***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background A commonly reported problem with the conduct of multicentre r and omised controlled trials ( RCTs ) is that recruitment is often slower or more difficult than expected , with many trials failing to reach their planned sample size within the timescale and funding originally envisaged . The aim of this study was to explore factors that may have been associated with good and poor recruitment in a cohort of multicentre trials funded by two public bodies : the UK Medical Research Council ( MRC ) and the Health Technology Assessment ( HTA ) Programme . Methods The cohort of trials was identified from the administrative data bases held by the two funding bodies . 114 trials that recruited participants between 1994 and 2002 met the inclusion criteria . The full scientific applications and subsequent trial reports su bmi tted by the trial teams to the funders provided the principal data sources . Associations between trial characteristics and recruitment success were tested using the Chi-squared test , or Fisher 's exact test where appropriate . Results Less than a third ( 31 % ) of the trials achieved their original recruitment target and half ( 53 % ) were awarded an extension . The proportion achieving targets did not appear to improve over time . The overall start to recruitment was delayed in 47 ( 41 % ) trials and early recruitment problems were identified in 77 ( 63 % ) trials . The inter-relationship between trial features and recruitment success was complex . A variety of strategies were employed to try to increase recruitment , but their success could not be assessed . Conclusion Recruitment problems are complex and challenging . Many of the trials in the cohort experienced recruitment difficulties . Trials often required extended recruitment periods ( sometimes supported by additional funds ) . While this is of continuing concern , success in addressing the trial question may be more important than recruitment alone OBJECTIVE To determine the effectiveness of community based occupational therapy on daily functioning of patients with dementia and the sense of competence of their care givers . DESIGN Single blind r and omised controlled trial . Assessors were blinded for treatment allocation . SETTING Memory clinic and day clinic of a geriatrics department and participants ' homes . PARTICIPANTS 135 patients aged > or = 65 with mild to moderate dementia living in the community and their primary care givers . INTERVENTIONS 10 sessions of occupational therapy over five weeks , including cognitive and behavioural interventions , to train patients in the use of aids to compensate for cognitive decline and care givers in coping behaviours and supervision . MAIN OUTCOME MEASURES Patients ' daily functioning assessed with the assessment of motor and process skills ( AMPS ) and the performance scale of the interview of deterioration in daily activities in dementia ( IDDD ) . Care giver burden assessed with the sense of competence question naire ( SCQ ) . Participants were evaluated at baseline , six weeks , and three months . RESULTS Scores improved significantly relative to baseline in patients and care givers in the intervention group compared with the controls ( differences were 1.5 ( 95 % confidence interval 1.3 to 1.7 ) for the process scale ; -11.7 ( -13.6 to -9.7 ) for the performance scale ; and ( 11.0 ; 9.2 to 12.8 ) for the competence scale ) . This improvement was still significant at three months . The number needed to treat to reach a clinical ly relevant improvement in motor and process skills score was 1.3 ( 1.2 to 1.4 ) at six weeks . Effect sizes were 2.5 , 2.3 , and 1.2 , respectively , at six weeks and 2.7 , 2.4 , and 0.8 , respectively , at 12 weeks . CONCLUSIONS Occupational therapy improved patients '  daily functioning and reduced the burden on the care giver , despite the patients ' limited learning ability . Effects were still present at 12 weeks , which justifies implementation of this intervention . TRIAL REGISTRATION Clinical Trials NCT00295152 [ Clinical Trials.gov ] BACKGROUND Attention is currently focused on family care of stroke survivors , but the effectiveness of support services is unclear . We did a single-blind , r and omised , controlled trial to assess the impact of family support  on stroke patients and their carers . METHODS Patients with acute stroke admitted to hospitals in Oxford , UK , were assigned family support or normal care within 6 weeks of stroke . After 6 months , we assessed , for carers , knowledge about stroke , Frenchay activities index , general health question naire-28 scores , caregiver strain index , Dartmouth co-op charts , short form 36 ( SF-36 ) , and satisfaction scores , and , for patients , knowledge about stroke and use of services , Barthel index , Rivermead mobility index , Frenchay activities index , London h and icap scale , hospital