Addressing the gap for racially diverse research involvement: The King's Model for minority ethnic research participant recruitment

Objectives

Ethnic minorities (EM) are still underrepresented in research recruitment. Despite wide literature outlining the barriers, enablers and recommendations for driving inclusion and diversity in research, there is still little evidence for successful diversity in research participation, which has a direct impact on the quality of care provided to ethnically diverse individuals. A new, comprehensive approach to recruitment strategies is therefore necessary.

Study design

service improvement initiative.

Methods

In the light of the Covid-19 pandemic and the key public health need to address the disparity in care provided to non-white populations, we used a novel, comprehensive approach (The King's Model) comprising of local and community actions to promote inclusive research recruitment. We then compared rates of diverse recruitment in studies where the novel approach, was applied to studies which had been closed to recruitment at the time of analysis and where ethnicity data was available.

Results

Our results demonstrate that following the introduction of the King's Model for diverse recruitment, commercial interventional study diverse recruitment increased from 6.4% to 16.1%, and for non-commercial studies, from 30.2% to 41.0% and 59.2% in the selected studies.

Conclusions

King's Model is potentially a useful tool in enhancing non-Caucasian recruitment to clinical research. Enriched by additional recommendations based on our experiences during the Covid-19 research recruitment drive, we propose the King's Model is used to support ethnically diverse research recruitment. Further evidence is needed to replicate our findings, although this preliminary evidence provides granular details necessary to address the key unmet need of validating clinical research outcomes in non-white populations.

FM2-3 Slave to the rhythm: seasonal differences in non-motor symptoms in parkinson’s

Objectives

To determine the effect of the change of season on non-motor symptoms in Parkinson’s disease (PD).

Design

Cross-sectional retrospective study.

Subjects

364 consecutive Parkinson’s patients in the London area taking part in the Non-motor Longitudinal International Study (NILS) study at King’s College Hospital London between November 2011 and April 2018.

Methods

Participants were divided into three groups based on their assessment date, using a simplified ecological seasonal model:

November until February;

March until 15 June;

16 June until October.

The primary outcome was a seasonal difference in non-motor symptom scale (NMSS) total scores and the secondary outcomes were NMSS subscores. Outcomes were adjusted for multiple testing using formal Bonferroni correction.

Results

102 patients were allocated to group 1, 105 patients to group 2 and 157 patients to group 3. Seasonal differences were present in NMSS total scores (p=0.042), especially between groups 1 and 3 (p=0.037). Differences were also present for NMSS domain 1 (cardiovascular and falls; p=0.004), 2 (sleep and fatigue; p=0.049), 4 (hallucinations; p=0.003) and 9 (miscellaneous; p=0.031). Within domain 9 there was only a significant difference for question 28 (smell; p=0.008).

Conclusions

These results indicate that non-motor symptoms in Parkinson’s fluctuate throughout the year with lowest scores in the summer months and highest in the winter months. These variations need to be taken into account to avoid inappropriate changes in medication regimes.

FM2-2 Exploratory analysis whether wearable sensor data can correlate with aspects of non-motor symptoms in parkinson’s: a real life study with the parkinson’s kinetigraphTM

Objectives

To determine the association between the range and nature of non-motor symptoms (NMS) in people with Parkinson’s (PwP) and validated Parkinson’s KinetigraphTM (PKG) outcome measures.

Design

Cross-sectional retrospective study of participants enrolled in the Non-motor Longitudinal International Study (NILS, UKCRN No: 10084) at King’s College Hospital, London.

Subjects

108 PwP with a PKG recording within 4 months of a NILS assessment were included in the analysis.

Methods

PKG is a validated accelerometery-based measure for motor function in PwP, reporting scores for global bradykinesia (BKS) and dyskinesia (DKS). NMS were assessed by the NMS scale (NMSS).

Results

Using multiple linear regression, BKS was predicted by NMSS domains 6 (gastrointestinal tract; p=0.006) and 8 (sexual function; p=0.003). DKS was predicted by domains 3 (mood/cognition; p=0.016), domain 4 (perceptual problems; p=0.025), domain 6 (gastrointestinal tract; p=0.029) and domain 9 (miscellaneous, p=0.003). In these domains, anxiety, delusions, dysphagia, hyposmia, weight change and hyperhidrosis significantly predicted DKS. In addition, carbidopa dose predicted NMSS total scores (p=0.037), but not total LEDD (p=0.91).

Conclusions

In PwP, measures of BK and DK were mainly associated with gastrointestinal problems, underpinning the importance of gastric absorption of oral medications and constipation and the related motor effects in PwP. Interestingly, carbidopa appears to have a role in non-motor symptoms in PwP, which deserves further investigation.