrum für Klinische Studien Bremen, Bremen 28359, Germany
| | - Adam J Singer
- Department of Emergency Medicine, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY 11794, USA
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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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Cardenas-Rojas A, Castelo-Branco L, Pacheco-Barrios K, Shaikh ES, Uygur-Kucukseymen E, Giannoni-Luza S, Vasconcelos Felippe L, Gonzalez-Mego P, Luna-Cuadros MA, Gianlorenco ACL, Teixeira PE, Caumo W, Fregni F. Recruitment characteristics and non-adherence associated factors of fibromyalgia patients in a randomized clinical trial: A retrospective survival analysis. Contemp Clin Trials Commun 2021; 24:100860. [PMID: 34849424 PMCID: PMC8609141 DOI: 10.1016/j.conctc.2021.100860] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 10/08/2021] [Accepted: 11/09/2021] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Fibromyalgia is a complex pain condition that affects mostly women. Given the disease's lack of understanding, patients report poor adherence to medication and mistrust of medical services. This study aims to describe the recruitment characteristics and non-adherence associated factors of fibromyalgia patients to an RCT. METHODS We performed a retrospective longitudinal analysis with data from our ongoing RCT. We investigated characteristics of subjects recruited, consented, and randomized. Adherence was studied using survival analysis techniques, and its associated factors were identified using Cox proportional hazards regression model. RESULTS 524 subjects were contacted, 269 were eligible, 61 consented and 40 subjects were randomized. Thirty-eight percent were non-adherent to the protocol with a median of visits of five. The recruitment survey reported that 90% would likely participate in RCTs, 52% had previous participation, and 19% were aware of RCTs by their physicians. Some barriers were investigator-related (staff's friendliness and receiving the results of their trial participation) and center-related (privacy-confidentiality issues and the institution's reputation), without difference between adherent and non-adherent participants. We report significant factors for non-adherence as VAS anxiety score of 5 or more (5.3 HR, p = 0.01), Body Mass Index (BMI) (0.91 HR, p = 0.041) and Quality of Life (QoL) - Personal development subdomain (0.89 HR, p = 0.046). CONCLUSION Recruitment and adherence of fibromyalgia patients is a challenge; however, they seem eager to participate in RCTs. We recommend creating a comfortable, friendly and trusting environment to increase the recruitment rate. Higher anxiety, lower BMI and lower quality of life were associated with a higher attrition rate.
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Affiliation(s)
- Alejandra Cardenas-Rojas
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Luis Castelo-Branco
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Kevin Pacheco-Barrios
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Universidad San Ignacio de Loyola, Vicerrectorado de Investigación, Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Lima, Peru
| | - Emad Salman Shaikh
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Elif Uygur-Kucukseymen
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Stefano Giannoni-Luza
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Luna Vasconcelos Felippe
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Paola Gonzalez-Mego
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Maria Alejandra Luna-Cuadros
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Anna Carolyna Lepesteur Gianlorenco
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Physical Therapy, Federal University of Sao Carlos, Brazil
| | - Paulo E.P. Teixeira
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- MGH Institute of Health Professions, USA
| | - Wolnei Caumo
- Pain and Palliative Care Service at Clinical Hospital of Porto Alegre (HCPA), Federal University of Rio Grande do Sul, Brazil
| | - Felipe Fregni
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Thibaut A, Shie VL, Ryan CM, Zafonte R, Ohrtman EA, Schneider JC, Fregni F. A review of burn symptoms and potential novel neural targets for non-invasive brain stimulation for treatment of burn sequelae. Burns 2021; 47:525-537. [PMID: 33293156 PMCID: PMC8685961 DOI: 10.1016/j.burns.2020.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 04/30/2020] [Accepted: 06/06/2020] [Indexed: 12/12/2022]
Abstract
Burn survivors experience myriad associated symptoms such as pain, pruritus, fatigue, impaired motor strength, post-traumatic stress, depression, anxiety, and sleep disturbance. Many of these symptoms are common and remain chronic, despite current standard of care. One potential novel intervention to target these post burn symptoms is transcranial direct current stimulation (tDCS). tDCS is a non-invasive brain stimulation (NIBS) technique that modulates neural excitability of a specific target or neural network. The aim of this work is to review the neural circuits of the aforementioned clinical sequelae associated with burn injuries and to provide a scientific rationale for specific NIBS targets that can potentially treat these conditions. We ran a systematic review, following the PRISMA statement, of tDCS effects on burn symptoms. Only three studies matched our criteria. One was a feasibility study assessing cortical plasticity in chronic neuropathic pain following burn injury, one looked at the effects of tDCS to reduce pain anxiety during burn wound care, and one assessed the effects of tDCS to manage pain and pruritus in burn survivors. Current literature on NIBS in burn remains limited, only a few trials have been conducted. Based on our review and results in other populations suffering from similar symptoms as patients with burn injuries, three main areas were selected: the prefrontal region, the parietal area and the motor cortex. Based on the importance of the prefrontal cortex in the emotional component of pain and its implication in various psychosocial symptoms, targeting this region may represent the most promising target. Our review of the neural circuitry involved in post burn symptoms and suggested targeted areas for stimulation provide a spring board for future study initiatives.
