Balancing purity, pragmatism and partnership in occupational therapy clinical research: trials and tribulations of recruiting for a multisite stroke trial

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Journal ArticleDate:
2025Access:
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Codd, Y., Porter-Armstrong, A., Turtle, B., McNally, �., McArdle, M., Stinson, M., McIlwaine, P., Abbi, L., Morrow F., Hughes, T., Maguire, A., & Stapleton, T., Balancing purity, pragmatism and partnership in occupational therapy clinical research: trials and tribulations of recruiting for a multisite stroke trial, Irish Journal of Occupational Therapy, 53, 1, 2025, 41 - 50Download Item:
Abstract:
Purpose – The REfLECTS trial was a randomised controlled trial (RCT) testing effectiveness of mirror box therapy in upper limb rehabilitation among
sub-acute stroke patients. REfLECTS was a large-scale, rigorously planned study; however, implementation was challenging due to low recruitment
rates, 803 patients were screened and only 26 were recruited. The purpose of this study is to explore factors and challenges influencing the
recruitment of participants to this multisite RCT.
Design/methodology/approach – A Communities of Practice (CoP) approach was used. Bi-monthly steering meetings were held to address
recruitment issues and a focus group was conducted post-recruitment to identify influencing factors. Data from meeting minutes and the focus
group were amalgamated and analysed using thematic analysis.
Findings – The trial team (n ¼ 14) comprising academics (n ¼ 5) and clinicians (n ¼ 9) contributed to the steering meetings. The focus group (n ¼ 9)
included researchers (n ¼ 5) and clinicians (n ¼ 4). Two major themes were identified: impact of COVID-19, including shorter in-patient stays affecting trial
recruitment and clinical trials (and tribulations) highlighting therapist-led dilemmas and patient-related factors leading to patients declining to participate.
Research limitations/implications – The CoP identifies important contextual clinical service-based and therapist-led factors, which have
pragmatic impacts on the design and implementation of high-quality occupational therapy clinical trials. High-quality occupational therapy evidence
for stroke rehabilitation is essential, however, there is a need to critically reflect on how clinical research can best be implemented in clinical practice
to ensure implementation and subsequent usability of findings. Provision of ongoing support for clinicians during trial implementation is essential to
manage the therapist-led clinical dilemma.
Originality/value – Good research helps us improve therapy, however, maintaining research purity in the pragmatic “real world” of stroke rehabilitation
is challenging. Clinicians encounter ethical dilemmas with randomisation in high-quality clinical trial methodologies and this study identifies the need for
ongoing trial implementation support to ensure clinician and patient engagement, enhance recruitment and maintain research integrity.
Author's Homepage:
http://people.tcd.ie/coddyhttp://people.tcd.ie/stapley
Description:
PUBLISHED
Author: Codd, Yvonne; Stapleton, Tadhg
Type of material:
Journal ArticleCollections
Series/Report no:
Irish Journal of Occupational Therapy53
1
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Full text availableSubject (TCD):
Inclusive Society , CLINICAL-TRIAL METHODOLOGY , HEALTH SERVICES RESEARCH , Occupational Therapy , Stroke , Stroke rehabilitationDOI:
https://doi.org/10.1108/IJOT-11-2024-0045ISSN:
2398-8819Metadata
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