Practical Aspects of Repeated Measures Stroke Research: Recruitment, Resources, Time Frames and Survey Instruments

ABSTRACT
Background & Purpose: Systematic reviews of discharge planning interventions for stroke patients consistently fail to demonstrate strong evidence of effectiveness. This is commonly related to methodological inadequacies of the primary studies. This pilot study explored the feasibility and costs of conducting methodologically sound research using repeated data collection to determine acute stroke patients’ wellbeing following hospital discharge. Methods: Researcher time was costed for the tasks of obtaining ethics permission, recruiting, obtaining consent, and retaining patients for two interviews. Recruitment occurred over 15 weeks from a tertiary hospital stroke unit. At both interviews, a semi-structured interview and four assessment instruments were administered (Nottingham Leisure Questionnaire (NLQ), Stroke-Adapted Sickness Impact Profile (SASIP), Geriatric Depression Screening Scale (GDSS), and the Orientation-Concentration-Memory Test (OCMT)). Changes in group scores assisted in sample size calculations. Results: It cost approximately $240 and took 1.7 weeks to recruit and consent each patient (with or without care taker). All assessment instruments were readily completed by telephone interview, although patients expressed frustration with some OCMT questions. NLQ and SASIP were the most sensitive for this sample, and based on change over time in these instruments, at least 60 patients are required in each arm for a well-powered intervention study. Conclusion: The real costs of planning research, recruiting patients, and collecting data should be recognized when budgeting for research into stroke outcomes post-discharge. Well-powered stroke follow-up studies require multi-site commitment and consistent researcher presence on the ward. It is recommended that a battery of questions are drawn from the four assessment instruments, and validated for telephone administration, to minimize respondent burden.