Skip to main content
NCBI home page
NIHPA Author Manuscripts logoLink to NIHPA Author Manuscripts
. Author manuscript; available in PMC: 2018 Apr 20.
Published in final edited form as: Int J Clin Trials. 2017 Apr-Jun;4(2):72–79. doi: 10.18203/2349-3259.ijct20171917

STRATEGIES TO ENHANCE RECRUITMENT METHODS IN PHANTOM LIMB PAIN CLINICAL TRIALS

Camila Bonin Pinto 1,2,*, Faddi Ghassan Saleh Vélez 1,*, Melanie N French 1, Dian Zeng 1, David Crandell 3, Nadia Bolognini 4,5, Lotfi B Merabet 6, Felipe Fregni 1
PMCID: PMC5909712  NIHMSID: NIHMS956595  PMID: 29683138

Abstract

Phantom Limp Pain (PLP) was first described in 1551. To date, its mechanisms and novel interventions remain mostly untested. Only limited conclusions can be drawn from few and small randomized clinical trials (RCTs) on PLP. In this scenario, recruitment strategies are crucial in order to overcome inherent challenges to recruit PLP subjects for clinical trials. Although there are many methods to enhance recruitment and also retention, in this article we discuss these methods based on a common topic: dissemination. We summarize and discuss 10 strategies of recruitment related to the dissemination of information based on the notion that an increase in trial awareness may lead to both increased recruitment and also increased external generalizability. In addition, in our discussion we included insights based on our experience recruiting PLP patients for our large NIH-sponsored clinical trial. Although specific regulatory considerations need to be considered when choosing the methods of recruitment, which may vary across different countries and Institutional Review Boards (IRBs), these strategies may be applicable to most of research settings.

INTRODUCTION

Phantom Limb Pain (PLP) is a painful sensation resulting from maladaptive changes in central and peripheral systems that take place after a limb amputation1,2. In the United States, the incidence of upper- or lower-limb amputations is approximately 185,000 per year. Among these amputees, it is estimated that 60% to 80% will experience PLP1,3. Additionally, most of the prospective studies show that this pain is persistent with the vast majority of amputees reporting only a mild decrease in pain intensity even 2 years after the amputation (5 to 10%). Therefore, PLP remains as a significant clinical problem that impairs quality of life3.

PLP is a type of neuropathic pain that is usually refractory to treatment. One of the reasons is the lack of mechanistic trials investigating the neural correlates of PLP. Such information is best collected in randomized clinical trials. Indeed, in the fields of rare diseases (i.e. porphyria, amyloidosis, gaucher disease, etc) as well as in other more prevalent conditions such as lung cancer (leading cause of cancer related mortality in the United states) in elderly populations, lack of efficient number of clinical trials led to a delay in developing novel treatments for those conditions4–8. In addition, another example is seen in the field of nephrology, that is among the clinical subspecialties with fewer amount of well designed RCTs, in particular due to the small number of potential patients that are interested in participating in a research study5,8–10. Similarly, although a few trials have been conducted in PLP, they are mostly small and underpowered clinical trials.

One of the reasons for the lack of clinical trials in PLP is the challenge for recruitment in this population. Despite the relative high prevalence and incidence of PLP, other factors, such as mobility, stability, prosthesis selection therapy, can affect recruitment. In addition, other clinical aspects such as severity and frequency of pain episodes; previous pain related diseases and comorbidities can also lead to slow recruitment rates and inability to reach the target sample size11.

In fact, we have designed and started the conduction of a relatively large clinical trial in PLP sponsored by NIH to understand the neural mechanisms and test a new intervention for pain12. Given our experience in this trial, we propose and discuss 10 strategies of recruitment based on a common topic: dissemination. We discuss challenges and potential benefits of such strategies related to enhancing awareness of the trial.

STRATEGY 1: NEWSPAPER AND MAGAZINE ADS

Raising awareness among the general population is an essential step for a successful recruitment plan. In this regard, print advertisements, such as newspaper and magazine ads, have become a primary option for many research studies13. This is an excellent strategy to reach a broader population, and have shown promising results for diseases that have a high prevalence. As an example, a study recruiting subjects with diagnosis of type II diabetes, reported state and local print advertisements to be second and third most effective recruitment strategies employed respectively, recruiting up to 41% of their subjects14.

