Dual Field PEMF Therapy in Lower Extremity Painful Diabetic Distal Symmetric Peripheral Neuropathy (RELIEF)
A Multi-Center, Double-Blind, Sham-Controlled, Randomized Trial of Dual Field PEMF Therapy [Provant® Therapy System] in Lower Extremity Painful Diabetic Distal Symmetric Peripheral Neuropathy (DSPN) (The RELIEF Trial)
Study Overview
Status
Status
Conditions
Conditions
Intervention / Treatment
Intervention / Treatment
Detailed Description
Eligible subjects will be entered into a 14-day ePRO diary run-in period to collect average baseline pain scores related to their diabetic neuropathy in the lower extremities, diary compliance, and analgesic consumption (maintenance and prn prescribed peripheral neuropathic pain medication pill counts). Subjects will collect electronic patient-reported outcome (ePRO) data each morning around the same time during the run-in period.
Subjects will return to the clinic at Baseline (Day 0) for review of eligibility, diary compliance, average baseline diabetic neuropathic pain score of ≥4 and <9, and review of stable analgesic pain consumption profile during the 14-day run-in period. Qualified subjects based on diary compliance and average pain score will be randomized 1:1 (active: sham) and will be instructed to self-treat twice daily for 120 days. Subjects will record electronic patient-reported outcome (ePRO) data following each morning treatment for 120 days. Subjects consenting to distal thigh and distal leg skin biopsies during the Screening visit will have biopsies collected and sent to the central laboratory for assessment. All subjects will have baseline assessments conducted.
Subjects will receive a telephone call at Day 7 to ensure compliance to treatment and diary completion, provide follow-up information on the biopsy sites (if applicable), complete a blinding assessment as well as be assessed for safety and concomitant medication changes.
At Month 1 subjects will return to the clinic for evaluation of safety, concomitant medication changes, review device usage and ePRO diary completion, and Patient Global Impression (PGI). Treatment satisfaction will also be assessed.
At Month 2 subjects will return to the clinic for evaluation of safety, concomitant medication changes, treatment satisfaction, review of device usage (reports will be supplied to the site) and ePRO diary completion, quality of life outcomes (WPAIQ and NeuroQoL), Patient Global Impression (PGI), and interim visit measurements of SPP.
At Month 3, subjects will return to the clinic for evaluation of safety, concomitant medication changes, review device usage (reports will be supplied to the site) and ePRO diary completion, and Patient Global Impression (PGI). Treatment satisfaction will also be assessed.
At Month 4 (end of Part A / start of Part B), subjects will return to the clinic for evaluation of safety, treatment satisfaction, review of device usage (reports will be supplied to the site), HbA1c, concomitant medication changes, weight, quality of life outcomes (WPAIQ and NeuroQoL), PGI, final measurements of SPP, NCS, QST and be assessed to determine their Toronto Clinical Neuropathy Score. Those subjects who consented and had biopsies collected at the Enrollment visit, will have their end of study biopsies during this visit and samples sent directly to the central laboratory for assessment. Subjects will return the study device and complete a blinding assessment.
Subjects that complete Part A will continue into the open-label extension period (Part B). All subjects will be reconsented if not completed at a prior visit and given an open-label active device. Subjects will record ePRO data for one week prior to the Month 6, 8, 10, and 12 visits following each morning treatment. Subjects will be reminded of the150-day (Month 5) phone call.
At Month 5, subjects will receive a telephone call to ensure compliance to treatment, and to be assessed for safety and concomitant medication changes.
At Month 6, subjects will receive a telephone call to ensure treatment compliance and collection of diary data, and to assess safety and concomitant medication changes.
At Month 7, subjects will receive a telephone call to ensure treatment compliance, and to assess safety and concomitant medication changes.
At Month 8, subjects will return to the clinic for evaluation of safety, measure QST, treatment satisfaction, review of device usage and collection of diary data, concomitant medication changes, quality of life outcomes (NeuroQoL), and PGI.
