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Published in: BMC Medical Research Methodology 1/2019

Open Access 01-12-2019 | Research article

The current use of feasibility studies in the assessment of feasibility for stepped-wedge cluster randomised trials: a systematic review

Authors: Caroline A. Kristunas, Karla Hemming, Helen Eborall, Sandra Eldridge, Laura J. Gray

Published in: BMC Medical Research Methodology | Issue 1/2019

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Abstract

Background

Stepped-wedge cluster randomised trials (SW-CRTs) are a pragmatic trial design, providing an unprecedented opportunity to increase the robustness of evidence underpinning implementation and quality improvement interventions. Given the complexity of the SW-CRT, the likelihood of trials not delivering on their objectives will be mitigated if a feasibility study precedes the definitive trial. It is not currently known if feasibility studies are being conducted for SW-CRTs nor what the objectives of these studies are.

Methods

Searches were conducted of several databases to identify published feasibility studies which were designed to inform a future SW-CRT. For each eligible study, data were extracted on the characteristics of and rationale for the feasibility study; the process for determining progression to the main trial; how the feasibility study informed the main trial; and whether the main trial went ahead. A narrative synthesis and descriptive analysis are presented.

Results

Eleven feasibility studies were identified, which included eight completed study reports and three protocols. Three studies used a stepped-wedge design and these were the only studies to be randomised. Studies were predominantly of a mixed-methods design. Only one study assessed specific features related to the feasibility of using a SW-CRT and one investigated the time taken to complete the study procedures. The other studies were mostly assessing the feasibility and acceptability of the intervention.