Even though patient’s motivation to participate in clinical research may vary, a study by McDonald et.al. showed that 16% of the adults would consider participating in an RCT if they have contact with the trial information. In addition to that, two different studies aiming to identify the primary learning sources that patients utilize in order to consider their participation in clinical trials showed that reading materials regarding the study procedures influenced about 41% of potential subjects11,15.

Although sometimes it can be effective, other times the yield rate is poor, as ads target a broad population. Recruitment is especially challenging for PLP studies when compared to recruiting for other pain syndromes, as PLP has a relatively low prevalence16.

One point of consideration is whether to promote ads only in newspapers and magazines that amputees will read or also the general population. Given that PLP is a unique population that might have mobility limitations, they may access to fewer publications distributed in public transportation locations and on street-corners. However, family and friends of PLP subjects may also transmit this information. There is little data showing whether also targeting a general population would be beneficial.

A particular option for targeting PLP subjects is the inMotion Magazine published by the Amputee Coalition17. This nationally distributed magazine can reach a large amount of potential eligible participants; however, it cannot target specific locations near the study center. Other options include local, state specific, and regional print distributions that are available in the research center area. As an example, for Boston based studies the New England Amputee Association prints newsletters that are distributed in local meetings18.

STRATEGY 2: ONLINE AND SOCIAL MEDIA ADS

Similar to print advertisements, online ads and social media are a convenient and cost effective recruitment method to reach a large population. Nowadays, internet and social media have become a primary source of information. Approximately 87% of adults in the United States utilize internet as primary method to acquire information and 76% of them use social networking sites19. Compared to traditional strategies, such as newspaper advertisement, which is limited by space and time, online ads are more flexible20, cost-effective, time-efficient, and easy to implement21. In particular, a review by Topolovec-Vranic in 2016 reported that 6 out of 8 studies targeting hard-to-reach populations found this to be the most effective method of recruitment22.

However, there are specific drawbacks that can affect this type of recruitment strategy. One of those is the existence of multiple competing online advertisements. Therefore, it is important to assess the successful rate of clicks and rate of contact in order to evaluate its efficacy and perform pertinent modifications when necessary.

Although there may not be specific considerations for online ads and social media for PLP trials, adequate strategy should include actions such as: (1) use of simple and clear sentences to illustrate key aspects of the trial improving comprehension and readability; (2) use of graphics and videos to reach an increasing visual-based audience; (3) continued monitoring of the reached population23,24.

STRATEGY 3: MASS CAMPAIGN WITH FLYERS

Additional broad-base recruitment strategies are flyers and brochures, which are low cost and relatively low effort. However, similar to other broad-base recruitment strategies, it is less effective for recruitment of clinical populations, especially those with low prevalence. This strategy may be useful to enhance awareness of family members and friends and may represent the first contact with trial information for patients with PLP. A study in subacute and chronic low back pain showed that about 3% of enrolled subjects had their first contact with the study through posted flyers25.

In the same way, it is important to identify the target population profile in order to define the wide of distribution in order to optimize time efficiency. In the case of PLP population, amputee clinics, support groups and prosthetic companies are adequate locations to distribute flyers. In addition, study staff can be encouraged to place flyers in community areas that receive high traffic, such as designated public transportation areas, libraries, community centers and gyms. A study utilizing flyers in high traffic areas (near hospital elevators) showed to be among the most effective strategies26. Although flyer distribution may seem straightforward, training research team to develop and select target locations can be a difficult task. Therefore, it is worth spending time training and implement flyer recruitment strategies.

STRATEGY 4: DEVELOPING A BLOG/WEBSITE

Social media dissemination through blogs or websites is a concept that has been recently more explored since it enables wide dissemination throughout different population. On the other hand, most articles argue that even though this generates a large amount of interested participants, the actual yield is usually very low24,27. It is only when the study generates topics of “human interest” that social media is effective; therefore a mass campaign of online dissemination could be effective for enrollment only when captivating and media-appropriated materials are created in regards of the research topic. However, in order to achieve efficient results, it requires a large dedication of time by the research staff13,28.

