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Clifford AM, Cheung PS, Malley NO, Byrne S, Whiston A, Kennelly B, Mphepo T, Eshghimanesh Z, Thabane L, Louw Q, Moss H, Gowran RJ, Neill DO, Glynn L, Woods CB, Maher C, Sheikhi A, Salsberg J, Bhriain ON. Findings from a pragmatic cluster randomised controlled feasibility trial of a music and dance programme for community dwelling older adults. Arch Gerontol Geriatr 2024; 122:105371. [PMID: 38471410 DOI: 10.1016/j.archger.2024.105371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 02/09/2024] [Accepted: 02/15/2024] [Indexed: 03/14/2024]
Abstract
INTRODUCTION Functional decline, chronic illness, reduced quality of life and increased healthcare utilisation are common in older adults. Evidence suggests music and dance can support healthy ageing in older adults. This study explored the feasibility, potential for effect and cost effectiveness of the Music and Movement for Health (MMH) programme among community-dwelling older adults using a pragmatic cluster-randomised, controlled feasibility trial design. METHODS Community-dwelling adults aged 65 years or older were recruited to seven clusters in the Mid-West region of Ireland. Clusters were block randomised to either the MMH intervention or control. Primary feasibility outcomes included recruitment, retention, adherence, fidelity, and safety. Secondary outcomes measured physical activity, physical and cognitive performance, and psychosocial well-being, along with healthcare utilisation were assessed at baseline and after 12 weeks. RESULTS The study successfully met feasibility targets, with recruitment (n = 100), retention (91 %), adherence (71 %), data completeness (92 %) and intervention fidelity (21 out of 24) all meeting predetermined criteria. Both groups exhibited an increase in self-reported physical activity and improved physical function. Participants in the intervention group scored consistently better in psychosocial measures compared to the control group at follow-up. The health economic analysis confirmed the feasibility of the methodology employed and points to the potential cost-effectiveness of the MMH relative to the control or no organised programme. DISCUSSION AND IMPLICATIONS The MMH intervention and study design were found to be feasible and acceptable with important findings to inform future evaluation of the clinical and cost-effectiveness of a definitive randomised controlled trial.
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Affiliation(s)
- Amanda M Clifford
- School of Allied Health, Ageing Research Centre, University of Limerick, Limerick, V94T9PX, Ireland; Health Research Institute, University of Limerick, Limerick, Ireland; Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Stellenbosch University, Cape Town, South Africa.
| | - Pui-Sze Cheung
- School of Allied Health, Ageing Research Centre, University of Limerick, Limerick, V94T9PX, Ireland; Health Research Institute, University of Limerick, Limerick, Ireland; Irish World Academy of Music and Dance, University of Limerick, Limerick, V94DK18, Ireland
| | - Nicola O' Malley
- School of Allied Health, Ageing Research Centre, University of Limerick, Limerick, V94T9PX, Ireland; Health Research Institute, University of Limerick, Limerick, Ireland
| | - Steven Byrne
- School of Allied Health, Ageing Research Centre, University of Limerick, Limerick, V94T9PX, Ireland; Health Research Institute, University of Limerick, Limerick, Ireland; Department of Nursing & Midwifery, University of Limerick, Ireland
| | - Aoife Whiston
- School of Allied Health, Ageing Research Centre, University of Limerick, Limerick, V94T9PX, Ireland
| | - Brendan Kennelly
- Cairnes School of Business and Economics, University of Ireland Galway, Galway, Ireland
| | - Tumeliwa Mphepo
- Cairnes School of Business and Economics, University of Ireland Galway, Galway, Ireland
| | | | - Lehana Thabane
- Department of Health Research Methods, McMaster University, Hamilton ON, Canada; Research Institute of St Joe's Hamilton, St Joseph's Healthcare Hamilton, Hamilton ON, Canada; Faculty of Health Sciences, University of Johannesburg, Johannesburg, South Africa
| | - Quinette Louw
- Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Stellenbosch University, Cape Town, South Africa
| | - Hilary Moss
- Health Research Institute, University of Limerick, Limerick, Ireland; Irish World Academy of Music and Dance, University of Limerick, Limerick, V94DK18, Ireland
| | - Rosemary Joan Gowran
- School of Allied Health, Ageing Research Centre, University of Limerick, Limerick, V94T9PX, Ireland; Health Research Institute, University of Limerick, Limerick, Ireland; Assisting Living and Learning (ALL) Institute, Maynooth University, Maynooth, Ireland
| | - Desmond O' Neill
- Centre for Ageing, Neuroscience and the Humanities, Trinity College Dublin, Dublin, Ireland
| | - Liam Glynn
- Health Research Institute, University of Limerick, Limerick, Ireland; School of Medicine, University of Limerick, Limerick, Ireland
| | - Catherine B Woods
- Health Research Institute, University of Limerick, Limerick, Ireland; Physical Activity for Health Research Cluster, Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland
| | - Catherine Maher
- Rehabilitation Unit, Community Hospital of the Assumption, HSE, Thurles, Tipperary, Ireland
| | - Ali Sheikhi
- Health Research Institute, University of Limerick, Limerick, Ireland
| | - Jon Salsberg
- Health Research Institute, University of Limerick, Limerick, Ireland; School of Medicine, University of Limerick, Limerick, Ireland
| | - Orfhlaith Ni Bhriain
- Health Research Institute, University of Limerick, Limerick, Ireland; Irish World Academy of Music and Dance, University of Limerick, Limerick, V94DK18, Ireland
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Zahrieh D, Kandler BW, Le-Rademacher J. The symbolic two-step method applied to cancer care delivery research: Safeguarding against designing an underpowered cluster randomized trial with a continuous outcome by accounting for the imprecision in the within- and between-center variation. Clin Trials 2024:17407745231219680. [PMID: 38243404 DOI: 10.1177/17407745231219680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2024]
