Introduction
poststroke, death, cognitive impairment, Stroke, stroke, disability, intracranial stenting, major functional disabilities, USN, cerebral lesion, hemisphere strokes, Cognitive impairment
STROKE, RECRUITMENT, STROKE
There is a high demand for stroke rehabilitation in the Brazilian public health system, but most studies that have addressed rehabilitation for unilateral spatial neglect (USN) after stroke have been performed in high-income countries. Therefore, the aim of this study was to analyze USN patient recruitment in a multicenter noninvasive brain stimulation clinical trial performed in Brazil and to provide study design recommendations for future studies. We evaluated the reasons for exclusion of patients from a multicenter, randomized, double-blinded clinical trial of rehabilitation of USN patients after stroke. Clinical and demographic variables were compared between the included and excluded patients. A descriptive statistical analysis was performed. Only 173 of the 1953 potential neglect patients (8.8%) passed the initial screening. After screening evaluation, 87/173 patients (50.3%) were excluded for clinical reasons. Cognitive impairment led to the exclusion of 21/87 patients (24.1%). Low socioeconomic status led to the exclusion of 37/173 patients (21.4%). Difficulty obtaining transportation to access treatment was the most common reason for their exclusion (16/37 patients, 43.3%). The analyzed Brazilian institutions have potential for conducting studies of USN. The recruitment of stroke survivors with USN was restricted by the study design and limited financial support. A history of cognitive impairment, intracranial stenting or craniectomy, and lack of transportation were the most common barriers to participating in a multicenter noninvasive brain stimulation trial among patients with USN after stroke.Stroke is the second leading cause of death and disability worldwide, mainly occurring in low- and middle-income countries (USN designates a consistent, exaggerated spatial asymmetry in processing information in peri-personal and/or extra-personal space due to an acquired cerebral lesion, more frequently associated with right hemisphere strokes (Many individuals with USN after stroke have major functional disabilities as well as decreased rates of adherence to rehabilitation programs and independence in self-care skills (The development of rehabilitation strategies that are more cost-effective and accessible to the entire population has been a major objective of research related to the rehabilitation of poststroke patients in low- and middle-income countries. Based on this premise, it is essential to conduct clinical studies with feasible treatment strategies in developing countries so that evidence-based services can be structured taking into account the personal, social, and demographic characteristics of the population. Clinical study protocols should be developed to identify and understand the difficulties in recruitment and the reasons for participant exclusion in low- and middle-income countries. Therefore, this study aimed to identify the characteristics and main barriers to patient participation in a research protocol performed in a developing country.