A website or blog may be useful to disseminate information for PLP subjects. In fact, a blog discussing topics related to PLP would also be useful, such topics should be: (1) aspects of daily living of an amputee with PLP; (2) theories that explain the underlying mechanism of PLP; (3) general problems that an amputee might encounter in acute and chronic phase post amputation; (4) tips for adequate care of the stump or prosthesis.

There are several easy resources to help with blogging, such as Facebook page blog, in which weekly or biweekly posts are uploaded discussing topics related with pain, PLP and amputees. The main goal is to produce updated posts and discussions as well as open forums that allow readers to solve questions and enquires. Moreover, easy templates for website creation can also help to create more customized websites. Such websites and blogs may help to enhance communication with PLP subjects; being a source for patients and clinicians.

STRATEGY 5: DISSEMINATION THROUGH PHONE CALLS

Phone calls are a method that provides direct communication with potential participants; however, due to IRB regulations, the patient must be the first to establish contact using this method.

The vast majority of Institutional Review Boards (IRBs) do not allow researchers to “cold call” potential participants; therefore, this cannot be adopted as a recruitment strategy. However, this method may be relevant to establish a bridge of communication after the research group is initially approached by a potential participant or a subject consents to be called. This may be particularly useful for the PLP patients, who would not require leaving their home to have access to the study information, which was already proven to be efficacious in other trials with populations with mobility difficulties29.

Despite the advantages of a direct phone contact, some challenges exist. It may not be easy to reach participants during normal business hours. In addition, when talking on the phone social cues are hard to interpret. Also, it may be more difficult to explain complex information over the phone.

To overcome these potential communication barriers, one suggestion is to use a simple telephone script with plain language. This will help to guide the call and assure that the information is consistently and accurately communicated. Although this is a useful method, it is relevant to point out that in person first-contact can double the response rate by phone call30. In addition, although online methods have substituted the need for regular calls, this method should not be underappreciated.

STRATEGY 6: TARGETED CAMPAIGN TO SUPPORT GROUPS

Targeted campaign to support groups is among the most effective methods of recruitment31. This strategy allows one to one communication with the target population; researchers can respond to questions and concerns by clarifying aspects of the trial in person, which may help participants feel more confident to make the decision to enroll in the trial. In order to get a patient’s attention, it is encouraged not just to discuss the trial but to increase the awareness of the condition that is being studied32,33. However, it may not be easy to schedule support group meetings presentations; in addition, many meetings many have low turn-out rates34.

In regards to our trial, the New England area has the following support groups: (1) New England Amputee Association (NEAA); (2) COP Amputee Association (COPAA); (3) Amputee Networking group at UMass Memorial Medical Center; (4) Limb Loss support group at Clinton Hospital, MA; (5) Support group at Kent hospital; (6) Spaulding Rehabilitation Hospital support group. We have performed several talks and received a number of follow-up calls. From these meetings, there was one subject that enrolled in the trial. However, this strategy is extremely time demanding and costly.

An adequate plan of action is to establish close communication and frequent follow-up with support group administrators as well as to participate in the events organized for the groups. Active participation in numerous support groups ensures an increase in the reached population.

STRATEGY 7: DISSEMINATION TO THERAPISTS

Physical therapists are at the frontline working with amputees with or without phantom limb patients, with many reporting spending 80% of their time with direct patient care35. Therefore, making them great proxies to give information about a given study36.

Nevertheless, in some cases health care providers are not familiarized with clinical trials methodology or the details of a specific study, thus increasing the difficulties explaining study information to potential trial participants. In addition, as they have competing interests and clinical responsibilities35, research may be viewed as additional work.

In this context, providing adequate training that includes clear explanation of all study procedures, and sharing trial information and preliminary results, as well as frequent follow up meetings seems to be a feasible practice that could overcome potential difficulties and may optimize enrollment rates. Training methods might include educational presentations and seminars as well as group meetings.

