Feasibility and lessons learned on remote trial implementation from TestBoston, a fully remote, longitudinal, large-scale COVID-19 surveillance study

A 40-week phase 2B randomized, multicenter, double-blind, placebo-controlled study evaluating the safety and efficacy of memantine in amyotrophic lateral sclerosis

INTRODUCTION

Amyotrophic lateral sclerosis (ALS) is a rapidly progressive neurodegenerative disease with no known cure, limited treatment options with minimal benefits, and significant unmet need for disease modifying therapies.

AIMS

This study investigated memantine's impact on ALS progression, with an additional focus on the effects of memantine on cognitive and behavioral changes associated with the disease.

METHODS

A randomized, double-blind, placebo-controlled clinical trial was conducted from December 2018 to September 2020. ALS patients were enrolled in-person and remotely across 13 sites in the United States. Participants were randomized to memantine (20 mg twice daily) or placebo in a 2:1 ratio and completed 36 weeks of treatment. The primary outcome of disease progression was assessed by the Revised Amyotrophic Lateral Sclerosis Functional Rating Scale (ALSFRS-R), and blood was collected for biomarker analysis.

RESULTS

Of the 99 participants enrolled in the study, 89 were randomized to memantine or placebo (ages 24-83 years, male-to-female ratio ~3:2). Fifty-two participants completed the study treatment with no significant differences in disease progression, biomarker changes (including neurofilament light chain [NfL]), or neuropsychiatric testing noted between the groups. Initial NfL values correlated with the rate of ALSFRS-R decline.

DISCUSSION

In this study, memantine did not impact ALS disease progression or neuropsychiatric symptoms. Trials with remote enrollment may help trial participation and success.

Reliability of the Italian Version of the Fugl-Meyer Upper Extremity Scale Administered Remotely

Background/Objectives: Despite the increase in home-based rehabilitation, outcome measures for telerehabilitation are still underdeveloped. The Fugl-Meyer Assessment (FMA) is one of the most widely used tools for evaluating post-stroke motor deficits, with the upper extremity component (FMA-UE) recommended for assessing motor deficits of the arm. This study aims to examine the intrarater and interrater reliability of the Italian version of the FMA-UE, administered remotely via video conferencing during a robotic telerehabilitation program. Methods: Twenty stroke patients participated and underwent 20 sessions of remote upper limb rehabilitation with a robotic device. In-person evaluations were conducted before (T0) and after (T1) treatment, with additional remote assessments throughout. The study evaluated both intrarater and interrater reliability using Intraclass Correlation Coefficients (ICC) and Bland-Altman plots, classifying reliability as excellent for scores above 0.90. Results: Bland-Altman analysis showed no systematic variance for both intrarater and interrater reliability of the FMA-UE scale. Excellent reliability was found with intrarater ICC = 0.972 and interrater ICC = 0.981. Sections A and C of the FMA-UE showed excellent intrarater reliability, while sections B and D had satisfactory results. Both intrarater and interrater reliability analysis of the total score of the FMA-UE scale also showed strong agreement with Cohen's Kappa values above 0.70. Conclusions: The findings suggest that the remote administration of the FMA-UE scale is a reliable tool for assessing upper limb motor function in stroke patients, supporting its use in telerehabilitation settings.

Telehealth counseling plus mHealth intervention for cannabis use in emerging adults: Development and a remote open pilot trial

INTRODUCTION

To improve treatment access for emerging adults with cannabis use disorder (CUD), we developed a telehealth counseling-plus-mHealth intervention and remotely conducted a single-arm open pilot study to preliminarily evaluate its feasibility in primary care.

METHODS

A multidisciplinary team including youth developed the intervention using the structure of the MOMENT intervention: two weekly counselor-delivered Motivational Enhancement Therapy (MET) sessions, then two weeks of smartphone surveys (4 prompted/day) querying socioemotional contexts and cannabis use, with pre-programmed messages on report of personal triggers for use (Ecological Momentary Intervention; EMI). The team adapted the MET for virtual delivery; created material to enhance self-reflection, plan behavior change, and anticipate withdrawal; shortened the sessions; and tested them with five youth actors. EMI messages were created to align with the MET and programmed to minimize repetition. Patients aged 18-25 using recreational cannabis ≥3 days/week were recruited from an urban medical practice. Participants received the intervention and responded to surveys on satisfaction and burden. At baseline, post-intervention, and two months, participants reported behavior change readiness/importance/confidence and cannabis use. EMI engagement was calculated as % days with ≥1 phone survey completed.

RESULTS

Fourteen eligible patients enrolled; 79 % used cannabis daily/near-daily and 100 % reported use problems. All completed both MET sessions and responded to EMI surveys. All agreed/strongly agreed that they felt respected by, comfortable with, and trust for the counselor and that the activities and discussion were helpful; all rated the MET sessions as very good/excellent. Technical issues were infrequent and minor. Median EMI engagement was 100 % (≥1 report/day) in each week. Behavior change confidence was higher post-intervention and importance and confidence were higher at two months vs. baseline. By two months, 11 participants had started to change cannabis use; median percent days of use in the past 30 days declined by 27 % and average times of use per use day declined by 28 %. All rated intervention quality as good, very good, or excellent.