At Month 9, subjects will receive a telephone call to ensure treatment compliance, and to assess safety and concomitant medication changes.
At Month 10, subjects will receive a telephone call to ensure treatment compliance and collection of diary data, and to assess safety and concomitant medication changes.
At Month 11, subjects will receive a telephone call to ensure treatment compliance, and to assess safety and concomitant medication changes.
At Month 12 (end of open-label treatment extension), subjects will return to the clinic for evaluation of safety, weight, QST, NCS, TCNSS, PGI, treatment satisfaction, review of device usage and collection of diary data, concomitant medication changes, quality of life outcomes (NeuroQoL), and will return the study device. Subjects who consented and had biopsies collected at the 4 Month visit, will have their end of study biopsies performed during this visit.
Study Type
Study Type
Enrollment (Actual)
Enrollment
Phase
Phase
- Not Applicable
Contacts and Locations
Study Locations
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Arizona
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Mesa, Arizona, United States, 85206
- Physician's Research Group
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California
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Northridge, California, United States, 91325
- Valley Clinical Research
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Sacramento, California, United States, 95821
- Northern California Research
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Tustin, California, United States, 92780
- Diabetes Research Center
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Colorado
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Denver, Colorado, United States, 80209
- Mountain View Clinical Research
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Florida
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Eustis, Florida, United States, 32726
- Lake Internal Medicine Associates
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Fort Myers, Florida, United States, 33912
- Clinical Physiology Associates
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Miami, Florida, United States, 33176
- Spotlight Research Center
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Winter Haven, Florida, United States, 33880
- Clinical Research of Central Florida
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Georgia
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Blue Ridge, Georgia, United States, 30514
- River Birch Research Alliance, LLC
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Indiana
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Evansville, Indiana, United States, 47714
- MediSphere Medical Research Center, LLC
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Kansas
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Wichita, Kansas, United States, 67207
- Heartland Research Associate, LLC
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Missouri
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Hazelwood, Missouri, United States, 63042
- Healthcare Research Network
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Kansas City, Missouri, United States, 64114
- The Center for Pharmaceutical Research, LLC
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Nevada
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Las Vegas, Nevada, United States, 89128
- Palm Research Center
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New York
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Westfield, New York, United States, 14787
- Great Lakes Medical Resarch
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North Carolina
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Cary, North Carolina, United States, 27513
- Wake Family Medicine, PC
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Washington
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Renton, Washington, United States, 98057
- Rainier Clinical Research
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Participation Criteria
Eligibility Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Type 1 or Type 2 diabetes
- Pain attributed to symmetrical lower extremity diabetic peripheral neuropathy for at least 6 months
- DPN pain over the preceding 24 hours is ≥4 and <9 based on the 11-point NPRS (0-10)
- 22 to 80 years of age
- On stable diabetes treatment
- HbA1c less than or equal to 10%
- No recent changes to analgesic prescriptions
- ABI of ≥0.8 to ≤1.3
- Walks independently
- Willing and able to give consent
- If female, must be post-menopausal, surgically sterile, abstinent or practicing an effective method of birth control
- Can access an internet browser or smart phone
To be randomized after the 14-day run-in period, average pain (NPRS) must be ≥ 4 and < 9 over preceding 7 days and subject must be 70% compliant with ePRO assessments (electronic diary)
Exclusion Criteria:
- Active, open ulcer on either extremity
- Significant peripheral vascular disease
- Venous insufficiency
- History of solid organ transplant or severe renal disease
- Diagnosed with a non-diabetic cause of chronic neuropathy
- Previous or current history of primary or tertiary hyperparathyroidism, hypercalcemia, psychiatric disorder, alcohol dependency, Hepatitis B or C, or HIV infection
- Significant cardiovascular disease
- Uncontrolled medical illness
- Requires or anticipates the need for surgery during the study
- Total foot depth of >8 cm
- Has received any investigational drug or device within 30 days
- Has used systemic corticosteroids within 3 months
- History of malignancy within 5 years in treatment area
- A psychiatric disorder of sufficient severity
- Receiving prn narcotic medications
- History of drug or alcohol abuse within 1 year
- Implanted pacemaker, defibrillator, neurostimulator, spinal cord stimulator, bone stimulator, cochlear implant, or other implanted device with an implanted metal lead(s0
- Pregnant or planning to become pregnant
- Previous treatment with Provant Therapy
- Unwilling to follow instructions or comply with study instructions
- Pain from any other source that could confuse DPN pain assessment
- Clinically significant foot deformity
- Skin condition that could alter peripheral sensations
- Previous surgery to the spine or lower extremity with residual symptoms of pain or difficulty with movement.