In addition, others strategies, such as: (1) payment of protected research time; (2) the inclusion in particular trial procedures; (3) continuing education credits after attending research presentations or (4) the invitation to collaborate in publications. In this regard, Kenyon and collaborators showed that increasing training time and payment of protected research time could increase on average 69% of the recruitment rates when compared with the same rates 6 months prior to this modification; therefore, increased training can be a feasible solution to improve recruitment rates in clinical trials37.

A potential strategy to enhance this relationship is to increase active participation in study procedures as well as the providing weekly thank you notes, prizes for best recruiter, and emails reminders.

STRATEGY 8: DISSEMINATION TO CLINICIANS

Clinicians represent an excellent source of potential eligible participant referral, since patients usually pay more attention to health care providers. However, recent data showed a lack of communication between the research staff and clinical practitioners38,39. This lack in communication increases the challenges to improve the dissemination of the components of novel trials40.

Clinician’s lack of time is the principal factor that can hinder recruitment, as most physicians already have a backed up schedule with between appointments, rounds, and other duties of their work38. Moreover, there is also a group of clinicians that may lack interest to collaborate in clinical research.

Nonetheless, particular efforts should be given to improving clinician’s collaboration as current the literature shows bigger enrollment rates in studies in which the physician provided information in an understandable language and built a trustable relationship with potential participants38.

Clinician’s primary specialty interest may be an important factor to facilitate this process. In our trial, we plan to continue targeting physiatrists, neurologists and anesthesiologists involved in the management of chronic and neuropathic pain; in addition, other groups, such as orthopedic, vascular and trauma surgeons that are in direct contact with this population will remain as a target of consideration. Therefore, a strategy will be to increase their involvement through activities, such as ground rounds talks and department presentations41,42.

Discussions about protected time to execute research in the case of residents can be fundamental and also facilitate this collaboration. Moreover, the development of academic projects involving residents and observers/students can enhance the interest and be beneficial for both sides.

STRATEGY 9: DISSEMINATION TO SPECIFIC CLINICS

Outpatient clinics are another example of particularly specific methods of dissemination and have shown superior results in terms of recruitment. Due to the specificity of this method, a greater volume of potential participants can be given information about the trial43,44

Key points to facilitate recruitment include establishing a good relationship with clinics and a clear explanation of the research methods. For instance, IRB approved strategies in which a co-investigator stays in the clinic for potential subjects interested in learning more may decrease the amount of time that physicians spend on the trial and enhance effectiveness of this strategy. In addition, other methods such as constant communication with clinics collaborating with the trial is also very important45,46.

STRATEGY 10: DISSEMINATION IN PLP CONFERENCES

The final strategy for dissemination is through medical conferences. This is a great opportunity to network with potential health care providers in the field and also to enhance awareness of the trial. The research group needs to monitor the calendar of national and international meetings, participating with posters and oral presentation. Researcher groups can also contact conference organizers in order to check whether and how it is possible to promote clinical trials and sponsor the recruitment among colleagues. Also in some of these conferences, there is also participation of patients who may be interested in learning more about a prospective trial47.

For the particular case of PLP, the Amputee Coalition National Amputee conference is an example of an important event in which patients and clinicians get together to discuss the main problems and solutions facing the amputee community48. Even though potential collaboration and interest may not be from local research groups or patients, it is still important to develop this strong network as usually subjects also contact different health care providers in various locations.

In addition, local meetings in rehabilitation, pain and neurology may be useful for PLP. For instance, Massachusetts Neurological Association (MNA) annual meeting 201749; Hawkathon digital health50; Spaulding Rehabilitation Hospital Hackathon51; American Academy of Neurology annual meeting 2017 in Boston52.

DISCUSSION

According to the NIH, about 80% of the clinical trials in the US missed their timelines and patient’s recruitment and enrollment are the primary causes of this delay. This setback increases research costs, and can delay the approval of the therapeutic intervention under investigation45,46. This is an even a bigger problem for conditions in which there is no established guidelines of treatment, such as phantom limb pain. In this context, different strategies of recruitment can be used to increase enrollment and prevent delays in clinical trials. However, existing literature point out to the fact that most of RCTs lack standardized recruitment plans; therefore, jeopardizing the process efficacy. In addition, the cost effectiveness of each strategy needs to be considered (Figure 1); even strategies with higher cost and lower effectiveness should be considered whenever a wide dissemination strategy is recommended for optimizing recruitment efforts.