CONCLUSIONS

Emerging adults were highly satisfied and engaged with a telehealth MET counseling-plus-mHealth EMI intervention for cannabis use and reported higher motivation to change cannabis use and less use post-intervention and at 2-month follow-up.

Quantitative biomechanical analysis in validating a video-based model to remotely assess physical frailty: a potential solution to telehealth and globalized remote-patient monitoring

Assessing physical frailty (PF) is vital for early risk detection, tailored interventions, preventive care, and efficient healthcare planning. However, traditional PF assessments are often impractical, requiring clinic visits and significant resources. We introduce a video-based frailty meter (vFM) that utilizes machine learning (ML) to assess PF indicators from a 20 s exercise, facilitating remote and efficient healthcare planning. This study validates the vFM against a sensor-based frailty meter (sFM) through elbow flexion and extension exercises recorded via webcam and video conferencing app. We developed the vFM using Google's MediaPipe ML model to track elbow motion during a 20 s elbow flexion and extension exercise, recorded via a standard webcam. To validate vFM, 65 participants aged 20-85 performed the exercise under single-task and dual-task conditions, the latter including counting backward from a random two-digit number. We analyzed elbow angular velocity to extract frailty indicators-slowness, weakness, rigidity, exhaustion, and unsteadiness-and compared these with sFM results using intraclass correlation coefficient analysis and Bland-Altman plots. The vFM results demonstrated high precision (0.00-7.14%) and low bias (0.00-0.09%), showing excellent agreement with sFM outcomes (ICC(2,1): 0.973-0.999), unaffected by clothing color or environmental factors. The vFM offers a quick, accurate method for remote PF assessment, surpassing previous video-based frailty assessments in accuracy and environmental robustness, particularly in estimating elbow motion as a surrogate for the 'rigidity' phenotype. This innovation simplifies PF assessments for telehealth applications, promising advancements in preventive care and healthcare planning without the need for sensors or specialized infrastructure.

Impact of financial compensation on enrollment and participation in a remote, mobile-app based research study

Background

There is no consensus on how to determine appropriate financial compensation for research recruitment. Selecting incentive amounts that are reasonable and respectful, without undue inducement, remains challenging. Previously, we demonstrated that incentive amount significantly impacts participants' willingness to complete various hypothetical research activities. Here we further explore this relationship in a mock decentralized study.

Methods

Adult ResearchMatch volunteers were invited to join a prospective study where interested individuals were given an opportunity to view details for a study along with participation requirements, then offered a randomly generated compensation amount between $0 and $50 to enroll and participate. Individuals agreeing to participate were then asked to complete tasks using a remote mobile application (MyCap), for two weeks. Tasks included a weekly survey, a daily gratitude journal and daily phone tapping task.

Results

Willingness to participate was 85% across all incentive levels but not significantly impacted by amount. Task completion appeared to increase as a function of compensation until a plateau at $25. While participants described the study as low burden and reported that compensation was moderately important to their decision to join, only 31% completed all study tasks.

Conclusion

While offering compensation in this study did not have a strong effect on enrollment rate, this work provides insight into participant motivation when joining and participating in studies employing mobile applications.

Motivation to participate and attrition factors in a COVID-19 biobank: A qualitative study

BACKGROUND

The Biobanque québécoise de la COVID-19 (Quebec Biobank for COVID-19, or BQC19) is a provincial initiative that aims to manage the longitudinal collection, storage, and sharing of biological samples and clinical data related to COVID-19. During the study, BQC19 investigators reported a high loss-to-follow-up rate. The current study aimed to explore motivational and attrition factors from the perspective of BQC19 participants and health care and research professionals.

METHODS

This was an inductive exploratory qualitative study. Using a theoretical sampling approach, a sample of BQC19 participants and professionals were invited to participate via semi-structured interviews. Topics included motivations to participate; participants' fears, doubts, and barriers to participation; and professionals' experiences with biobanking during the COVID-19 pandemic.

RESULTS

Interviews were conducted with BQC19 participants (n = 23) and professionals (n = 17) from 8 clinical data collection sites. Motivations included the contribution to science and society in crisis, self-worth, and interactions with medical professionals. Reasons for attrition included logistical barriers, negative attitudes about public health measures or genomic studies, fear of clinical settings, and a desire to move on from COVID-19. Motivations and barriers seemed to evolve over time and with COVID-19 trends and surges. Certain situations were associated with attrition, such as when patients experienced indirect verbal consent during hospitalization. Barriers related to human and material resources and containment/prevention measures limited the ability of research teams to recruit and retain participants, especially in the ever-evolving context of crisis.

CONCLUSION

The pandemic setting impacted participation and attrition, either by influencing participants' motivations and barriers or by affecting research teams' ability to recruit and retain participants. Longitudinal and/or biobanking studies in a public health crisis setting should consider these factors to limit attrition.