anxiety and depression scales , Dartmouth co-op charts , and satisfaction . FINDINGS 323 patients and 267 carers were followed up . Carers in the intervention group had significantly better Frenchay activities indices ( p=0.03 ) , SF-36 scores ( energy p=0.02 , mental health p=0.004 , pain p=0.03 , physical function p=0.025 , and general health perception p=0.02 ) , quality of life on the Dartmouth co-op chart ( p=0.01 ) , and satisfaction with underst and ing of stroke ( 82 vs 71 % , p=0.04 ) than those in the control group . Patients ' knowledge about stroke , disability , h and icap , quality of life , and satisfaction with services and underst and ing of stroke did not differ between groups . Fewer patients in the intervention group than in the control group saw a physiotherapist after discharge ( 44 vs 56 % , p=0.04 ) , but use of other services was similar . INTERPRETATION Family support significantly increased social activities and improved quality of life for carers , with no significant effects on patients Objective : This study examines the use of a community-delivered behavior management program for persons with traumatic brain injury and their caregivers and its effect on reduction of ratings of caregiver burden . Design : A control group was compared with an education only and education plus behavior management group with r and om assignment to conditions . Participants : Total number of participants was 27 persons with brain injury and their caregivers . Main Outcome Measures : Dependent measures were subscales of the Question naire on Re sources and Stress ( QRS ) and an adapted version of the Maslach Burnout Inventory ( MBI ) . Results : An analysis of covariance adjusting for baseline burden and stress ratings showed no significant change in these measures associated with treatment . Conclusions : The results are discussed in terms of the potential modifiability of caregiver burden , the small sample size , and the sensitivity of current measures of caregiver stress and burden to detect clinical ly meaningful change BACKGROUND Based on the National Institute on Aging/National Institute of Nursing Research Re sources for Enhancing Alzheimer 's Caregiver Health ( REACH ) r and omized controlled trial ( REACH II ) , REACH VA ( Department of Veterans Affairs ) was the first national clinical translation of a proven behavioral intervention for dementia caregivers , running from September 2007 through August 2009 . This article describes the population and outcomes of the REACH VA translation of REACH II into the VA . METHODS Clinical staff members from 24 VA Medical Center Home-Based Primary Care programs in 15 states delivered the intervention to stressed caregivers of patients with dementia . Like REACH II , the 6-month REACH VA intervention , structured through a protocol and individualized through a risk assessment , targeted education , support , and skills training to address caregiving risk areas of safety , social support , problem behaviors , depression , and health through 12 individual in-home and telephone sessions and 5 telephone support group sessions . Staff members of the Memphis VA Medical Center , Memphis , Tennessee , collected data on burden , depression , health and healthy behaviors , caregiving frustrations , social support , dementia-related behaviors , and time spent providing care and on duty . RESULTS From baseline to 6 months , caregivers reported significantly decreased burden , depression , impact of depression on daily life , caregiving frustrations , and number of troubling dementia-related behaviors . A 2-hour decrease in hours per day on duty approached significance . Caregivers ( 96 % ) believed that the program should be provided by the VA to caregivers . CONCLUSIONS This clinical translation achieved outcomes similar to the REACH II r and omized controlled trial , providing clinical ly significant benefits for caregivers of a veteran with a progressive dementing disease . This model of caregiver support can inform public policy in providing assistance to caregivers OBJECTIVE caregiver effects of geriatric care models focusing primarily at the patient have not been consistently studied . We studied caregiver effects of a nurse-led comprehensive geriatric evaluation and management ( GEM ) programme for community-dwelling frail older people that showed-in a r and omised comparison with usual care -- health-related quality of life benefits for the care receivers . METHODS this r and omised trial included 110 caregiver/patient dyads who were followed up for 6 months . Primary analyses were intention-to-treat analyses of caregiver burden assessed with Zarit Burden Interview  ( ZBI ; 0 - 88 ; higher means more burden ) . Preplanned subgroup analyses were conducted for cognition , living arrangement and patient/caregiver co-residence . RESULTS overall , perceived caregiver burden showed no significant differences between