title: Strategies to improve recruitment and retention of older stroke survivors to a randomized clinical exercise trial.
abstract: BACKGROUND
  Relatively few exercise randomized clinical trials (RCTs) among stroke survivors have reported the effectiveness of recruitment and retention strategies, despite its central importance to study integrity.
  
  
  OBJECTIVE
  Our objective is to examine recruitment and retention strategies used among a group of older community-dwelling stroke survivors for an exercise RCT.
  
  
  METHODS
  Recruitment strategies were multidimensional using both paid (ie, newspaper, radio and, television) and unpaid advertisements (ie, staff visits, flyers, and brochures placed at outpatient rehabilitation centers, physician offices, and community facilities working with older adults; free media coverage of the study, presentations at stroke support groups, relatives/friends, and study Web site) to obtain referrals. Retention strategies centered on excellent communication, the study participants' needs, and having dedicated study staff. Attrition rates and adherence to the intervention were used to examine the effectiveness of these retention strategies.
  
  
  RESULTS
  A total of 393 referrals were received, 233 persons were screened, and 145 stroke survivors enrolled in the study. During 3 years of study recruitment, we achieved 97% of our enrollment target. We enrolled 62% of those screened. Study enrollment from paid advertising was 21.4% (n = 31), whereas unpaid advertisements resulted in 78.6% (n = 114) of our participants. Attrition was 10% (n = 14 dropouts), and adherence to the intervention was 85%.
  
  
  CONCLUSIONS
  Recruitment and retention of participants in an exercise RCT are time and labor intensive. Multiple recruitment and retention strategies are required to ensure an adequate sample of community-dwelling stroke survivors. Many of these strategies are also relevant for exercise RCTs among adults with other chronic illnesses.
authors: Biobehavioral Health Science Division, College of Nursing, University of Arizona, Tucson, Arizona. Electronic address: rtaylor@nursing.arizona.edu.
authors: Ruth E
authors: RE
authors: Taylor-Piliae
authors: Department of Pharmacology, College of Medicine, University of Arizona, Tucson, Arizona.
authors: Daniella
authors: D
authors: Boros
authors: Department of Pharmacology, College of Medicine, University of Arizona, Tucson, Arizona; Department of Neurology, University Physicians Healthcare, University of Arizona Health Network, Tucson, Arizona.
authors: Bruce M
authors: BM
authors: Coull
mesh_terms: D000329:Advertising; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D001130:Arizona; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008389:Marketing of Health Services; D008875:Middle Aged; D010349:Patient Compliance; D010352:Patient Dropouts; D018579:Patient Selection; D020521:Stroke / Q000175:diagnosis / Q000503:physiopathology; D000071939:Stroke Rehabilitation; D026302:Tai Ji; D013997:Time Factors; D016896:Treatment Outcome
keywords: Stroke survivors; clinical trial; community-dwelling; exercise; recruitment; retention