Lessons of a multicenter noninvasive brain stimulation trial in patients with unilateral spatial neglect after stroke: barriers to trial participation from a developing country

Background: There is a high demand for stroke rehabilitation in the Brazilian public health system, however most studies that addressed rehabilitation for unilateral spatial neglect (USN) after stroke have been performed in highincome countries. Objectives: Analyze the USN patient recruitment in a multicenter non-invasive brain stimulation clinical trial performed in Brazil. Design and setting: Observation study of reasons for exclusion of patients in a multicenter, randomized, double-blinded clinical trial performed at Botucatu Medical School. Methods: We evaluated reasons for exclusion of patients in a multicenter, randomized, double-blinded clinical trial of rehabilitation of USN patients after stroke. Results: 173 of 1956 potential neglect patients (8.8%) passed initial screening. After screening evaluation, 87/173 patients (50.3%) were excluded for clinical reasons. Cognitive impairment led to exclusion of 21/87 patients (24.1%). Low socioeconomic status led to exclusion of 37/173 patients (21.4%). Difficulty in transportation to access treatment was the most common reason (16/37 patients, 43.3%). Conclusions: The analyzed Brazilian institutions have potential for conducting studies in USN. Recruitment of stroke survivors with USN was restricted by the study design and limited financial support. Cognitive impairment, presence of stent or craniectomy and lack of transportation was the most common barriers to participate in a multicenter non-invasive brain stimulation trial in patients with unilateral spatial neglect after stroke.