Challenges in Recruitment for the Study of Noninvasive Brain Stimulation in Stroke: Lessons from Deep Brain Stimulation

详细信息    查看全文

• 作者：Kelsey A. Potter-Baker ; PhD^* ; Corin E. Bonnett ; MPH^* ; Patrick Chabra ; BS^* ; Sarah Roelle ; BS^* ; Nicole Varnerin ; BSE^* ; David A. Cunningham ; MS^* ; Vishwanath Sankarasubramanian ; PhD^* ; Svetlana Pundik ; MD^&dagger ; ; ^&Dagger ; ; Adriana B. Conforto ; MD ; PhD^§ ; ; ^‖ ; Andre G. Machado ; MD ; PhD^¶ ; ; Ela B. Plow ; PT ; PhD^* ; ^# ; ^{plowe2@ccf.org" class="auth_mail" title="E-mail the corresponding author}
• 关键词：tDCS ; rehabilitation ; TMS ; DBS ; clinical trial ; patient recruitment
• 刊名：Journal of Stroke and Cerebrovascular Diseases
• 出版年：2016
• 出版时间：April 2016
• 年：2016
• 卷：25
• 期：4
• 页码：927-937
• 全文大小：1062 K

文摘

Noninvasive brain stimulation (NIBS) can augment functional recovery following stroke; however, the technique lacks regulatory approval. Low enrollment in NIBS clinical trials is a key roadblock. Here, we pursued evidence to support the prevailing opinion that enrollment in trials of NIBS is even lower than enrollment in trials of invasive, deep brain stimulation (DBS).

Methods

We compared 2 clinical trials in stroke conducted within a single urban hospital system, one employing NIBS and the other using DBS, (1) to identify specific criteria that generate low enrollment rates for NIBS and (2) to devise strategies to increase recruitment with guidance from DBS.

Results

Notably, we found that enrollment in the NIBS case study was 5 times lower (2.8%) than the DBS trial (14.5%) (χ² = 20.815, P < .0001). Although the number of candidates who met the inclusion criteria was not different (χ² = .04, P < .841), exclusion rates differed significantly between the 2 studies (χ² = 21.354, P < .0001). Beyond lack of interest, higher exclusion rates in the NIBS study were largely due to exclusion criteria that were not present in the DBS study, including restrictions for recurrent strokes, seizures, and medications.

Conclusions

Based on our findings, we conclude and suggest that by (1) establishing criteria specific to each NIBS modality, (2) adjusting exclusion criteria based on guidance from DBS, and (3) including patients with common contraindications based on a probability of risk, we may increase enrollment and hence significantly impact the feasibility and generalizability of NIBS paradigms, particularly in stroke.