What are the barriers to participation in a neuromodulation pilot trial for aphasia after stroke?

Abstract

Purpose Aphasia is a common and debilitating manifestation of stroke. Transcranial electrical stimulation uses low-intensity electric currents to induce changes in neuronal activity. Recent evidence suggests that noninvasive techniques can be a valuable rehabilitation tool for patients with aphasia. However, it is difficult to recruit patients with aphasia for trials, and the reasons for this are not well understood. This study aimed to elucidate the main difficulties involved in patient’s recruitment and inclusion in a randomized clinical study of neuromodulation in aphasia. Methods We evaluated the reasons for the exclusion of patients in a pilot, randomized, double-blinded clinical trial in which patients diagnosed with motor aphasia after stroke were recruited from March to November 2018. A descriptive statistical analysis was performed. Results Only 12.9% (4) of patients with ischemic stroke were included in the clinical trial. A total of 87.1% (27) of the 31 recruited patients were excluded for various reasons including: sensory aphasia (32.2%), dysarthria (25.8%), spontaneous clinical recovery (16.1%), previous stroke (6.4%), and death or mutism (3.2%). Conclusion The presence of other types of aphasia, dysarthria, spontaneous recovery, deaths, and mutism were barriers to recruiting patients evidenced in this neuromodulation study.

Challenges and Opportunities in Stroke Nursing Research: Global Views From a Panel of Nurse Researchers

“…Time and logistics are fundamental barriers to successful recruitment and retention for both the researcher and the participants. One team identified that 6 factors (dysarthria, sensory aphasia, history of a previous stroke, spontaneous clinical recovery, death, or mutism) limit recruitment and retention in stroke 12. A change in patient circumstances can also affect the research as their condition may worsen and they become too unwell to continue.…”

“…One team identified that 6 factors (dysarthria, sensory aphasia, history of a previous stroke, spontaneous clinical recovery, death, or mutism) limit recruitment and retention in stroke. 12 A change in patient circumstances can also affect the research as their condition may worsen and they become too unwell to continue. In a study about optimizing recruitment for stroke recovery research, physician engagement and a streamlined customer service were important factors to improve enrollment and maximize efficiency.…”