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PubMed1995

Binge eating disorder, retention, and dropout in an adult obesity program.

OBJECTIVE: The purpose of this study was to identify factors associated with dropout in a weight reduction program among obese, nonpurging binge and nonbinge eaters. METHOD: We categorized 156 obese, nonpurging women previously randomized to a behavior modification-based (BM) or a food addiction theory-based (FD) weight reduction intervention by binge status using the DSM-IV criteria for binge eating disorder (BED). Subjects were monitored prospectively for dropout during the 6-month intervention period. RESULTS: Results of a Cox proportional hazards survival analysis indicated binge status had a statistically significant (p = .04) protective effect against dropout. Binge eaters were half as likely to dropout versus nonbinge eaters. DISCUSSION: We conclude that (1) the DSM-IV criteria for BED is a useful method of classifying obese individuals in weight loss interventions and (2) the identification of subgroups among obese subjects is an important step in understanding retention in weight loss programs. Future research can confirm this finding.

Adult↗
PubMed2006

Predictors of dropout and remission in family therapy for adolescent anorexia nervosa in a randomized clinical trial.

OBJECTIVE: The purpose of this study is to explore the predictors of dropout and remission in the treatment of adolescent anorexia nervosa (AN) using family therapy. METHOD: Data derived from a randomized clinical trial comparing short and long term family therapy for adolescents with AN were used. A rotated component analysis was employed to reduce the number of variables and to address problems of collinearity and multiple testing. Dropout was defined as participating in less than 80% of the assigned therapy. Participants were classified as remitted if they obtained an ideal body weight greater than 95% and a global eating disorder Examination score within two standard deviations of community norms at the end of 12 months. RESULTS: Co-morbid psychiatric disorder and being randomized to longer treatment predicted greater dropout. The presence of co-morbid psychiatric disorder, being older, and problematic family behaviors led to lower rates of remission. A reduction of child behavioral symptoms, a decline in problematic family behaviors, and early weight gain were all within treatment changes that increased the chance of remission. CONCLUSION: Co-morbid psychiatric disorder, family behaviors, and early response to treatment are important factors when predicting dropout and remission in family therapy for adolescent AN.

Adolescent↗
PubMed2005

Ablation therapy in containing extension of hepatocellular carcinoma: a simulative analysis of dropout from the waiting list for liver transplantation.

The dropout from the waiting list for liver transplantation among patients with hepatocellular carcinoma (HCC) is reportedly as high as 12% to 40% per year, mostly due to tumor progression. Considering the scarcity of donor organs, it would be beneficial if we could retain them within the Milan criteria with a bridging therapy. We retrospectively analyzed the prognosis of 288 HCC patients with relatively preserved liver function we treated with ablation therapy between 1997 and 2001, concentrating on whether they subsequently remained in the criteria, and analyzed the risk factors of dropout with Cox proportional hazards model. During a median follow-up period of 39 months (range, 1-86 months), 33 (11%) died without tumor progression, while 85 (30%) dropped out due to tumor progression. The overall dropout rate was 9.0% and 32.8% at 1 and 3 years, respectively, and that due to tumor progression was 6.2% and 23.0%. Cox regression analysis indicated that a high serum level of alpha-fetoprotein or des-gamma-carboxy prothrombin, and a tumor size exceeding 3 cm in diameter affected the dropout due to tumor progression, while low albumin concentration was a risk factor of death independently of tumor progression. In conclusion, local ablation therapy for HCC was effective in containing the tumor progression within the Milan criteria in selected patients.

Adult↗
PubMed2003

Is patient dropout from a longitudinal study of lung function predictable and reversible?

