Recruitment and retention rates in randomised controlled trials of exercise therapy in people with multimorbidity: a systematic review and meta-analysis

Harris, Lasse K; Skou, Søren Thorgaard; Juhl, Carsten Bogh; Jäger, Madalina

doi:10.1186/s13063-021-05346-x

Cited by 21 publications

(13 citation statements)

References 59 publications

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“…While we were unable to find any systematic reviews that screened for frailty and documented retention, our results are similar to other systematic reviews of retention in RCTs of PR in populations with chronic health conditions (e.g. 82.8% for adults with major depressive disorder [ 54 ], 93% for adults with cancer, cardiovascular disease or diabetes [ 55 ]) and 90% in people with multimorbidity [ 56 ]. In contrast, systematic reviews of PR interventions in adults with human immunodeficiency viruses ( n = 36 RCTs, 71%) [ 57 ] and schizophrenia ( n = 19 RCTs, 73%) [ 58 ] documented lower retention rates.…”

Section: Discussionsupporting

confidence: 65%

Retention in RCTs of physical rehabilitation for adults with frailty: a systematic review and meta-analysis

O’Grady

Farley

Takaoka

et al. 2022

Trials

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Background Physical rehabilitation (PR) interventions can improve physical function for adults with frailty; however, participant retention rates in randomized controlled trials (RCTs) are unknown. Objective is to summarize participant retention rates in RCTs of PR for adults with frailty. Design is a systematic review and meta-analysis (DOI:10.17605/OSF.IO/G6XR2). Participants are adults ≥ 18 years with frailty. Setting consists of inpatient, outpatient and community-based interventions. Intervention includes any PR intervention. Methods We searched 7 electronic databases from inception to April 15, 2020 for published RCTs. Our primary outcome was participant retention rate to primary outcome measurement. Secondary outcomes included retention by study group, participant retention to intervention completion, reported reasons for attrition and reported strategies for maximizing retention. We completed screening, data extraction and risk of bias (ROB) assessments independently and in duplicate. We conducted a meta-analysis, calculating retention rates and 95% confidence intervals (CIs) using fixed or random-effects models, as appropriate. Results We included 21 RCTs, enrolling 1685 adults with frailty (median age 82.5 years (79.0, 82.2), 59.8% female (57.5, 69.8)). Twenty RCTs reported retention data, of which 90.0% (n = 18) had high ROB. The pooled participant retention rate to primary outcome measurement was 85.0% [95%CI (80.0, 90.0), I2 = 83.9%, p < 0.05]. There were no differences by group for retention to the primary outcome [intervention 87.0% (83.0, 91.0), p < 0.05, comparator 85.0% (79.0, 90.0), p < 0.05] or in retention to intervention completion [83.0% (95.0% CI (78.0–87.0), p < 0.05]. Of the 18 studies reporting 24 reasons for attrition, 51.3% were categorized as potentially modifiable by the research team (e.g. low motivation). Only 20.0% (n = 4) of studies reported strategies for maximizing retention. Conclusions In this review of 21 RCTs of PR, we identified acceptable rates of retention for adults with frailty. High retention in PR interventions appears to be feasible in this population; however, our results are limited by a high ROB and heterogeneity.

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Section: Discussionsupporting

confidence: 65%

Retention in RCTs of physical rehabilitation for adults with frailty: a systematic review and meta-analysis

O’Grady

Farley

Takaoka

et al. 2022

Trials

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“…Overall, we performed one scoping review [35], five systematic reviews [27,[36][37][38][39][40], two registry-based studies [41,42], one qualitative interview study [43], and a mixed-methods feasibility study [34], to identify knowledge gaps and develop an exercise therapy and self-management intervention for people with multimorbidity (Table 1) and Fig. 1.…”

Section: Resultsmentioning

confidence: 99%

“…These conditions are linked by a common risk factor (physical inactivity) and pathogenesis (systemic low-grade inflammation), resulting in a cascade of reactions resulting in a 'vicious cycle' of chronic diseases and poor outcomes [44,45]. For two systematic reviews, we included studies reporting at least 80% of the patients with multimorbidity (as defined above) [27,40]. This pragmatic approach was pre-specified [37], and adopted to capture all the studies which included people with multimorbidity, given the expected inconsistency of reporting of the conditions across trials.…”