Conclusion

Published feasibility studies for SW-CRTs are scarce and those that are being reported do not investigate issues specific to the complexities of the trial design. When conducting feasibility studies in advance of a definitive SW-CRT, researchers should consider assessing the feasibility of study procedures, particularly those specific to the SW-CRT design, and ensure that the findings are published for the benefit of other researchers.
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Literature
1.
go back to reference Mdege ND, Man M, Taylor (nee Brown), Celia A, Torgerson DJ: systematic review of stepped wedge cluster randomized trials shows that design is particularly used to evaluate interventions during routine implementation. J Clin Epidemiol 2011, 64(9):936–948. Mdege ND, Man M, Taylor (nee Brown), Celia A, Torgerson DJ: systematic review of stepped wedge cluster randomized trials shows that design is particularly used to evaluate interventions during routine implementation. J Clin Epidemiol 2011, 64(9):936–948.
2.
go back to reference The Gambia Hepatitis Intervention Study. The Gambia hepatitis study group. Cancer Res. 1987;47(21):5782. The Gambia Hepatitis Intervention Study. The Gambia hepatitis study group. Cancer Res. 1987;47(21):5782.
3.
go back to reference Hemming K, Haines TP, Chilton PJ, Girling AJ, Lilford RJ. The stepped wedge cluster randomised trial: rationale, design, analysis, and reporting. BMJ (Online). 2015;350:h391. Hemming K, Haines TP, Chilton PJ, Girling AJ, Lilford RJ. The stepped wedge cluster randomised trial: rationale, design, analysis, and reporting. BMJ (Online). 2015;350:h391.
4.
go back to reference Grayling MJ, Wason JM, Mander AP. Stepped wedge cluster randomized controlled trial designs: a review of reporting quality and design features. Trials. 2017;18(1):33.CrossRef Grayling MJ, Wason JM, Mander AP. Stepped wedge cluster randomized controlled trial designs: a review of reporting quality and design features. Trials. 2017;18(1):33.CrossRef
5.
go back to reference Kotz D, Spigt M, Arts ICW, Crutzen R, Viechtbauer W. Use of the stepped wedge design cannot be recommended: a critical appraisal and comparison with the classic cluster randomized controlled trial design. J Clin Epidemiol. 2012;65(12):1249–52.CrossRef Kotz D, Spigt M, Arts ICW, Crutzen R, Viechtbauer W. Use of the stepped wedge design cannot be recommended: a critical appraisal and comparison with the classic cluster randomized controlled trial design. J Clin Epidemiol. 2012;65(12):1249–52.CrossRef
6.
go back to reference Zhan Z, Van Den Heuvel ER, Doornbos PM, Burger H, Verberne CJ, Wiggers T, De Bock GH. Strengths and weaknesses of a stepped wedge cluster randomized design: its application in a colorectal cancer follow-up study. J Clin Epidemiol. 2014;67(4):454–61.CrossRef Zhan Z, Van Den Heuvel ER, Doornbos PM, Burger H, Verberne CJ, Wiggers T, De Bock GH. Strengths and weaknesses of a stepped wedge cluster randomized design: its application in a colorectal cancer follow-up study. J Clin Epidemiol. 2014;67(4):454–61.CrossRef
7.
go back to reference Arain M, Campbell MJ, Cooper CL, Lancaster GA. What is a pilot or feasibility study? A review of current practice and editorial policy. BMC Med Res Methodol. 2010;10:67.CrossRef Arain M, Campbell MJ, Cooper CL, Lancaster GA. What is a pilot or feasibility study? A review of current practice and editorial policy. BMC Med Res Methodol. 2010;10:67.CrossRef
8.
go back to reference Whitehead AL, Sully BGO, Campbell MJ. Pilot and feasibility studies: is there a difference from each other and from a randomised controlled trial? Contemporary Clinical Trials. 2014;38(1):130–3.CrossRef Whitehead AL, Sully BGO, Campbell MJ. Pilot and feasibility studies: is there a difference from each other and from a randomised controlled trial? Contemporary Clinical Trials. 2014;38(1):130–3.CrossRef
9.
go back to reference Eldridge S, Kerry S. A practical guide to cluster randomised trials in health services research. US: John Wiley & Sons Inc; 2012.CrossRef Eldridge S, Kerry S. A practical guide to cluster randomised trials in health services research. US: John Wiley & Sons Inc; 2012.CrossRef
10.