Predictive factors for individuals dropping out from a longitudinal study of lung function have not been described, nor have methods for re-recruiting dropouts been developed. Our aims were to identify factors predictive of dropout and methods of re-recruiting dropouts from a longitudinal study of lung function. Details at enrollment into a longitudinal birth cohort study were compared between those who dropped out and those who were assessed 6 and 11 years later. Strategies for identifying individuals successfully contacted at 11 but not 6 years were described. Of 253 infants enrolled prenatally, 123 (49%) were followed up at age 6 and 194 (77%) at age 11 years. At 6 years, independent risk factors for a child dropping out were: no other sibling enrolled (OR, 4.0; 95% CI, 1.6, 10.1; P = 0.003); being first-born (OR, 2.8; 95% CI, 1.5, 5.2; P = 0.001); mother completing education at age 15 years (OR, 2.5; 95% CI, 1.3, 4.9; P = 0.007); and mother born overseas (OR, 2.3; 95% CI; 2.8; P = 0.01). The following were predictive of a child dropping out at 11 years: mother born overseas (OR, 4.8; 95% CI, 2.2, 10.2; P < 0.001); paternal smoker (OR, 3.1; 95% CI, 1.5, 6.5; P = 0.003); no other sibling enrolled (OR, 4.1; 95% CI, 1.1, 15.7; P = 0.04); and being first-born (OR, 2.1; 95% CI, 1.0, 4.3; P < 0.05). Of the 74 families successfully followed up at 11 but not 6 years, 35 (47%) were contacted by using data already held in study records, and 32 (43%) were contacted by databases available to the public. In conclusion, factors present at enrollment and predictive of dropout from a longitudinal cohort study can be identified. Using a variety of methods, re-recruitment is possible for many individuals who previously dropped out.

Australia↗
PubMed2007

HIV viral dynamic models with dropouts and missing covariates.

In recent years HIV viral dynamic models have received great attention in AIDS studies. Often, subjects in these studies may drop out for various reasons such as drug intolerance or drug resistance, and covariates may also contain missing data. Statistical analyses ignoring informative dropouts and missing covariates may lead to misleading results. We consider appropriate methods for HIV viral dynamic models with informative dropouts and missing covariates and evaluate these methods via simulations. A real data set is analysed, and the results show that the initial viral decay rate, which may reflect the efficacy of the anti-HIV treatment, may be over-estimated if dropout patients are ignored. We also find that the current or immediate previous viral load values may be most predictive for patients' dropout. These results may be important for HIV/AIDS studies.

Bias↗
PubMed1980

Physical exercise rehabilitation: long-term dropout rate in cardiac patients.

The long-term dropout rate was examined in a physical exercise rehabilitation program in which 203 cardiac patients were followed for 40 months. The dropout curve was found to be downward-sloping and negatively accelerated with most of the dropouts occurring during the first 3 months. This dropout rate appeared to resemble the group release curve previously found in the treatment of addictive behaviors. Implications of the present findings are discussed in terms of the development of strategies to facilitate long-term compliance.

Adult↗
PubMed2006

Helping alliance and early dropout from psychiatric out-patient care: the influence of patient factors.

BACKGROUND: The study examined client factors of relevance in the establishment of helping alliance and in the prediction of dropout from a routine psychiatric setting admitting a variety of diagnoses and staffed with a multiprofessional team. METHOD: Newly admitted patients (n=122) and staff completed questionnaires regarding helping alliance, and the patients also completed questionnaires regarding motivation, symptoms and interpersonal problems. The patients were also diagnosed according to ICD-10 and were followed up concerning early dropout. RESULTS: Several variables correlated with helping alliance, and multivariate analyses showed that cold/distant factor, motivation and interpersonal sensitivity factor were the most important factors in establishing helping alliance. Moreover, it was the alliance as perceived by the patients (and not by the staff) that proved to be the most essential variable. A logistic regression analysis showed that early dropout was predicted by low helping alliance, low age and cold/distant factor. CONCLUSION: The most important client factors for establishing helping alliance and for predicting early dropout seem to be those relevant to interpersonal processes. Furthermore, the therapists'/staff's responsiveness to these client factors seems to be of decisive importance.

