title: Challenges in recruitment, attendance and adherence of acute stroke survivors to a randomized trial in Brazil: a feasibility study.
abstract: BACKGROUND
  There is a high demand for stroke rehabilitation in the Brazilian public health system which should make undertaking clinical trials straightforward.
  
  
  OBJECTIVE
  The aims of this study were to 1) determine the rate of recruitment of community-dwelling stroke survivors into a randomized trial of the effects of strength training in addition to task-specific gait training, 2) compare the effectiveness of various recruitment strategies on accrual rates, and 3) determine the attendance at training sessions and adherence to the intervention protocol.
  
  
  METHODS
  Participants within six months of a stroke were screened for eligibility and invited to participate. Recruitment strategies were classified as advertisement or referral. The number of people who were screened, eligible and recruited for each strategy was recorded. Attendance at training sessions and adherence to the intervention protocol were recorded.
  
  
  RESULTS
  Over the first 14 months, 150 stroke survivors were screened, 10 were recruited, and 35 (23%) were eligible. Twenty-five of these patients (71%) were unable to participate with lack of transport given as the most common reason. The most successful strategy was referral via hospital-based physical therapists (50%). Overall attendance was 72% with lack of transport being the most common reason for non-attendance. Overall adherence to the protocol was 97% with feeling unwell being the most common reason for non-adherence.
  
  
  CONCLUSIONS
  Recruitment of stroke survivors was inefficient. Lack of transport was the most common barrier to participate in and attend training sessions. Funding for transport is essential to make carrying out trials in Brazil feasible. Trial Registration ACTRN12609000803291.
authors.affiliation: Physical Therapy Department, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil. ascianni@task.com.br
authors.forename: Aline
authors.initials: A
authors.lastname: Scianni
authors.forename: Luci F
authors.initials: LF
authors.lastname: Teixeira-Salmela
authors.forename: Louise
authors.initials: L
authors.lastname: Ada
mesh_terms: D000328:Adult; D001938:Brazil; D005081:Exercise Therapy; D005240:Feasibility Studies; D006801:Humans; D010349:Patient Compliance / Q000706:statistics & numerical data*; D018579:Patient Selection; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic / Q000706:statistics & numerical data*; D000071939:Stroke Rehabilitation; D017741:Survivors; D055815:Young Adult