go back to reference Eldridge SM, Chan CL, Campbell MJ, Bond CM, Hopewell S, Thabane L, Lancaster GA. CONSORT 2010 statement: extension to randomised pilot and feasibility trials. Pilot and Feasibility Studies. 2016;2(1):64.CrossRef Eldridge SM, Chan CL, Campbell MJ, Bond CM, Hopewell S, Thabane L, Lancaster GA. CONSORT 2010 statement: extension to randomised pilot and feasibility trials. Pilot and Feasibility Studies. 2016;2(1):64.CrossRef
11.
go back to reference Thabane L, Ma J, Chu R, Cheng J, Ismaila A, Rios LP, Robson R, Thabane M, Giangregorio L, Goldsmith CH. A tutorial on pilot studies: the what, why and how. BMC Med Res Methodol. 2010;10:1.CrossRef Thabane L, Ma J, Chu R, Cheng J, Ismaila A, Rios LP, Robson R, Thabane M, Giangregorio L, Goldsmith CH. A tutorial on pilot studies: the what, why and how. BMC Med Res Methodol. 2010;10:1.CrossRef
12.
go back to reference Lancaster GA, Dodd S, Williamson PR. Design and analysis of pilot studies: recommendations for good practice. J Eval Clin Pract. 2004;10(2):307–12.CrossRef Lancaster GA, Dodd S, Williamson PR. Design and analysis of pilot studies: recommendations for good practice. J Eval Clin Pract. 2004;10(2):307–12.CrossRef
13.
go back to reference Eldridge SM, Lancaster GA, Campbell MJ, Thabane L, Hopewell S, Coleman CL, Bond CM. Defining feasibility and pilot studies in preparation for randomised controlled trials: development of a conceptual framework. PLoS One. 2016;11(3):e0150205.CrossRef Eldridge SM, Lancaster GA, Campbell MJ, Thabane L, Hopewell S, Coleman CL, Bond CM. Defining feasibility and pilot studies in preparation for randomised controlled trials: development of a conceptual framework. PLoS One. 2016;11(3):e0150205.CrossRef
14.
go back to reference Caille A, Kerry S, Tavernier E, Leyrat C, Eldridge S, Giraudeau B. Timeline cluster: a graphical tool to identify risk of bias in cluster randomised trials. BMJ. 2016;354:i4291.CrossRef Caille A, Kerry S, Tavernier E, Leyrat C, Eldridge S, Giraudeau B. Timeline cluster: a graphical tool to identify risk of bias in cluster randomised trials. BMJ. 2016;354:i4291.CrossRef
15.
go back to reference Kristunas CA, Hemming K, Eborall HC, Gray LJ: The use of feasibility studies for stepped-wedge cluster randomised trials: protocol for a review of impact and scope. BMJ Open 2017, 7(e017290). Kristunas CA, Hemming K, Eborall HC, Gray LJ: The use of feasibility studies for stepped-wedge cluster randomised trials: protocol for a review of impact and scope. BMJ Open 2017, 7(e017290).
16.
go back to reference Brown CA, Lilford RJ. The stepped wedge trial design: a systematic review. BMC Med Res Methodol. 2006;6:54.CrossRef Brown CA, Lilford RJ. The stepped wedge trial design: a systematic review. BMC Med Res Methodol. 2006;6:54.CrossRef
17.
go back to reference Beard E, Lewis JJ, Copas A, Davey C, Osrin D, Baio G, Thompson JA, Fielding KL, Omar RZ, Ononge S, Hargreaves J, Prost A. Stepped wedge randomised controlled trials: systematic review of studies published between 2010 and 2014. Trials. 2015;16(1):353.CrossRef Beard E, Lewis JJ, Copas A, Davey C, Osrin D, Baio G, Thompson JA, Fielding KL, Omar RZ, Ononge S, Hargreaves J, Prost A. Stepped wedge randomised controlled trials: systematic review of studies published between 2010 and 2014. Trials. 2015;16(1):353.CrossRef
18.
go back to reference Moher D, Shamseer L, Clarke M, Ghersi D, Liberati A, Petticrew M, Shekelle P, Stewart L, PRISMA-P Group: Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Systematic Reviews 2015, 4(1):1. Moher D, Shamseer L, Clarke M, Ghersi D, Liberati A, Petticrew M, Shekelle P, Stewart L, PRISMA-P Group: Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Systematic Reviews 2015, 4(1):1.
19.
go back to reference Brady MC, Stott D, Weir CJ, Chalmers C, Sweeney P, Donaldson C, Barr J, Barr M, Pollock A, Mcgowan S, Bowers N, Langhorne P. Clinical and cost effectiveness of enhanced oral healthcare in stroke care settings (SOCLE II): a pilot, stepped wedge, cluster randomized, controlled trial protocol. Int J Stroke. 2015;10(6):979–84.CrossRef Brady MC, Stott D, Weir CJ, Chalmers C, Sweeney P, Donaldson C, Barr J, Barr M, Pollock A, Mcgowan S, Bowers N, Langhorne P. Clinical and cost effectiveness of enhanced oral healthcare in stroke care settings (SOCLE II): a pilot, stepped wedge, cluster randomized, controlled trial protocol. Int J Stroke. 2015;10(6):979–84.CrossRef