Figure 1.

Figure 1

Open in a new tab

Relationship between Recruitment Costs and Efforts

The effectiveness of the recruitment methods seems to be proportional to the amount of information reaching potential subjects. In fact, here we reviewed 10 strategies to disseminate information about a given study. We believe that the information about the trial need to reach not only subjects and health care providers but a larger community that may also be related to the PLP subjects for instance family members and friends. We therefore built a scheme correlating the strategy of dissemination with the targeted group (Figure 2).

Figure 2.

Figure 2

Open in a new tab

Strategy of dissemination and target group

We propose that the frequent assessment of each recruitment strategy is an essential step to improve the recruitment plan and perform adjustment to overcome difficulties throughout the development of the study. Although these methods are challenging for clinical trials with other populations, specific characteristics of the PLP population add extra barriers that require to be addressed with additional care.

In the past year, our research group have been testing and implementing these strategies. According to current literature, this is in agreement with recent guidelines for recruitment; nevertheless, assessing and revising the methods and their efficacy is an important step to any successful recruitment plan. In this review, we aimed to put all these strategies in the context of a main theme: dissemination.

Each of the presented methods might require periodic adjustments based on analysis of the time spent versus the yield resulted. Therefore, it will be possible to identify most effective strategies, as well modifying less effective ones. Moreover, none of these methods will likely be effective by themselves, so a multi- targeted approach is the most accurate design towards a successful recruitment plan.

Recruitment teams have to consider that this multi-targeted approach is usually time demanding and the results will be seen in a longer period of time. Therefore, organization and frequent assessment of the methods are essential for the success of recruitment. In addition, someone needs to “see a message” about a study 3 to 4 times before they decided to learn more and about 9 times before they act on it53. Therefore, keeping a strong dissemination strategy regardless of short-term gains is essential.

Despite the availability of a large amount of literature that shows a high incidence level for PLP among amputees (about 60 – 80%)3, the recruitment yield (meaning those who are interested in the trial and those who ended up enrolling) is still small, between 5 to 10%. In addition to that, there are other competing needs for PLP subjects such as mobility, balance as well as concomitant problems inherent to the amputation (neuromas, heterotopic ossification, infection, reopening of amputation wound) that may require more of their personal time to address and prevent them to participate in a pain trial. The most important action for a researcher planning a PLP trial is to anticipate to these problems, budget the necessary resources and develop a strong plan of dissemination to enhance recruitment.

Acknowledgments

Funding: This research was supported by an NIH RO1 grant (1R01HD082302-01A1). We thank all the participants of the clinical trials and colleagues who collaborate raising efforts and awareness in regards of clinical research.

Footnotes

Conflict of interest: The authors followed the International Committee or Journal of Medical Journals Editors (ICMJE) form for disclosure of potential conflicts of interest. All listed authors concur with the submission of the manuscript. The final version has been approved by all authors. The authors have no financial or personal conflicts of interest.