- Clinically significant arthropathy
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Quadruple
Number of Arms
Arms and Interventions
Participant Group / ArmParticipant Group / Arm |
Intervention / TreatmentIntervention / Treatment |
|---|---|
|
Experimental: Active Group
Treatment with active Provant Therapy System
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Treatment with active Provant Therapy System
|
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Sham Comparator: Sham Group
Treatment with in-active (sham) Provant Therapy System
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Treatment with inactive Provant Therapy System
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What is the study measuring?
Primary Outcome Measures
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
Change in Pain Intensity
Time Frame: Baseline through 4 months
|
Absolute change in pain intensity as measured by the 11-point, numerical pain rating scale (NPRS) (0-10; where 0=no pain, to 10=worst possible pain).
|
Baseline through 4 months
|
Secondary Outcome Measures
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
Patients With 2 Point or 30% Reduction in Pain at 4 Months
Time Frame: Baseline to 4 months
|
Percentage of patients who have either a 2 point or 30% reduction in (pain) NPRS at 4 Months. Absolute change in pain intensity as measured by the 11-point, numerical pain rating scale (NPRS) (0-10; where 0=no pain, to 10=worst possible pain). |
Baseline to 4 months
|
|
Patient Global Impression at 4 Months
Time Frame: Baseline through 4 months.
|
Patient Global Impression at 4 Months.
The question assesses change since the start of the study on a 7-point scale ("Since the start of the study, how has your diabetic neuropathy in your legs changed?"), and to score it as either very much worse, much worse, minimally worse, no change, minimally improved, much improved or very much improved.
|
Baseline through 4 months.
|
|
Time to 30% or 2-point Reduction in NPRS, Whichever Comes First, Through 4 Months
Time Frame: Through 4 months
|
Absolute change in pain intensity as measured by the 11-point, numerical pain rating scale (NPRS) (0-10; where 0=no pain, to 10=worst possible pain).
Number of participants achieving a 30% or 2-point reduction at or prior to weeks 1, 4, 8, 12 and 17 are displayed below.
|
Through 4 months
|
|
Change in Neuropathy Related Quality of Life (NeuroQoL) Between Baseline and End of Treatment at 4 Months.
Time Frame: Baseline to 4 months
|
A validated set of health-related quality of life measures that are domain specific.Subjects will completed 6 domains: (1) Pain, (2) Lost/Reduced Feeling, (3) Diffuse Sensory Motor Symptoms, (4) Restrictions in Activities of Daily Living, (5) Disruptions in Social Relationships, and (6) Emotional Distress.The short forms were completed by the subject at the Enrollment Visit and end of study visit (Day 121). Each question in the domain was rated on a symptom scale from 1 (never) to 5 (all the time) and a bothersome scale from 1 (none) to 3 (very much). The total score for the domain was calculated by multiplying the symptom score by the bothersome score. The scale range is from 1 to 15 where the minimum (best/least symptomatic) score is 1 and the maximum (worst/most symptomatic) score is 15. The mean change from Baseline to month 4 is displayed below. |
Baseline to 4 months
|
|
Change is Skin Perfusion Pressure (SPP) for Baseline to End of Treatment at 4 Months
Time Frame: Baseline to 4 months
|
SPP was measured at two locations on each foot (dorsal right and left and plantar right and left). Mean change displayed from Baseline to 4-months displayed below. SPP measures pressure in mmHg; an increase in pressure is favorable.
|
Baseline to 4 months
|
|
Changes in Nerve Conduction Studies of Velocity Between Baseline and End of Treatment at 4 Months.