Abstract
BACKGROUND Knowing the predictive factors of the variation in a center-level continuous outcome of interest is valuable in the design and analysis of parallel-arm cluster randomized trials. The symbolic two-step method for sample size planning that we present incorporates this knowledge while simultaneously accounting for patient-level characteristics. Our approach is illustrated through application to cluster randomized trials in cancer care delivery research. The required number of centers (clusters) depends on the between- and within-center variance; the within-center variance is a function of estimates obtained by regressing the log within-center variance on predictive factors. Obtaining accurate estimates of the components needed to characterize the within-center variation is challenging. METHODS Using our previously derived sample size formula, our objective in the current research is to directly account for the imprecision in these estimates, using a Bayesian approach, to safeguard against designing an underpowered study when using the symbolic two-step method. Using estimates of the required components, including the number of centers that contribute to those estimates, we make formal allowance for the imprecision in these estimates on which a sample size will be based. RESULTS The mean of the distribution for power is consistently smaller than the single point estimate that the sample size formula yields. The reduction in power is more pronounced in the presence of increased uncertainty about the estimates with the reduction becoming more attenuated with increased numbers of centers that contribute to the estimates. CONCLUSIONS Accounting for imprecision in the estimates of the components required for sample size estimation using the symbolic two-step method in the design of a cluster randomized trial yields conservative estimates of power.
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Affiliation(s)
- David Zahrieh
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
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Tishkovskaya SV, Sutton CJ, Thomas LH, Watkins CL. Determining the sample size for a cluster-randomised trial using knowledge elicitation: Bayesian hierarchical modelling of the intracluster correlation coefficient. Clin Trials 2023; 20:293-306. [PMID: 37036110 PMCID: PMC10262340 DOI: 10.1177/17407745231164569] [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] [Indexed: 04/11/2023]
Abstract
BACKGROUND The intracluster correlation coefficient is a key input parameter for sample size determination in cluster-randomised trials. Sample size is very sensitive to small differences in the intracluster correlation coefficient, so it is vital to have a robust intracluster correlation coefficient estimate. This is often problematic because either a relevant intracluster correlation coefficient estimate is not available or the available estimate is imprecise due to being based on small-scale studies with low numbers of clusters. Misspecification may lead to an underpowered or inefficiently large and potentially unethical trial. METHODS We apply a Bayesian approach to produce an intracluster correlation coefficient estimate and hence propose sample size for a planned cluster-randomised trial of the effectiveness of a systematic voiding programme for post-stroke incontinence. A Bayesian hierarchical model is used to combine intracluster correlation coefficient estimates from other relevant trials making use of the wealth of intracluster correlation coefficient information available in published research. We employ knowledge elicitation process to assess the relevance of each intracluster correlation coefficient estimate to the planned trial setting. The team of expert reviewers assigned relevance weights to each study, and each outcome within the study, hence informing parameters of Bayesian modelling. To measure the performance of experts, agreement and reliability methods were applied. RESULTS The 34 intracluster correlation coefficient estimates extracted from 16 previously published trials were combined in the Bayesian hierarchical model using aggregated relevance weights elicited from the experts. The intracluster correlation coefficients available from external sources were used to construct a posterior distribution of the targeted intracluster correlation coefficient which was summarised as a posterior median with a 95% credible interval informing researchers about the range of plausible sample size values. The estimated intracluster correlation coefficient determined a sample size of between 450 (25 clusters) and 480 (20 clusters), compared to 500-600 from a classical approach. The use of quantiles, and other parameters, from the estimated posterior distribution is illustrated and the impact on sample size described. CONCLUSION Accounting for uncertainty in an unknown intracluster correlation coefficient, trials can be designed with a more robust sample size. The approach presented provides the possibility of incorporating intracluster correlation coefficients from various cluster-randomised trial settings which can differ from the planned study, with the difference being accounted for in the modelling. By using expert knowledge to elicit relevance weights and synthesising the externally available intracluster correlation coefficient estimates, information is used more efficiently than in a classical approach, where the intracluster correlation coefficient estimates tend to be less robust and overly conservative. The intracluster correlation coefficient estimate constructed is likely to produce a smaller sample size on average than the conventional strategy of choosing a conservative intracluster correlation coefficient estimate. This may therefore result in substantial time and resources savings.
