Trials often do not succeed in including as many patients as anticipated beforehand. The aim of this paper was to describe why we were not able to include more than a few patients in our randomized controlled treatment trial on the effectiveness of bracing patients with idiopathic scoliosis, and to describe which lessons can be learnt. A pilot study on the willingness to participate in such a trial was conducted amongst 21 patients and their parents. A description of how we prepared and designed this trial, the problems we faced and how we tried to improve the inclusion are given. A total of four patients were included, and 14 refused to participate in an 18-month period. There were a lot less eligible patients than anticipated (40 instead of 100 per year), and the patients' participation rate was much lower than we had found in our pilot study (21% instead of 70%). The trial failed to include more than a few patients because of an overestimation of the number of eligible patients and because a lot less eligible patients were willing to participate compared to our pilot study. One reason for a low participation rate could be that this trial evaluated a frequently used existing treatment instead of a new treatment, and patients and parents might be afraid of not being treated (despite an intensive secure system for the control arm).

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Keywords Brace, Idiopathic scoliosis, Randomized controlled trial, Treatment
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Journal European Spine Journal
Bunge, E.M, Habbema, J.D.F, & de Koning, H.J. (2010). A randomised controlled trial on the effectiveness of bracing patients with idiopathic scoliosis: Failure to include patients and lessons to be learnt. European Spine Journal, 19(5), 747–753. doi:10.1007/s00586-010-1337-6