Advisory Committee Chair
Elizabeth Barstow
Advisory Committee Members
Emily Riser
Hui-Ju Young
James Rimmer
Tapan Mehta
Document Type
Dissertation
Date of Award
1-1-2025
Degree Name by School
Doctor of Philosophy (PhD) School of Health Professions
Abstract
Background: Recruiting people with multiple sclerosis (PwMS) into research can be a significant challenge. This is often due to limited awareness of the research objectives, lack of accessibility, and restrictive inclusion criteria. In addition to a general reluctance to participate, assessing multiple sclerosis (MS) and assigning appropriate interventions can be challenging due to the heterogeneity of symptoms. Identifying outcome measures that accurately reflect a participant’s perception and functional performance, while remaining sensitive to change across different levels of disability, poses a challenge. Methods: Data from the Tele-Exercise and Multiple Sclerosis (TEAMS) trial was analyzed to identify effective recruitment strategies (Study 1), explore the correlation of a subjective scale with the five performance-based measures at all study timepoints (Study 2), and study the utilization of subjective and objective measures for guiding intervention assignment (Study 3). Results: In Study 1, the engagement framework utilized resulted in more than 1700 PwMS screened, and 759 enrolled in the TEAMS study. In Study 2, the correlation was statistically significant (p<0.001) between the Patient Determined Disease Steps (PDDS) and all the performance-based measures at all time points. A chi-square test with Monte Carlo simulation identified two statistically significant associations between the PDDS scale and the minimal important difference (MCID) with the Dynamic Gait Index (DGI) (p=0.04), and the Five Times Sit to Stand (FTSTS) (p=0.002). Study 3 showed a strong, statistically significant positive correlation between the Timed 25-Foot Walk (T25FW) and PDDS scores (rs = .72, p < .001) as well as a strong positive correlation between T25FW benchmarks (< 6s, 6-7.99s, > 8s, unable to complete) and PDDS modified ranges (0-2, 3-4, 5-6, 7) (rs = 0.73, p < .001). A chi-square test with Monte Carlo simulation showed a significant association between the TEAMS intervention level and the PDDS modified ranges (p= 0.005). Conclusion: Study 1 highlights the importance of engaging stakeholders, clinicians, and organizations in achieving participant enrollment goals. Studies 2 and 3 underscore the value of combining subjective and objective measures for assessment and intervention assignment. Together, these findings emphasize the significance of stakeholder engagement and personalized assessment in advancing MS research.
Recommended Citation
Flemming Tracy, Tracy, "Optimizing Recruitment Strategies, Outcome Measures, and Intervention in Clinical Research with Adults with Multiple Sclerosis: Insights from the Tele-Exercise and Multiple Sclerosis (TEAMS) Study" (2025). All ETDs from UAB. 6835.
https://digitalcommons.library.uab.edu/etd-collection/6835
Comments
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