Pragmatic randomised evaluation of stable thoracolumbar fracture treatment outcomes (PRESTO): study protocol for a randomised controlled feasibility trial combined with a qualitative study and survey

Embedding qualitative research in randomised controlled trials to improve recruitment: findings from two recruitment optimisation studies of orthopaedic surgical trials

BACKGROUND

Recruitment of patients is one of the main challenges when designing and conducting randomised controlled trials (RCTs). Trials of rare injuries or those that include surgical interventions pose added challenges due to the small number of potentially eligible patients and issues with patient preferences and surgeon equipoise. We explore key issues to consider when recruiting to orthopaedic surgical trials from the perspective of staff and patients with the aim of informing the development of strategies to improve recruitment in future research.

DESIGN

Two qualitative process evaluations of a UK-wide orthopaedic surgical RCT (ACTIVE) and mixed methods randomised feasibility study (PRESTO). Qualitative semi-structured interviews were conducted and data was analysed thematically.

SETTING

NHS secondary care organisations throughout the UK. Interviews were undertaken via telephone.

PARTICIPANTS

Thirty-seven health professionals including UK-based spinal and orthopaedic surgeons and individuals involved in recruitment to the ACTIVE and PRESTO studies (e.g. research nurses, surgeons, physiotherapists). Twenty-two patients including patients who agreed to participate in the ACTIVE and PRESTO studies (n=15) and patients that declined participation in the ACTIVE study (n=7) were interviewed.

RESULTS

We used a mixed methods systematic review of recruiting patients to randomised controlled trials as a framework for reporting and analysing our findings. Our findings mapped onto those identified in the systematic review and highlighted the importance of equipoise, randomisation, communication, patient's circumstances, altruism and trust in clinical and research teams. Our findings also emphasised the importance of considering how eligibility criteria are operationalised and the impact of complex patient pathways when recruiting to surgical trials. In particular, the influence of health professionals, who are not involved in trial recruitment, on patients' treatment preferences by suggesting they would receive a certain treatment ahead of recruitment consultations should not be underestimated.

CONCLUSIONS

A wealth of evidence exploring factors affecting recruitment to randomised controlled trials exists. A methodological shift is now required to ensure that this evidence is used by all those involved in recruitment and to ensure that existing knowledge is translated into methods for optimising recruitment to future trials.

TRIAL REGISTRATION

ACTIVE: ( ISRCTN98152560 ). Registered on 06/03/2018. PRESTO: ( ISRCTN12094890 ). Registered on 22/02/2018.

Rapid efficacy of percutaneous kyphoplasty (PKP) in treating thoracolumbar fractures in elderly patients

OBJECTIVE

This study aims to investigate the effects of percutaneous kyphoplasty (PKP) on the elderly patients with thoracolumbar fractures and its influence on their complications and quality of life.

METHODS

Totally 175 elderly patients with thoracolumbar fractures admitted to our hospital from June 2017 to January 2019 were selected as the research participants. Seventy patients in the control group (CG) were treated with conventional therapy, and 105 in the research group (RG) were treated by percutaneous kyphoplasty (PKP). The surgical indications (time of hospitalization and ground exercise), pressure injury and pain (VAS score) of patients in both groups were tested and compared. The ODI score, quality of life GQOLI-74 scale score, height of anterior vertebral border and cobb angle of patients were compared, and their total effective and complication rates were statistically analyzed.

RESULTS

The surgical indications of patients in the RG were better than those in the CG. Those with pressure injury in stages 1 and 2 were fewer, and VAS and ODI scores were lower; GQOLI-74 scale score was higher, height of anterior vertebral border was higher than that in the CG, and the cobb angle was smaller The total effective rate was higher and the incidence of complications was lower than that in the CG.

CONCLUSION

PKP is more effective and faster in treating thoracolumbar fractures in elderly patients with fewer postoperative complications, and can promote the recovery of function and quality of life.