"The challenge of this is not only building the center, but attracting users across the national community and for them to become aware of what we have to offer," says Marcas Bamman, PhD, director of the new REACT Center and MR3 Network Coordinating Center at UAB.
REACT -- Rehabilitation Research Resource to Enhance Clinical Trials -- commenced last October under a $5.7 million NIH grant to cover five years. It serves as one of six centers nationwide that will offer expertise, technology, and resources to support clinical and translational research in medical rehabilitation. "Each center provides its own research resources, training and education," Bamman says, with focuses falling into anything from rehab engineering technology to neuromodulation.
Marcus Bamman, Phd
The first of its kind, REACT fills a gap overlooked in rehabilitation research -- fostering rehab studies from the initial idea into viable clinical studies. "The problem now is that they get stuck in the pilot phase," Bamman says. "We're trying to take those preliminary results and advance that to larger clinical trials that could impact the field.
"If a large study shows a big impact, it can change public policy," says S. Louis Bridges, Jr., MD, PhD, and director of the REACT Pilot Core, which ushers investigators through preliminary research in medical rehabilitation. Exposure in a high-impact journal can stir enough credibility for insurance companies to cover that treatment or approach to rehabilitation, for example.
A major obstacle has been that successful pilot studies on low-incidence population, like those with spinal cord injury, often stall for lack of recruitment needed to attain clinical trial status."Essentially, the researchers have been limited to potential subjects at their institution," Bamman says. "And they don't know how to take the next step from a single site to conduct a large-scale trial across perhaps eight to ten sites to boost their enrollment numbers."
With the REACT investigative team, researchers across the USA can harness UAB expertise in rheumatology, neurology, physical medicine and rehab, physical therapy, bio stats, exercise biology, and clinical trial design. "Using vouchers, they can also access our labs that can do assays, evaluations or measurements for their studies," Bridges says. This is an unusual resource to offer non-UAB researchers.
Four pilot studies have already received funding through REACT. "The pilot program gives seed money to flesh out their idea," Bridges says, including submissions from outside UAB. "It's given to those we thought to be strongest in the likelihood to lead to clinical trials.
"The initial four pilots cover chronic conditions in need of innovative rehab approaches, such as ways to improve arm function debilitated by the thickening of skin by scleroderma or how exercise might reduce trips to the hospital in people with emphysema suffering from shortness of breath.
"Some of these ideas may sound counterintuitive," Bridges says. But like pilot award on high intensity training to abate arthritis in the knee, the concepts are sound enough to warrant funding in the search for needed rehabilitative breakthrough approaches.
"In medical rehab, treatments are often complex and multifactorial, and significant research is needed for treatment optimization," Bamman says.
Maximal leveraging of these centers to advance the field was the stimulation for the six research centers to agree with NIH to choose one of them as a central coordinating organization. UAB won the honor and formed the Medical Rehabilitation Research Resource Network or MR3 Network Coordinating Center.
Collectively, the MR3 Network will enable investigators to accelerate their research in everything from regenerative medicine to clinical trials, offering expertise and options not available before. "Ensuring that researchers take full advantage of these six centers is not an easy thing to do," Bamman says. "But we're in a unique position now to help.
"For instance, now if an investigator from the West Coast accesses REACT to fund a study in stroke rehabilitation, "We can help design the trial and provide pilot funding," Bamman says. "But we can also direct them to the South Carolina center that focuses entirely on stroke rehab." MR3 could set up a visit for the investigator and help them explore a scholarship opportunity with the stroke center to learn new technology and new ways to evaluate patients. "That's just one example of the collaboration we can harness with this new coordination center," he says.
To help define the major barriers to high impact clinical trials, REACT disseminated a national survey to the field. Recruitment and retention of subjects topped the list. Using the feedback, REACT tailored their offerings to suit the needs in pilot funding, consultative service, support, and education.
For the medical community, MR3 will publish a national newsletter a few times a year outlining their rehab research updates, highlights, and advances at the six centers. Healthcare professionals can subscribe by visiting the https://react.center and clicking at the top on "Join REACT".