References

  • 1.Ziegler-Graham K, MacKenzie E, Ephraim P, Travison T, Brookmeyer R. Estimating the prevalence of limb loss in the United States: 2005 to 2050. Arch Phys Med Rehabil. 2008;89(3):422–9. doi: 10.1016/j.apmr.2007.11.005. [DOI] [PubMed] [Google Scholar]
  • 2.Dillingham TR, Pezzin LE, Mackenzie EJ. Limb Amputation and Limb Deficiency: Epidemiology and Recent Trends in the United States. South Med J. 2002;95(8):875–84. doi: 10.1097/00007611-200208000-00018. [DOI] [PubMed] [Google Scholar]
  • 3.Flor H. Phantom-limb pain: Characteristics, causes, and treatment. Lancet Neurol. 2002;1(3):182–9. doi: 10.1016/s1474-4422(02)00074-1. [DOI] [PubMed] [Google Scholar]
  • 4.Rao A, Sharma N, Gajra A. Management of lung cancer in the elderly. Cancer Treatment and Research. 2016:251–84. doi: 10.1007/978-3-319-40389-2_12. [DOI] [PubMed] [Google Scholar]
  • 5.Volkow ND, McLellan AT. Opioid Abuse in Chronic Pain – Misconceptions and Mitigation Strategies. N Engl J Med. 2016;374(13):1253–63. doi: 10.1056/NEJMra1507771. [DOI] [PubMed] [Google Scholar]
  • 6.Bell SA, Tudur Smith C. A comparison of interventional clinical trials in rare versus non-rare diseases: an analysis of ClinicalTrials.gov. Orphanet J Rare Dis. 2014;9:170. doi: 10.1186/s13023-014-0170-0. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 7.Jonker AH, Mills A, Lau LPL, Ando Y, Baroldi P, Bretz F, Burman CF, Collignon O, et al. Small Population Clinical Trials Task Force Workshop Report and Recommendations: July 2016 Small Population Clinical Trials: Challenges in the Field of Rare Diseases. 2016 [Google Scholar]
  • 8.ISR Reports. The Expanding Web of Clinical Trial Patient Recruitment–read this. 2014 Available from: http://www.isrreports.com/wp-content/uploads/2014/04/ISR-The-Expanding-Web-of-Clinical-Trial-Patient-Recruitment-Whitepaper.pdf. Accessed 4 February 2017.
  • 9.Rosner BMH, Fervenza FC, Bunchman TE. Randomized Clinical Trials: Why is Nephrology so Far Behind? 2008:5–6. [Google Scholar]
  • 10.Strippoli GFM. The Number, Quality, and Coverage of Randomized Controlled Trials in Nephrology. J Am Soc Nephrol. 2004;15(2):411–9. doi: 10.1097/01.asn.0000100125.21491.46. [DOI] [PubMed] [Google Scholar]
  • 11.McDonald AM, Knight RC, Campbell MK, et al. What influences recruitment to randomised controlled trials? A review of trials funded by two UK funding agencies. Trials. 2006;7:9. doi: 10.1186/1745-6215-7-9. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 12.Pinto CB, Saleh Velez FG, Bolognini N, Crandell D, Merabet LB, Fregni F. Optimizing Rehabilitation for Phantom Limb Pain Using Mirror Therapy and Transcranial Direct Current Stimulation: A Randomized, Double-Blind Clinical Trial Study Protocol. JMIR Res Protoc. 2016;5(3):e138. doi: 10.2196/resprot.5645. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 13.Frandsen M, Thow M, Ferguson SG. The Effectiveness Of Social Media (Facebook) Compared With More Traditional Advertising Methods for Recruiting Eligible Participants To Health Research Studies: A Randomized, Controlled Clinical Trial. JMIR Res Protoc. 2016;5(3):e161. doi: 10.2196/resprot.5747. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 14.Miller EG, Nowson CA, Dunstan DW, et al. Recruitment of older adults with type 2 diabetes into a community-based exercise and nutrition randomised controlled trial. Trials. 2016;17:12. doi: 10.1186/s13063-016-1589-5. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 15.Nanji A. Newspaper Readership Trends by Platform and Age. marketingprofs [Google Scholar]
  • 16.Hapca A, Jennings CG, Wei L, Wilson A, Macdonald TM, Mackenzie IS. Effectiveness of newspaper advertising for patient recruitment into a clinical trial. Br J Clin Pharmacol. 2014;77(6):1064–72. doi: 10.1111/bcp.12262. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 17.Amputee Coalition. inMotion Magazine. 2017 Available from: http://www.amputee-coalition.org/limb-loss-resource-center/publications/inmotion/. Acessed 5 February 2017.