Time Frame: Baseline to 4 Months
|
Using the NC-stat DPNCheck, the sural nerve conduction velocity was recorded on the right and left legs.
An increase in velocity would suggest DPN improvement.
The mean change from Baseline to 4-months is displayed below.
|
Baseline to 4 Months
|
|
Changes in Quantitative Sensory Testing (QST) Between Baseline and End of Treatment at 4 Months.
Time Frame: Baseline to 4 months
|
Contact thermal stimulation will be delivered using the Medoc Ltd. Q-Sense system to assess cool sensation threshold, warm sensation threshold and heat pain threshold modalities using the method of limits. Within the cool and warm sensation modalities, the trial is repeated 4 times on each foot and 3 times on each foot for heat pain threshold modality. The cool thermal testing will be conducted prior to the warm and heat pain thermal testing. Mean change from baseline to 4-months displayed below. |
Baseline to 4 months
|
|
Changes in Nerve Conduction Studies of Amplitude Between Baseline and End of Treatment at 4 Months.
Time Frame: Baseline to 4 Months
|
Using the NC-stat DPNCheck, the sural nerve conduction amplitude was recorded on the right and left legs.
An increase in amplitude would suggest DPN improvement.
The mean change from Baseline to 4-months is displayed below.
|
Baseline to 4 Months
|
Other Outcome Measures
Other Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
Exploratory Endpoint: Changes in the Work Productivity and Activity Impairment Questionnaire (WPAIQ) (Questions 2-4)
Time Frame: Baseline to 4 Months
|
The Work Productivity and Activity Impairment Questionnaire (WPAIQ) is a validated 6 question assessment tool that measures time missed from work, impairment of work and regular activities due to their health problem. Subjects are asked if they are working (Question 1), and if answer is yes, subjects are asked about the effect their diabetic neuropathy (DN) has on their ability to work and perform regular activities in the past 7 days. Mean change from Baseline to 4-months are displayed below (Questions 2-4) for subjects that responded "Yes" to working in Question 1. Questions 2-4 are answered in number of hours. |
Baseline to 4 Months
|
|
Exploratory Endpoint: Changes in Intraepidermal Nerve Fiber Density (IENFD) at the Distal Thigh and Distal Leg - Part A
Time Frame: Baseline to Month 4
|
Optional two 3 mm punch skin biopsies will be performed at baseline and end of treatment to assess IENFD. At the Enrollment Visit, one biopsy will be obtained at the distal leg, 10 cm above the lateral malleolus on the right leg and a second biopsy will be obtained at the distal thigh, 10 cm above the superior margin of the patella on the lateral right leg. At the end of Part A study visit Month 4 (Day 121), a second set of biopsies will be obtained lateral to the baseline biopsies and shipped overnight to the central lab. For Active Group and Sham Group displayed below, result are the change in nerve fiber density from Baseline to Month 4. |
Baseline to Month 4
|
|
Exploratory Endpoint: Change in Pain Intensity During Part B
Time Frame: Baseline through 12 months
|
Absolute change in pain intensity as measured by the 11-point, numerical pain rating scale (NPRS) (0-10; where 0=no pain, to 10=worst possible pain).
Results below display the change from Baseline to Month 12 for subjects that participated in the open-label extension (Part B), stratified by their original randomization in Part A.
|
Baseline through 12 months
|
|
Exploratory Endpoint: Changes in Nerve Conduction Studies of Velocity During Part B
Time Frame: Baseline to Month 12
|
Using the NC-stat DPNCheck, the sural nerve conduction velocity was recorded on the right and left legs.
An increase in velocity would suggest DPN improvement.
