Abstract
STUDY DESIGN: A narrative review and perspective based on the experience of a single site in the U.S recruiting participants for clinical trials during the subacute phase (2 weeks to 3 months) following a traumatic spinal cord injury (SCI). OBJECTIVES: To discuss challenges and propose strategies for enrolling individuals with SCI in research during the subacute phase within a comprehensive inpatient rehabilitation program. SETTING: Acute rehabilitation hospitals where patients with SCI typically spend part of the subacute post-injury period. METHODS: This review draws on the authors' experience in research recruitment and retention. Key barriers and potential solutions are explored from both a practical and conceptual standpoint. RESULTS: Challenges identified include heterogeneous impairments, older age, higher incidence of incomplete injuries, placement issues, competition among studies, limited patient volume, tight rehabilitation schedules, logistical and medical concerns, and misalignment of research measures with clinical practices. Based on experience and literature review, strategic planning including integration of individuals with lived experience into the study design team, patient education, simplified consent processes, flexible research protocols, collaboration between clinical and research teams, and patient-centered approaches can enhance recruitment efforts. CONCLUSIONS: Research recruitment during the subacute phase of SCI presents numerous medical, injury-specific, and systems-based challenges. However, this period remains critical for advancing research influencing long-term outcomes for individuals with SCI. We recommend a collaborative, patient-centered approach that integrates research within clinical care, guided by practical experience and informed by existing literature, which can improve recruitment efforts and ultimately support meaningful advancements in SCI rehabilitation research.