  • 18.New england amputee association. New England Amputee Association. 2013 Available from: http://www.newenglandamputeeassociation.com/. Accessed 10 February 2017.
  • 19.Social Networking Use. Pew Research Center. Available from: http://www.pewresearch.org/data-trend/media-and-technology/social-networking-use/. Accessed 25 January 2017.
  • 20.Frandsen M, Walters J, Ferguson SG. Exploring the viability of using online social media advertising as a recruitment method for smoking cessation clinical trials. Nicotine Tob Res. 2014;16(2):247–51. doi: 10.1093/ntr/ntt157. [DOI] [PubMed] [Google Scholar]
  • 21.Beneld JA, Szlemko WJ. Internet- based data collection: Promises and realities. Journal Res Pract. 2006;2(2) [Google Scholar]
  • 22.Topolovec-Vranic J, Natarajan K. Use of Social Media in Recruitment for Medical Research Studies: A Scoping Review. J Med Internet Res. 2016;18(11):e286. doi: 10.2196/jmir.5698. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 23.Graham AL, Milner P, Saul JEPL. Online Advertising as a Public Health and Recruitment Tool: Comparison of Different Media Campaigns to Increase Demand for Smoking Cessation Interventions. J Med Internet Res. 2008;10(5):e50. doi: 10.2196/jmir.1001. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 24.Madden M. PEW Internet & American Life Project (Data Memo) 2006 Mar;:1–5. 2001. [Google Scholar]
  • 25.Hondras MA, Long CR, Haan AG, Spencer LB, Meeker WC. Recruitment and enrollment for the simultaneous conduct of 2 randomized controlled trials for patients with subacute and chronic low back pain at a CAM research center. J Altern Complement Med. 2008;14(8):983–92. doi: 10.1089/acm.2008.0066. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 26.Kelechi TJ, Watts AWJ. Recruitment strategy effectiveness for a Ostomy, cryotherapy intervention for a venous leg ulcer prevention study. J Wound Ostomy Cont Nurs. 37(1):39–4. doi: 10.1097/WON.0b013e3181c68ca4. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 27.Gossen Rahlyn. How Clinical Research Sites Can Engage Patients Using Facebook. Available from: https://rebarinteractive.com/clinical-research-sites-engage-patients-facebook/. Accessed 29 January 2017.
  • 28.Ramo DE, Rodriguez TMS, Chavez K, Sommer MJ, Prochaska JJ. Facebook recruitment of young adult smokers for a cessation trial: Methods, metrics, and lessons learned. Internet Interv. 2014;1(2):58–64. doi: 10.1016/j.invent.2014.05.001. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 29.DiGuiseppi C, Goss C, Xu S, Magid D, Graham A. Telephone screening for hazardous drinking among injured patients seen in acute care clinics: feasibility study. Alcohol Alcohol. 2006;41(4):438–45. doi: 10.1093/alcalc/agl031. [DOI] [PubMed] [Google Scholar]
  • 30.Harris LE, Tierney WM. Assessing inner-city patients’ hospital experiences. A controlled trial of telephone interviews versus mailed surveys. Med Care. 1997;35(1):70. doi: 10.1097/00005650-199701000-00006. [DOI] [PubMed] [Google Scholar]
  • 31.Akhtar S, Gladson B. Type 2 Diabetes CommunityBased Recruitment Strategies. Appl Clin Trials. 2013;22(6) [Google Scholar]
  • 32.Cheng KF, Leung PC, Wong LY, Fong YS. Patient recruitment for clinical trials on traditional Chinese medicine: Challenges, barriers, and strategies. Patient Prefer Adherence. 2008;2:207–13. doi: 10.2147/ppa.s3400. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 33.Goodman L, Sia C, Carnes R, et al. Advocacy recruiting for Huntington’s disease clinical trials. PLoS Curr. 2011 doi: 10.1371/currents.RRN1230. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 34.Merkel PA, Manion M, Gopal-Srivastava R, et al. The partnership of patient advocacy groups and clinical investigators in the rare diseases clinical research network. Orphanet J Rare Dis. 2016;11(1):66. doi: 10.1186/s13023-016-0445-8. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 35.Blanton S, Morris DM, Prettyman MG, et al. Lessons learned in participant recruitment and retention: the excite trial. Phys Ther. 2006;86(11):1520–33. doi: 10.2522/ptj.20060091. [DOI] [PubMed] [Google Scholar]