Results below display the mean change in velocity and from Baseline to Month 12 for subjects that participated in the open-label extension (Part B), stratified by their original randomization in Part A.
|
Baseline to Month 12
|
|
Exploratory Endpoint: Change in Neuropathy Related Quality of Life (NeuroQoL) During Part B
Time Frame: Baseline to Month 12
|
A validated set of health-related quality of life measures that are domain specific.Subjects will completed 6 domains: (1)Pain, (2)Lost/Reduced Feeling, (3)Diffuse Sensory Motor Symptoms, (4)Restrictions in Activities of Daily Living, (5)Disruptions in Social Relationships, and (6)Emotional Distress.The short forms were completed by the subject at the Enrollment Visit, end of study visit (Day 121) and at 12 months. Each question in the domain was rated on a symptom scale from 1 (never) to 5 (all the time) and a bothersome scale from 1 (none) to 3 (very much). The total score for the domain was calculated by multiplying the symptom score by the bothersome score. The scale range is from 1 to 15 where the minimum (best/least symptomatic) score is 1 and the maximum (worst/most symptomatic) score is 15. Results below display the change from Baseline to Month 12 for subjects that participated in the open-label extension (Part B), stratified by their original randomization in Part |
Baseline to Month 12
|
|
Exploratory Endpoint: Changes in Nerve Conduction Studies of Amplitude During Part B
Time Frame: Baseline to Month 12
|
Using the NC-stat DPNCheck, the sural nerve conduction amplitude was recorded on the right and left legs.
An increase in amplitude would suggest DPN improvement.
Results below display the mean change in amplitude from Baseline to Month 12 for subjects that participated in the open-label extension (Part B), stratified by their original randomization in Part A.
|
Baseline to Month 12
|
|
Exploratory Endpoint: Changes in the Work Productivity and Activity Impairment Questionnaire (WPAIQ) (Questions 5-6)
Time Frame: Baseline to 4 Months
|
The Work Productivity and Activity Impairment Questionnaire (WPAIQ) is a validated 6 question assessment tool that measures time missed from work, impairment of work and regular activities due to their health problem. Subjects are asked if they are working (Question 1), and if answer is yes, subjects are asked about the effect their diabetic neuropathy (DN) has on their ability to work and perform regular activities in the past 7 days. Mean change from Baseline to 4-months displayed below (Questions 5-6) for subjects that responded "Yes" to working in Question 1. Questions 5 and 6 use a 0-10 scale where 0 = no effect on work and/or daily activities and 10 =DN completely prevented me from working and/or doing daily activities. |
Baseline to 4 Months
|
|
Exploratory Endpoint: Changes in Intraepidermal Nerve Fiber Density (IENFD) at the Distal Thigh and Distal Leg - Part B
Time Frame: Baseline to Month 12
|
Optional two 3 mm punch skin biopsies will be performed at baseline and end of treatment to assess IENFD. At the Enrollment Visit, one biopsy will be obtained at the distal leg, 10 cm above the lateral malleolus on the right leg and a second biopsy will be obtained at the distal thigh, 10 cm above the superior margin of the patella on the lateral right leg. At the end of Part A study visit Month 4 (Day 121), a second set of biopsies will be obtained lateral to the baseline biopsies and shipped overnight to the central lab. At the end of Part B study visit Month 12 (Day 361), a final set of biopsies will be obtained lateral to the Month 4 biopsies. Results displayed are the change in nerve fiber density from Baseline to Month 12 for subjects that participated in the open-label extension (Part B), stratified by their original randomization in Part A. |
Baseline to Month 12
|
Collaborators and Investigators
Sponsor
Sponsor
Study record dates
Study Major Dates
Study Start (Actual)
Study Start
Primary Completion (Actual)
Primary Completion
Study Completion (Actual)
Study Completion
Study Registration Dates
First Submitted
First Submitted
First Submitted That Met QC Criteria
First Submitted That Met QC Criteria
First Posted (Actual)
First Posted
Study Record Updates
Last Update Posted (Actual)
Last Update Posted
Last Update Submitted That Met QC Criteria
Last Update Submitted That Met QC Criteria
Last Verified
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
Other Study ID Numbers
- RBI.2017.002
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
product manufactured in and exported from the U.S.
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