Adolescent↗
PubMed1976

Comparison of active participants and dropouts in CAPRI cardiopulmonary rehabilitation programs.

Of 547 men and 56 women enrolled up to April 1974 in Cardiopulmonary Research Institute (CAPRI) community programs for cardiopulmonary rehabilitatation, 84.5 percent had clinical manifestations of coronary heart disease. These medically supervised programs of physical training involved 30 to 60 minutes of graded levels of working, calisthenics and, if indicated, jogging for 3 mornings/week. Altogether 352 (58.4 percent) dropped out after an average of 8.6 months for men and 5.7 months for women. The remaining 230 men and 21 women remained active for 22 and 20 months, respectively. In retrospect, there were few minor differences between active participants and dropouts in physical characteristics, clinical diagnoses and responses to exercise testing on enrollment. Elapsed time to morbidity tended to be longer in active persons than in dropouts. Over one half of active men and about one third of dropouts were working. Of six early deaths, one occurred before training was instituted, and five within the first 2 weeks of training. Among men, the respective total mortality rates were 2.7 and 4.7/100 person-years for active participants and dropouts; among women, the rates were 0 and 3.8 respectively. Whereas 24 episodes of cardiac arrest occurred in 13 men, with three fatalities outside the training program, in 11 instances of exertional arrest during class training all defibrillations were successful. Without this benefit of medical supervision there would have been little difference in mortality experience.

Animals↗
PubMed1986

Successful program for recovery of dropouts to a clinical trial.

This is a report of a successful program to return dropout participants to active participation at a single clinic of a multicenter long-term clinical trial, the Coronary Primary Prevention Trial of the Lipid Research Clinics Program. The specific objectives were to re-engage dropouts into active participation and to have them resume study medication. Thirty-six men had been absent from the Baylor-Methodist Clinic for 10 months to over four years. The program focused on resolving the presenting problems: psychosocial, somatic, and drug adherence. It was based on six general principles with corresponding goals and employed 13 activities and procedures in a specific operational sequence for reinstitution of the Coronary Primary Prevention Trial protocol. Counseling techniques were used to improve protocol adherence. The recovery program was monitored bi-weekly by computer. The dropout group did not appear to exhibit any biases and approximated the remainder of the Baylor-Methodist cohort demographically. At six months into the recovery program, 90 percent of the dropouts had been recovered. Seventy percent of the recovered participants re-established medication-taking behavior. The mean rate of adherence to medication for all of the recovered group was 35 percent of the prescribed dose, 8 g per day. Review of the data for the cholesterol differential between the two treatment groups demonstrated a favorable effect of the reinstitution of the study medication. The program's methods are applicable to clinical practice.

Adult↗
PubMed1982

Can dropout and other noncompliance be minimized in a clinical trial? Report from the Veterans Administrative National Heart, Lung and Blood Institute cooperative study on antihypertensive therapy: mild hypertension.

Long-term clinical trials must face the problem of participants who drop out before the study is closed or who in other ways do not comply with the protocol. In a joint Veterans Administration-National Heart, Lung and Blood Institute study of mild hypertension, 1,012 men and women, 21 to 50 years of age with diastolic pressure from 85 to 105 mm Hg, were randomized into two double-blind treatment groups and followed for up to 30 months. The data were analyzed for factors related to dropout and to medication and visit noncompliance. Large differences in dropout and compliance rates were found by clinic and age but not by treatment allocations (active vs. placebo) nor race-sex. In addition, noncompliance was 78%-118% higher in participants who subsequently chose to drop out of the study. Indications were that the attitude of a clinic towards participant complaints, willingness to temporarily reduce medication and vigorous pursuit of those who failed to keep appointments were important factors in reducing dropout. Strategies for minimizing dropout and noncompliance must be part of the study protocol, clinic personnel should be trained in using such strategies, and both clinic and participant compliance should be centrally monitored.

Adult↗
PubMed2005

Factors associated with drug treatment dropout among injection drug users in Puerto Rico.