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Affiliation(s)
- Svetlana V Tishkovskaya
- Lancashire Clinical Trials Unit, Faculty of Health and Care, University of Central Lancashire, Preston, UK
| | - Chris J Sutton
- Centre for Biostatistics, Division of Population Health, Health Services Research & Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Lois H Thomas
- Faculty of Allied Health and Wellbeing, University of Central Lancashire, Preston, UK
| | - Caroline L Watkins
- Lancashire Clinical Trials Unit, Faculty of Health and Care, University of Central Lancashire, Preston, UK
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Colin CR, Woodcock L, Wright LY, Yakes Jimenez E, Papoutsakis C. The Need for and Challenges of Nutrition and Dietetics Registry Studies: An Update on the Academy of Nutrition and Dietetics Health Informatics Infrastructure. J Acad Nutr Diet 2023; 123:673-682. [PMID: 36623691 DOI: 10.1016/j.jand.2023.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 01/04/2023] [Indexed: 01/09/2023]
Affiliation(s)
- Casey R Colin
- Department of Nutrition and Dietetics, Brooks College of Health, University of North Florida, Jacksonville, Florida
| | | | - Lauri Y Wright
- Department of Nutrition and Dietetics, Brooks College of Health, University of North Florida, Jacksonville, Florida
| | - Elizabeth Yakes Jimenez
- Academy of Nutrition and Dietetics, Chicago, Illinois; Department of Pediatrics, University of New Mexico Health Sciences Center, Albuquerque, New Mexico; Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico; College of Population Health, University of New Mexico, Albuquerque, New Mexico
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Sarkodie SK, Wason JMS, Grayling MJ. A hybrid approach to comparing parallel-group and stepped-wedge cluster-randomized trials with a continuous primary outcome when there is uncertainty in the intra-cluster correlation. Clin Trials 2023; 20:59-70. [PMID: 36086822 PMCID: PMC9940131 DOI: 10.1177/17407745221123507] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND/AIMS To evaluate how uncertainty in the intra-cluster correlation impacts whether a parallel-group or stepped-wedge cluster-randomized trial design is more efficient in terms of the required sample size, in the case of cross-sectional stepped-wedge cluster-randomized trials and continuous outcome data. METHODS We motivate our work by reviewing how the intra-cluster correlation and standard deviation were justified in 54 health technology assessment reports on cluster-randomized trials. To enable uncertainty at the design stage to be incorporated into the design specification, we then describe how sample size calculation can be performed for cluster- randomized trials in the 'hybrid' framework, which places priors on design parameters and controls the expected power in place of the conventional frequentist power. Comparison of the parallel-group and stepped-wedge cluster-randomized trial designs is conducted by placing Beta and truncated Normal priors on the intra-cluster correlation, and a Gamma prior on the standard deviation. RESULTS Many Health Technology Assessment reports did not adhere to the Consolidated Standards of Reporting Trials guideline of indicating the uncertainty around the assumed intra-cluster correlation, while others did not justify the assumed intra-cluster correlation or standard deviation. Even for a prior intra-cluster correlation distribution with a small mode, moderate prior densities on high intra-cluster correlation values can lead to a stepped-wedge cluster-randomized trial being more efficient because of the degree to which a stepped-wedge cluster-randomized trial is more efficient for high intra-cluster correlations. With careful specification of the priors, the designs in the hybrid framework can become more robust to, for example, an unexpectedly large value of the outcome variance. CONCLUSION When there is difficulty obtaining a reliable value for the intra-cluster correlation to assume at the design stage, the proposed methodology offers an appealing approach to sample size calculation. Often, uncertainty in the intra-cluster correlation will mean a stepped-wedge cluster-randomized trial is more efficient than a parallel-group cluster-randomized trial design.
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Affiliation(s)
- Samuel K Sarkodie
- Samuel K Sarkodie, Population Health
Sciences Institute, Newcastle University, 4th Floor Ridley Building 1, Queen
Victoria Road, Newcastle upon Tyne NE1 7RU, UK.
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