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Affiliation(s)
- Aurore Thibaut
- Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, United States; GIGA-Institute and Neurology Department, University of Liège and University Hospital of Liège, Liège, Belgium
| | - Vivian L Shie
- Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, United States
| | - Colleen M Ryan
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States; Shriners Hospitals for Children-Boston, Boston, MA, United States
| | - Ross Zafonte
- Massachusetts General Hospital and Brigham and Women's Hospital, Boston, United States
| | - Emily A Ohrtman
- Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, United States
| | - Jeffrey C Schneider
- Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, United States.
| | - Felipe Fregni
- Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, United States.
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Pacheco-Barrios K, Cardenas-Rojas A, Thibaut A, Costa B, Ferreira I, Caumo W, Fregni F. Methods and strategies of tDCS for the treatment of pain: current status and future directions. Expert Rev Med Devices 2020; 17:879-898. [PMID: 32845195 PMCID: PMC7674241 DOI: 10.1080/17434440.2020.1816168] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 08/25/2020] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Transcranial direct current stimulation (tDCS) is a noninvasive neuromodulation technique that has been widely studied for the treatment of chronic pain. It is considered a promising and safe alternative pain therapy. Different targets have been tested, each having their own particular mechanisms for modulating pain perception. AREAS COVERED We discuss the current state of the art of tDCS to manage pain and future strategies to optimize tDCS' effects. Current strategies include primary motor cortex tDCS, prefrontal tDCS and tDCS combined with behavioral interventions while future strategies, on the other hand, include high-intensity tDCS, transcutaneous spinal direct current stimulation, cerebellar tDCS, home-based tDCS, and tDCS with extended number of sessions. EXPERT COMMENTARY It has been shown that the stimulation of the prefrontal and primary motor cortex is efficient for pain reduction while a few other new strategies, such as high-intensity tDCS and network-based tDCS, are believed to induce strong neuroplastic effects, although the underlying neural mechanisms still need to be fully uncovered. Hence, conventional tDCS approaches demonstrated promising effects to manage pain and new strategies are under development to enhance tDCS effects and make this approach more easily available by using, for instance, home-based devices.
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Affiliation(s)
- Kevin Pacheco-Barrios
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Boston, Massachusetts, USA
- Universidad San Ignacio de Loyola, Vicerrectorado de Investigación, Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud. Lima, Peru
| | - Alejandra Cardenas-Rojas
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Aurore Thibaut
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Boston, Massachusetts, USA
- Coma Science Group, GIGA Consciousness, University of Liege, Liège, Belgium
| | - Beatriz Costa
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Isadora Ferreira
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Wolnei Caumo
- Pain and Palliative Care Service at Hospital de Clínicas de Porto Alegre (HCPA), Laboratory of Pain and Neuromodulation at UFRGS, Porto Alegre, Brazil
| | - Felipe Fregni
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Boston, Massachusetts, USA
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Stockly O, Wolfe A, Espinoza L, Simko L, Kowalske K, Carrougher G, Gibran N, Bamer A, Meyer W, Rosenberg M, Rosenberg L, Kazis L, Ryan C, Schneider J. The impact of electrical injuries on long-term outcomes: A Burn Model System National Database study. Burns 2020; 46:352-359. [DOI: 10.1016/j.burns.2019.07.030] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 07/17/2019] [Accepted: 07/24/2019] [Indexed: 12/21/2022]
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Bamer AM, McMullen K, Gibran N, Holavanahalli R, Schneider JC, Carrougher GJ, Wiechman S, Wolfe A, Amtmann D. Factors Associated with Attrition of Adult Participants in a Longitudinal Database: A National Institute on Disability, Independent Living, and Rehabilitation Research Burn Model System Study. J Burn Care Res 2020; 41:270-279. [PMID: 31738436 PMCID: PMC9121819 DOI: 10.1093/jbcr/irz186] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/17/2023]
Abstract
Participant attrition in longitudinal studies can lead to substantial bias in study results, especially when attrition is nonrandom. A previous study of the Burn Model System (BMS) database prior to 2002 identified participant and study-related factors related to attrition. The purpose of the current study was to examine changes in attrition rates in the BMS longitudinal database since 2002 and to revisit factors associated with attrition. Individuals 18 years and older enrolled in the BMS database between 2002 and 2018 were included in this study. Stepwise logistic regression models identified factors significantly associated with attrition at 6, 12, and 24 months postburn injury. The percentage of individuals lost to follow-up was 26% at 6 months, 33% at 12 months, and 42% at 24 months. Factors associated with increased risk of loss to follow-up across two or more time points include male sex, lower TBSA burn size, being unemployed at the time of burn, shorter duration of acute hospital stay, younger age, not having private health insurance or workers' compensation, and a history of drug abuse. Retention levels in the BMS have improved by at least 10% at all time points since 2002. The BMS and other longitudinal burn research projects can use these results to identify individuals at high risk for attrition who may require additional retention efforts. Results also indicate potential sources of bias in research projects utilizing the BMS database.
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Affiliation(s)
- Alyssa M. Bamer
- Department of Rehabilitation Medicine, University of Washington, Seattle
| | - Kara McMullen
- Department of Rehabilitation Medicine, University of Washington, Seattle
| | - Nicole Gibran
- Department of Surgery, University of Washington, Seattle
| | | | - Jeffrey C. Schneider
- Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts
| | | | | | - Audrey Wolfe
- Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts
| | - Dagmar Amtmann
- Department of Rehabilitation Medicine, University of Washington, Seattle
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