study groups in changes over time . However , perceived burden was at baseline more than eight points higher in caregivers sharing a household with patients ( n = 23 ) compared to caregivers living separately ( n = 87 ) . The intervention performed better in caregivers living together with the patient than in caregivers living separately ( P for interaction = 0.04 ) . Co-resident caregivers experienced six-Zarit point improvement compared with four-point deterioration in the non-co-resident caregivers . CONCLUSIONS GEM at home benefited patients , but maybe not caregivers . Caregiver effects are related to whether caregivers live with the patient or not BACKGROUND Although there is a significant correlation between the degree of family support and clinical outcome , little research has focused on the effectiveness of family partnership intervention care ( FPIC ) for patients with poorly controlled type 2 diabetes . OBJECTIVES This study aim ed to compare FPIC with conventional care ( CC ) across a number of outcome measures in patients with poorly controlled type 2 diabetes . DESIGN The study was performed using a r and omized controlled trial design . PARTICIPANTS Patients with poorly controlled type 2 diabetes who were solely treated with oral antidiabetic agents and had at least two out of three hemoglobin A1C readings equal to or above 7 % in the previous 12 months , were r and omly assigned to the FPIC group ( n=28 ) and to the  CC group ( n=28 ) . METHODS Baseline and 6-month follow-up scores were compared using the following outcome measures : ( 1 ) hemoglobin A1C , ( 2 ) BMI , ( 3 ) lipid profile , ( 4 ) family supportive behaviours , ( 5 ) , knowledge of and attitudes toward diabetes , and ( 6 ) diabetes self-care behaviours . Descriptive and non-parametric statistics were employed to compare differences in outcome measures between the groups . RESULTS There were no significant differences in the reduction of hemoglobin A1C levels ( p=0.46 ) , lipid profile values ( p>0.05 ) , and improvement of diabetes self-care behaviours ( p=0.61 ) between the groups at 6 months post-intervention . However , there were significant differences in the scores of family supportive behaviours ( p=0.031 ) and patients ' knowledge of and attitudes toward diabetes between the groups ( p<0.05 ) . CONCLUSION These findings support the use of FPIC to enhance family supportive behaviours , and to improve patients ' knowledge of and attitudes toward diabetes . Thus , the study is of value in helping policy decision-makers to develop more effective diabetes control intervention programmes The present study examined the comparative efficacy of intervening at the caregiver/care-recipient dyadic level , versus the individual caregiver level , for caregivers and their care-recipients with HIV/AIDS . Participants were r and omly assigned to a Dyad Intervention ( DI ) , a Caregiver Intervention ( CI ) or Wait List Control group ( WLC ) , and assessed by interview and self-administered scales immediately before treatment and eight weeks later . Participants in the intervention groups also completed a four-month follow-up assessment . Dependent variables included global distress , social adjustment , dyadic adjustment , subjective health status , HIV/AIDS knowledge and target problem ratings . Results showed that caregivers in the DI group showed greater improvement from pre- to post-treatment on global distress , dyadic adjustment and target problems than the CI and WLC caregivers . The CI and DI caregivers showed greater improvement than the WLC group on all dependent variables except social adjustment . Care-recipients in the DI group improved significantly from pre- to post-treatment on dyadic adjustment , social adjustment , knowledge , subjective health status and Target Problem 1 , whereas the CI and WLC care-recipients failed to improve on any of these measures . The treatment gains made by the DI caregivers and care-recipients on most dependent variables were maintained at a four-month follow-up . Findings support a reciprocal determinism approach to the process of dyadic adjustment and suggest that intervening at the caregiver/care-recipient level may produce better outcomes for both the caregiver and care-recipient than intervening at the individual caregiver level CONTEXT Most older adults with dementia will be cared for by primary care physicians , but the primary care practice environment presents important challenges to providing quality care . OBJECTIVE To test the effectiveness of a collaborative care model to improve the quality of care for patients with Alzheimer disease . DESIGN , 
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Details regarding recruitment and retention methodology were sparse in these interventions .
Where available , data suggests that re sources need to be devoted towards recruitment of sample but that retention rates are generally adequate