title: Can response-adaptive randomization increase participation in acute stroke trials?
abstract: OBJECTIVE
  A response-adaptive randomization (RAR) trial design actively adjusts the ratio of participants assigned to each trial arm, favoring the better performing treatment by using outcome data from participants already in the trial. Compared with a standard clinical trial, an RAR study design has the potential to improve patient participation in acute stroke trials.
  
  
  METHODS
  This cross-sectional randomized survey included adult emergency department patients, age≥18, without symptoms of stroke or other critical illness. A standardized protocol was used, and subjects were randomized to either an RAR or standard hypothetical acute stroke trial. After viewing the video describing the hypothetical trial (http://youtu.be/cKIWduCaPZc), reviewing the consent form, and having questions answered, subjects indicated whether they would consent to the trial. A multivariable logistic regression model was fitted to estimate the impact of RAR while controlling for demographic factors and patient understanding of the design.
  
  
  RESULTS
  A total of 418 subjects (210 standard and 208 RAR) were enrolled. All baseline characteristics were balanced between groups. There was significantly higher participation in the RAR trial (67.3%) versus the standard trial (54.5%), absolute increase: 12.8% (95% confidence interval, 3.7-22.2). The RAR group had a higher odds ratio of agreeing to research (odds ratio, 1.89; 95% confidence interval, 1.2-2.9) while adjusting for patient level factors. Trial designs were generally well understood by the participants.
  
  
  CONCLUSIONS
  The hypothetical RAR trial attracted more research participation than standard randomization. RAR has the potential to increase recruitment and offer benefit to future trial participants.
authors.affiliation: From the University of Michigan Medical School, Ann Arbor (J.S.T.); and Department of Emergency Medicine (W.J.M.) and Department of Neurology (W.J.M.), University of Michigan Health System, Ann Arbor.
authors.forename: Jason S
authors.initials: JS
authors.lastname: Tehranisa
authors.affiliation: From the University of Michigan Medical School, Ann Arbor (J.S.T.); and Department of Emergency Medicine (W.J.M.) and Department of Neurology (W.J.M.), University of Michigan Health System, Ann Arbor. wmeurer@med.umich.edu.
authors.forename: William J
authors.initials: WJ
authors.lastname: Meurer
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D006801:Humans; D007258:Informed Consent / Q000592:standards*; D010358:Patient Participation / Q000523:psychology; D016032:Randomized Controlled Trials as Topic / Q000592:standards*; D012107:Research Design / Q000592:standards*; D020521:Stroke / Q000628:therapy*
keywords: cerebrovascular accident, acute; emergency medicine; stroke, acute; tissue plasminogen activator