This study examined factors associated with drug treatment dropout among injection drug users (IDUs) in Puerto Rico, a group that has contributed significantly to the self-sustaining AIDS epidemic in the island since the mid-1980s. A total of 557 IDUs were recruited from communities in a semirural region of Puerto Rico, as part of a longitudinal study testing the efficacy of a two-facet intervention model, based on motivational interviewing. Of 124 IDUs who had entered drug treatment at follow-up, 33 (26.6%) dropped out before completing all recommended sessions. Multiple logistic regression analysis showed that age, homelessness, and speedball use were significantly associated with drug treatment dropout. Conversely, participants who received the two-facet intervention were significantly less likely to drop out of drug treatment. Receiving psychiatric services also reduced the odds of treatment dropout. Improving adherence to drug treatment and reducing dropout rates are complex processes that need to be addressed at the individual behavioral and social support levels, as well as the program process and resource levels.

Adolescent↗
PubMed2005

Does stage-of-change predict dropout in a culturally diverse sample of adolescents admitted to inpatient substance-abuse treatment? A test of the Transtheoretical Model.

The Transtheoretical Model (TTM) () proposes that the stages-of-change construct can serve as useful tool for identifying those most at-risk of treatment dropout [Prochaska, J. O. (1999). How do people change, and how can we change to help many more people? In M. A. Hubble, B. L. Duncan, & S. D. Miller (Eds.), The heart and soul of change (pp. 227-255). Washington: American Psychological Association]. While researchers have found mixed support for this claim in adult samples, studies have not yet tested this issue in adolescent substance-abuse treatment settings. This paper reports findings from a Canadian study of adolescents (n = 130: 80 Caucasians, 50 Aboriginals) admitted to a hospital-based, residential substance-abuse treatment program. Two approaches were used to test the TTM's claim: (1) a hierarchical logistic regression model of dropout was developed using the subscales of the University of Rhode Island Change Assessment instrument (URICA), demographic variables, and subscales of the Addiction Severity Index (ASI); and (2) a chi-square analysis was employed to test the hypothesized relation between stage-of-change and dropout status. The findings demonstrated that the best predictive model of dropout included only the Precontemplation subscale of the URICA (OR: 4.3; 95% CI: 2.0-9.0). In addition, adolescents assigned to the Precontemplation stage manifested significantly higher rates of treatment attrition than individuals in the Contemplation or Preparation/Action stages. This study provides important empirical support for the predictive utility of the stage-of-change construct among a culturally diverse sample of adolescents admitted to an inpatient substance-abuse treatment program.

Adolescent↗
PubMed2004

Dropout rates for intent-to-treat and per protocol analyses.

PURPOSE: To describe dropout rates for the intent-to-treat and per protocol analyses from prospective clinical trials. METHODS: Review of prospective multi-center parallel studies of 100 patients or more from 1996 onwards. RESULTS: We identified 33 articles (70 treatment arms) that fit the criteria for this study. No statistical differences in dropout rates were observed among drug classes for either the intent-to-treat (P =.075) or per protocol analyses (P =.40). A difference was observed in the percent dropout rate for the intent-to-treat analyses decreasing with the length of the study (P <.0001). This finding was not observed by the number of study visits (P =.44). However, a statistically greater percent dropout rate was observed for the per protocol analyses increasing with the length of the study (P =.034) and number of study visits (P =.01). No statistical differences were observed or with increasing sample size of the study for either the intent-to-treat or per protocol analyses (P >.05). CONCLUSIONS: Known discontinuation rates for per protocol and intent-to-treat analyses may help in planning sample sizes for future clinical trials.

Antihypertensive Agents↗
PubMed1999

A comparative study of cocaine-treatment completers and dropouts.