  • 36.Scianni A, Teixeira-Salmela LF, Ada L. Challenges in recruitment, attendance and adherence of acute stroke survivors to a randomized trial in Brazil: a feasibility study. Rev Bras Fisioter. 2012;16(1):40–5. doi: 10.1590/s1413-35552012000100008. [DOI] [PubMed] [Google Scholar]
  • 37.Kenyon S, Rhodes ATD. A recipe for successful recruitment to a randomised controlled trial. MDIRS Midwifery Dig. 2005;15:16–9. [Google Scholar]
  • 38.Albrecht TL, Eggly SS, Gleason MEJ, et al. Influence of clinical communication on patients’ decision making on participation in clinical trials. J Clin Oncol. 2008;26(16) doi: 10.1200/JCO.2007.14.8114. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 39.Wade J, Donovan JL, Lane JA, Neal DE, Hamdy FC. It’s not just what you say, it’s also how you say it: opening the “black box” of informed consent appointments in randomised controlled trials. Soc Sci Med. 2009;68(11):2018–28. doi: 10.1016/j.socscimed.2009.02.023. [DOI] [PubMed] [Google Scholar]
  • 40.Fletcher B, Gheorghe A, Moore D, Wilson S, Damery S. Improving the recruitment activity of clinicians in randomised controlled trials: a systematic review. BMJ Open. 2012;2(1):e000496. doi: 10.1136/bmjopen-2011-000496. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 41.Newington L, Metcalfe A. Factors influencing recruitment to research: qualitative study of the experiences and perceptions of research teams. BMC Med Res Methodol. 2014;14(1):10. doi: 10.1186/1471-2288-14-10. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 42.Comis RL, Miller JD, Colaizzi DD, Kimmel LG. Physician-related factors involved in patient decisions to enroll onto cancer clinical trials. J Oncol Pract. 2009;5(2):50–6. doi: 10.1200/JOP.0922001. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 43.Picillo M, Kou N, Barone P, Fasano A. Recruitment strategies and patient selection in clinical trials for Parkinson’s disease: Going viral and keeping science and ethics at the highest standards. Park Relat Disord. 2015;21(9):1041–8. doi: 10.1016/j.parkreldis.2015.07.018. [DOI] [PubMed] [Google Scholar]
  • 44.Peindl KS, Wisner KL. Successful recruitment strategies for women in postpartum mental health trials. J Psychiatr Res. 2003;37(2):117–25. doi: 10.1016/s0022-3956(02)00086-9. [DOI] [PubMed] [Google Scholar]
  • 45.Carter A, Humphreys L, Snowdon N, et al. Participant recruitment into a randomised controlled trial of exercise therapy for people with multiple sclerosis. Trials. 2015;16(1) doi: 10.1186/s13063-015-0996-3. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 46.Shimizu R, Ogata K, Tamaura A, et al. Clinical trial network for the promotion of clinical research for rare diseases in Japan: muscular dystrophy clinical trial network. BMC Health Serv Res. 2016;16(1):241. doi: 10.1186/s12913-016-1477-4. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 47.Harmsworth S, Turpin S. Creating an Effective Dissemination Strategy: An Expanded Interactive Workbook for Educational Development Projects. TQEF Natl Co-ord Team. 2000 Jul;:1–33. 2000. [Google Scholar]
  • 48.National Conference. amputee coalition. 2017 Available from: http://www.amputee-coalition.org/events-programs/national-conference/. Accessed 15 January 2017.
  • 49.Neuromodulation in Clinical Practice. Massachusetts Neurologic Association; 2017. Available from: http://www.amputee-coalition.org/events-programs/national-conference/. Accessed 15 January 2017. [Google Scholar]
  • 50.Hawkathon Digital Health. Hawkathon Digital Health. 2017 Available from: http://www.hawkathon.org/. Accessed 10 January 2017.
  • 51.Education & training. Spaulding rehabilitation hospital network; 2016. Available from: http://spauldingrehab.org/education-and-training/hackathon/. Accessed 28 January 2017. [Google Scholar]
  • 52.Annual Meeting. American Academy of Neurology; 2017. Available from: https://www.aan.com/conferences/2017-annual-meeting/. Accessed 15 February 2017. [Google Scholar]
  • 53.Vakratsas D, Ambler T. How Advertising Works: What Do We Really Know? J Mark. 1999;63(1):26–43. [Google Scholar]

RESOURCES