20.
go back to reference Carrico AW, Nil E, Sophal C, Stein E, Sokunny M, Yuthea N, Evans JL, Ngak S, Maher L, Page K. Behavioral interventions for Cambodian female entertainment and sex workers who use amphetamine-type stimulants. J Behav Med. 2016;39(3):502–10.CrossRef Carrico AW, Nil E, Sophal C, Stein E, Sokunny M, Yuthea N, Evans JL, Ngak S, Maher L, Page K. Behavioral interventions for Cambodian female entertainment and sex workers who use amphetamine-type stimulants. J Behav Med. 2016;39(3):502–10.CrossRef
21.
go back to reference Chari SR, Smith S, Mudge A, Black AA, Figueiro M, Ahmed M, Devitt M, Haines TP. Feasibility of a stepped wedge cluster RCT and concurrent observational sub-study to evaluate the effects of modified ward night lighting on inpatient fall rates and sleep quality: a protocol for a pilot trial. Pilot feasibility stud. 2016;2:1.CrossRef Chari SR, Smith S, Mudge A, Black AA, Figueiro M, Ahmed M, Devitt M, Haines TP. Feasibility of a stepped wedge cluster RCT and concurrent observational sub-study to evaluate the effects of modified ward night lighting on inpatient fall rates and sleep quality: a protocol for a pilot trial. Pilot feasibility stud. 2016;2:1.CrossRef
22.
go back to reference Becker SJ, Squires DD, Strong DR, Barnett NP, Monti PM, Petry NM. Training opioid addiction treatment providers to adopt contingency management: a prospective pilot trial of a comprehensive implementation science approach. Subst Abus. 2016;37(1):134–40.CrossRef Becker SJ, Squires DD, Strong DR, Barnett NP, Monti PM, Petry NM. Training opioid addiction treatment providers to adopt contingency management: a prospective pilot trial of a comprehensive implementation science approach. Subst Abus. 2016;37(1):134–40.CrossRef
23.
go back to reference Ettema R, Schuurmans MJ, Schutijser B, Van Baar M, Kamphof N, Kalkman CJ. Feasibility of a nursing intervention to prepare frail older patients for cardiac surgery: a mixed-methods study. Eur J Cardiovasc Nurs. 2015;14(4):342–51.CrossRef Ettema R, Schuurmans MJ, Schutijser B, Van Baar M, Kamphof N, Kalkman CJ. Feasibility of a nursing intervention to prepare frail older patients for cardiac surgery: a mixed-methods study. Eur J Cardiovasc Nurs. 2015;14(4):342–51.CrossRef
24.
go back to reference McIlvennan CK, Thompson JS, Matlock DD, Cleveland JC, Dunlay SM, Larue SJ, Lewis EF, Patel CB, Walsh MN, Allen LA. A multicenter trial of a shared decision support intervention for patients and their caregivers offered destination therapy for advanced heart failure: DECIDE-LVAD. J Cardiovasc Nurs. 2016;31(6):E20.CrossRef McIlvennan CK, Thompson JS, Matlock DD, Cleveland JC, Dunlay SM, Larue SJ, Lewis EF, Patel CB, Walsh MN, Allen LA. A multicenter trial of a shared decision support intervention for patients and their caregivers offered destination therapy for advanced heart failure: DECIDE-LVAD. J Cardiovasc Nurs. 2016;31(6):E20.CrossRef
25.
go back to reference Napua M, Pfeiffer JT, Chale F, Hoek R, Manuel J, Michel C, Cowan JG, Cowan JF, Gimbel S, Sherr K, Gloyd S, Chapman RR, Option B. + in Mozambique: formative research findings for the Design of a Facility-Level Clustered Randomized Controlled Trial to improve ART retention in antenatal care. J Acquir Immune Defic Syndr. 2016;72(Suppl 2):181.CrossRef Napua M, Pfeiffer JT, Chale F, Hoek R, Manuel J, Michel C, Cowan JG, Cowan JF, Gimbel S, Sherr K, Gloyd S, Chapman RR, Option B. + in Mozambique: formative research findings for the Design of a Facility-Level Clustered Randomized Controlled Trial to improve ART retention in antenatal care. J Acquir Immune Defic Syndr. 2016;72(Suppl 2):181.CrossRef
26.
go back to reference Tume L. A 3-year review of emergency PICU admissions from the ward in a specialist cardio-respiratory Centre. Care of the Critically Ill. 2005;21(1):4–7. Tume L. A 3-year review of emergency PICU admissions from the ward in a specialist cardio-respiratory Centre. Care of the Critically Ill. 2005;21(1):4–7.
27.
