Challenges of Recruiting Patients Into Group-Based Stroke Rehabilitation Research: Reflections on Clinician Equipoise Within the Singing for People With Aphasia (SPA) Pilot Trial

Recruitment into clinical trials is a major challenge (McDonald et al., 2006; Sully et al., 2013; Amstutz et al., 2017; Walters et al., 2017). Recruitment that is too slow can lead to trials being halted and new, promising interventions abandoned (Amstutz et al., 2017). This has the concomitant effects of wasting participants’ time, research funding, and clinical resource, none of which sits well ethically. Where clinical populations are the focus of trials (such as a physical rehabilitation intervention for stroke survivors, or an online CBT programme for anxiety and depression), multiple sources are often utilized to recruit participants into research (e.g., patient lists, community groups, media-advertisements, disease-specific support programmes). Clinicians themselves often adopt a “gatekeeper” role, ultimately deciding whether or not to recommend a trial to their patients. Clinicians can therefore play a fundamental role in the success or failure of recruitment.

In this paper, we reflect on our experiences of the recruitment process during the recently-reported Singing for People with Aphasia (SPA) pilot feasibility Randomized Controlled Trial (RCT) (Tarrant et al., 2018). The project was completed successfully (Tarrant et al., 2021) and there was overwhelming support and positivity from clinicians (Speech and Language Therapists; SLTs), without which the study would not have succeeded. However, there were some challenges which considerably slowed participant recruitment. These issues will be of interest to behavioral scientists, trial managers, and other researchers who need to work with clinicians when recruiting to RCTs.