Sandra Carvalho1,2, Jorge Leite1,2,3, Felipe Jones1, Leslie R Morse4,5,6, Ross Zafonte4,7, Felipe Fregni8,9. 1. Spaulding Neuromodulation Center, Spaulding Rehabilitation Hospital, Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA. 2. Neuropsychophysiology Laboratory, CiPsi, School of Psychology, University of Minho, Campus de Gualtar, Braga, Portugal. 3. Univ Portucalense, Portucalense Institute for Human Development-INPP, Oporto, Portugal. 4. Spaulding-Harvard Spinal Cord Injury System, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA. 5. Rocky Mountain Regional Spinal Injury System, Craig Rehabilitation Hospital, Englewood, CO, USA. 6. Department of PMR, University of Colorado School of Medicine, Aurora, CO, USA. 7. Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. 8. Spaulding Neuromodulation Center, Spaulding Rehabilitation Hospital, Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA. fregni.felipe@mgh.harvard.edu. 9. Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. fregni.felipe@mgh.harvard.edu.
Abstract
STUDY DESIGN: Secondary analysis of a clinical trial. OBJECTIVES: To analyze adherence to 1-year transcranial Direct Current Stimulation (tDCS) clinical trial in people with chronic pain due to spinal cord injury (SCI). We also explore the association between dropout and several baseline variables such as age, depression levels, pain severity, number of days with pain in the last 7 days, walking ability, sleep, work, relationship with others, and enjoyment with life. SETTING: Boston, USA. METHODS:Forty-six participants were enrolled in this trial, and 33 participants were randomized to receive either active or sham tDCS. RESULTS: Using the full intention-to-treat (ITT) criteria, only 8 participants (24%) finished the study. The median time to dropout was seven (IQR:6,19) sessions (i.e., immediately after the first follow-up), regardless of the type of stimulation that participants received (active vs. sham tDCS) (χ2 = 0.025, p = 0.875). An exploratory analysis suggested that only the number of days with pain in the last 7 days was moderately associated with dropout, with people experiencing less pain being more prone to dropout from the study. CONCLUSIONS: Despite all the measures to improve study adherence (such as providing parking, flexibility to schedule sessions, follow-up with participants by phone), it seems that long follow-up periods may increase the likelihood of dropout. Given the need to understand long-term effects of interventions, longitudinal trials need to consider alternative designs or methods of treatment (for instance home treatment or home assessment) to decrease attrition rate.
RCT Entities:
STUDY DESIGN: Secondary analysis of a clinical trial. OBJECTIVES: To analyze adherence to 1-year transcranial Direct Current Stimulation (tDCS) clinical trial in people with chronic pain due to spinal cord injury (SCI). We also explore the association between dropout and several baseline variables such as age, depression levels, pain severity, number of days with pain in the last 7 days, walking ability, sleep, work, relationship with others, and enjoyment with life. SETTING: Boston, USA. METHODS: Forty-six participants were enrolled in this trial, and 33 participants were randomized to receive either active or sham tDCS. RESULTS: Using the full intention-to-treat (ITT) criteria, only 8 participants (24%) finished the study. The median time to dropout was seven (IQR:6,19) sessions (i.e., immediately after the first follow-up), regardless of the type of stimulation that participants received (active vs. sham tDCS) (χ2 = 0.025, p = 0.875). An exploratory analysis suggested that only the number of days with pain in the last 7 days was moderately associated with dropout, with people experiencing less pain being more prone to dropout from the study. CONCLUSIONS: Despite all the measures to improve study adherence (such as providing parking, flexibility to schedule sessions, follow-up with participants by phone), it seems that long follow-up periods may increase the likelihood of dropout. Given the need to understand long-term effects of interventions, longitudinal trials need to consider alternative designs or methods of treatment (for instance home treatment or home assessment) to decrease attrition rate.
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Authors: Alejandra Cardenas-Rojas; Luis Castelo-Branco; Kevin Pacheco-Barrios; Emad Salman Shaikh; Elif Uygur-Kucukseymen; Stefano Giannoni-Luza; Luna Vasconcelos Felippe; Paola Gonzalez-Mego; Maria Alejandra Luna-Cuadros; Anna Carolyna Lepesteur Gianlorenco; Paulo E P Teixeira; Wolnei Caumo; Felipe Fregni Journal: Contemp Clin Trials Commun Date: 2021-11-17