This study compared matched groups of completers and dropouts from residential treatment for cocaine abuse on a range of outcome measures, including cocaine and alcohol use, stress, coping, and social support characteristics. The most striking finding of this study was that treatment dropouts differed from treatment completers on only 2 of 14 dependent measures reflecting substance use, stress, coping, and social support characteristics during two 3-month follow-up periods. Both dropouts and completers demonstrated large decreases in cocaine and alcohol use from pretreatment to the first follow-up period. Completers and dropouts did not differ in level of substance use during either follow-up period.

Adaptation, Psychological↗
PubMed1994

Attrition from conjoint alcoholism treatment: do dropouts differ from completers?

This study addresses patient attrition in order to identify variables associated with retention in conjoint treatment for alcohol abuse and dependence. Subjects were 105 male alcoholics and their partners who participated in a randomized clinical trial of three approaches to conjoint treatment of alcoholism: (a) alcohol and behavioral marital therapy (ABMT); (b) ABMT plus Alcoholics Anonymous and Alanon (AA/ABMT); and (c) ABMT plus relapse prevention (RP/ABMT). Completers (n = 45) attended two assessment and 15-17 treatment sessions. Partial completers (n = 23) left treatment between the 5th and 15th treatment session. Thirty-seven dropouts left treatment between the first assessment session and the 5th treatment session; of these, 22 dropouts completed at least one treatment session (called early treatment dropouts). Of subjects who entered treatment, dropouts from early treatment were least compliant with treatment requirements in the first few sessions, less educated, and less committed to their relationship. Data indicate that therapists with more clinical experience were more likely to retain clients in treatment, regardless of treatment condition. The data do not reflect a linear relationship between most variables studied and a continuum of attrition status from assessment to completion of the program.

Adult↗
PubMed1997

Do extracurricular activities protect against early school dropout?

This study examined the relation between involvement in school-based extracurricular activities and early school dropout. Longitudinal assessments were completed for 392 adolescents (206 girls, 186 boys) who were initially interviewed during 7th grade and followed up annually to 12th grade. A person-oriented cluster analysis based on Interpersonal Competence Scale ratings from teachers in middle schools (i.e., 7th-8th grades) identified configurations of boys and girls who differed in social-academic competence. Early school dropout was defined as failure to complete the 11th grade. Findings indicate that the school dropout rate among at-risk students was markedly lower for students who had earlier participated in extracurricular activities compared with those who did not participate (p < .001). However, extracurricular involvement was only modestly related to early school dropout among students who had been judged to be competent or highly competent during middle school.

Adolescent↗
PubMed1994

Family-based treatment for childhood antisocial behavior: experimental influences on dropout and engagement.

Antisocial behavior in childhood and adolescence is an unquestionably serious problem for society. Family-based treatments are promising but face the challenging obstacle of premature parental dropout. To systematically study dropout, we randomly assigned 147 families with a markedly aggressive child (age 4 to 9 years) to a standard family treatment (SFT) focusing exclusively on parental management or to an enhanced family treatment (EFT) that also promoted frequent discussions of adult issues. EFT produced a significantly lower dropout rate than SFT overall, but particularly for high-adversity families. Dropouts were clearly distinguishable from completers on several dimensions. The results underscore the importance of addressing contextual variables such as family adversity in the treatment of childhood antisocial behavior.

Adolescent↗
PubMed2002

Predictors of quitting and dropout among women in a clinic-based smoking cessation program.

Most cessation studies assume that dropouts are smokers. Instead, the authors analyzed these outcomes separately using multinomial regression to model the relative risk of quitting versus continued smoking and dropping out. Female (N = 281) smokers were randomly assigned to a 12-week smoking cessation program plus either a 3-times-per-week exercise program or a contact control wellness program. Higher body mass index and longer prior quit attempts predicted cessation. Self-efficacy was associated with a lower likelihood of dropout. Greater nicotine dependence and lower education predicted continued smoking or dropout versus quitting among exercisers. Patterns of smoking, dropping out, and quitting between Weeks 5 and 12 were different between exercisers and controls. Dropouts should be considered as a separate category from smokers.

Adult↗