Section: Populationmentioning

confidence: 99%

Personalised exercise therapy and self-management support for people with multimorbidity: Development of the MOBILIZE intervention

Jäger

Dideriksen

Rasmussen

et al. 2022

Pilot Feasibility Stud

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Background To our knowledge, there is no intervention which includes personalised exercise therapy and self-management support for people with multimorbidity, although these interventions may be as effective as for people with single chronic conditions. Therefore, we developed a novel intervention, including personalised exercise therapy and self-management support for people with multimorbidity. Methods We followed the Medical Research Council framework and conducted one scoping review, five systematic reviews, two registry-based studies, one qualitative interview study and a mixed-methods feasibility study. Following an iterative approach, together with feedback from people with multimorbidity and relevant stakeholders, we developed the MOBILIZE intervention. Results The intervention included 24 (60 minutes) sessions of personalised exercise therapy and 24 (30 minutes) sessions of self-management support twice a week for 12 weeks, delivered in small groups by specifically trained physiotherapists. The intervention targets physiological, psychosocial, behavioural, and contextual factors to improve health-related quality of life and physical function in people living with multimorbidity. Conclusions We developed a personalised exercise therapy and self-management support programme for people with multimorbidity. The intervention will be tested for its safety and effectiveness in a randomised controlled trial.

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“…Our results are reasonably aligned with results from a systematic review published in 2021, where the authors investigated recruitment and retention rates in exercise RCTs for people with multimorbidity. 49 They reported an average recruitment rate of 75% and a retention rate of 90% however, the included studies were deemed to be of low quality and therefore results must be interpreted with caution.…”

Section: Discussionmentioning

confidence: 99%

Development and feasibility of an inter-agency physical activity and education programme for adults with multimorbidity in primary care: Activ8

Ryan

Smith

Cummins

et al. 2022

Journal of Multimorbidity and Comorbidity

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Background While physical activity is widely recommended for many long-term conditions, it may be difficult to achieve for patients managing multiple conditions. We aimed to determine the feasibility of an inter-agency exercise and education programme for patients with multimorbidity in primary care. Methods We conducted an uncontrolled pilot study with adults with multimorbidity, recruited in two community healthcare organisations in an urban area in Ireland. The six-week pilot intervention combined an individually tailored gym-based exercise programme and education to support self-management. Feasibility of the Activ8 programme was assessed using a mixed methods process evaluation. Outcome measures at baseline and at 6 weeks included recruitment and retention, gait speed, grip strength, quality of life and self-efficacy. Focus groups and interviews explored participants and facilitators’ perceptions of the programme. Results 19 participants with ≥2 chronic conditions were recruited over three-weeks with similar attrition at both sites (≤40%). Overall, the results indicate that Activ8 was feasible and acceptable to patients and practitioners. Quantitative outcome measures suggested improvements in most outcomes. Qualitative data analysis indicated that Activ8 addressed an overarching concept of patient-centeredness among participants. Three key themes included perceived personal programme impact, the personalised composition of the programme and the evolving nature of primary care practice. Conclusion While further definitive evidence is needed and attrition from the programme needs to be considered, the Activ8 Programme was acceptable to both patients and professionals in two different primary care areas with the potential for positive impacts for adults living with multimorbidity.

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Recruitment and retention rates in randomised controlled trials of exercise therapy in people with multimorbidity: a systematic review and meta-analysis

Cited by 21 publications

References 59 publications

Retention in RCTs of physical rehabilitation for adults with frailty: a systematic review and meta-analysis

Retention in RCTs of physical rehabilitation for adults with frailty: a systematic review and meta-analysis

Personalised exercise therapy and self-management support for people with multimorbidity: Development of the MOBILIZE intervention

Development and feasibility of an inter-agency physical activity and education programme for adults with multimorbidity in primary care: Activ8

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