go back to reference Prost A, Binik A, Abubakar I, Roy A, De Allegri M, Mouchoux C, Dreischulte T, Ayles H, Lewis JJ, Osrin D. Logistic, ethical, and political dimensions of stepped wedge trials: critical review and case studies. Trials. 2015;16(1). Prost A, Binik A, Abubakar I, Roy A, De Allegri M, Mouchoux C, Dreischulte T, Ayles H, Lewis JJ, Osrin D. Logistic, ethical, and political dimensions of stepped wedge trials: critical review and case studies. Trials. 2015;16(1).
28.
go back to reference Baio G, Copas A, Ambler G, Hargreaves J, Beard E, Omar R. Sample size calculation for a stepped wedge trial. Trials. 2015;16(1):354.CrossRef Baio G, Copas A, Ambler G, Hargreaves J, Beard E, Omar R. Sample size calculation for a stepped wedge trial. Trials. 2015;16(1):354.CrossRef
29.
go back to reference Martin J, Taljaard M, Girling A, Hemming K. Systematic review finds major deficiencies in sample size methodology and reporting for stepped-wedge cluster randomised trials. BMJ Open. 2016;6(2):e010166.CrossRef Martin J, Taljaard M, Girling A, Hemming K. Systematic review finds major deficiencies in sample size methodology and reporting for stepped-wedge cluster randomised trials. BMJ Open. 2016;6(2):e010166.CrossRef
30.
go back to reference Barker D, McElduff P, D'Este C, Campbell MJ. Stepped wedge cluster randomised trials: a review of the statistical methodology used and available. BMC Med Res Methodol. 2016;16(1):69.CrossRef Barker D, McElduff P, D'Este C, Campbell MJ. Stepped wedge cluster randomised trials: a review of the statistical methodology used and available. BMC Med Res Methodol. 2016;16(1):69.CrossRef
31.
go back to reference Kristunas C, Morris T, Gray L. Unequal cluster sizes in stepped-wedge cluster randomised trials: a systematic review. BMJ Open. 2017;7(11):e017151.CrossRef Kristunas C, Morris T, Gray L. Unequal cluster sizes in stepped-wedge cluster randomised trials: a systematic review. BMJ Open. 2017;7(11):e017151.CrossRef
32.
go back to reference Taljaard M, Hemming K, Shah L, Giraudeau B, Grimshaw JM, Weijer C. Inadequacy of ethical conduct and reporting of stepped wedge cluster randomized trials: results from a systematic review. Clinical Trials. 2017;14(4):333–41.CrossRef Taljaard M, Hemming K, Shah L, Giraudeau B, Grimshaw JM, Weijer C. Inadequacy of ethical conduct and reporting of stepped wedge cluster randomized trials: results from a systematic review. Clinical Trials. 2017;14(4):333–41.CrossRef
33.
go back to reference Heim N, van Stel HF, Ettema RG, van der Mast RC, Inouye SK, Schuurmans MJ. HELP! Problems in executing a pragmatic, randomized, stepped wedge trial on the hospital elder life program to prevent delirium in older patients. Trials. 2017;18(1):220.CrossRef Heim N, van Stel HF, Ettema RG, van der Mast RC, Inouye SK, Schuurmans MJ. HELP! Problems in executing a pragmatic, randomized, stepped wedge trial on the hospital elder life program to prevent delirium in older patients. Trials. 2017;18(1):220.CrossRef
34.
go back to reference Hargreaves JR, Copas AJ, Beard E, Osrin D, Lewis JJ, Davey C, Thompson JA, Baio G, Fielding KL, Prost A. Five questions to consider before conducting a stepped wedge trial. Trials. 2015;16(1). Hargreaves JR, Copas AJ, Beard E, Osrin D, Lewis JJ, Davey C, Thompson JA, Baio G, Fielding KL, Prost A. Five questions to consider before conducting a stepped wedge trial. Trials. 2015;16(1).
35.
go back to reference Morgan B, Hejdenberg J, Hinrichs-Krapels S, Armstrong D. Do feasibility studies contribute to, or avoid, waste in research? PLoS One. 2018;13(4):e0195951.CrossRef Morgan B, Hejdenberg J, Hinrichs-Krapels S, Armstrong D. Do feasibility studies contribute to, or avoid, waste in research? PLoS One. 2018;13(4):e0195951.CrossRef
Metadata
Title
The current use of feasibility studies in the assessment of feasibility for stepped-wedge cluster randomised trials: a systematic review
Authors
Caroline A. Kristunas
Karla Hemming
Helen Eborall
Sandra Eldridge
Laura J. Gray
Publication date
01-12-2019
Publisher
BioMed Central
Published in
BMC Medical Research Methodology / Issue 1/2019
Electronic ISSN: 1471-2288
DOI
https://doi.org/10.1186/s12874-019-0658-3

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