Objective Data on Daily Activity in Patients Treated with SCS: the Intellis Study

January 14, 2025 updated by: Kliment Gatzinsky, Sahlgrenska University Hospital

Objective Long-term Data Recording of Daily Activity in Patients with Failed Back Surgery Syndrome Treated with Spinal Cord Stimulation - a Prospective 12-month Follow-up Study

In spinal cord stimulation (SCS), most outcome data are based on patient questionnaires. The lack of tools for objective evaluation of the effects of SCS on chronic pain has posed a barrier for providing solid proof of the therapy. Currently, however, SCS-devices with an accelerator included are available on the market. The position orientation data provided by the neurostimulator therefore gives new possibilities for objective measurement of gross activity in daily life.

Study Overview

Status

Status

Indicates the current recruitment status or the expanded access status.
Completed

Conditions

Conditions

The disease, disorder, syndrome, illness, or injury that is being studied. On ClinicalTrials.gov, conditions may also include other health-related issues, such as lifespan, quality of life, and health risks.

Intervention / Treatment

Intervention / Treatment

A process or action that is the focus of a clinical study. Interventions include drugs, medical devices, procedures, vaccines, and other products that are either investigational or already available. Interventions can also include noninvasive approaches, such as education or modifying diet and exercise.

Detailed Description

Although the interaction between chronic pain and physical functioning is a well-accepted paradigm, objective data on how pain affects individuals' daily life is scanty. Most data are based on patient questionnaires. The purpose of this study is to objectively assess the activity of daily living in chronic pain patients treated with spinal cord stimulation (SCS).

Indication: Chronic pain in the low-back and/or leg(s) due to failed back surgery syndrome

Study Design: Prospective, open-label, multi-center, observational, study.

Sample Size: 50 patients receiving an Intellis neurostimulator for treatment with SCS.

Study Centers: Up to 10 sites in Europe

Objectives:

  1. Utilize an existing neurostimulator-based data diary to measure gross daily activity in patients with chronic pain
  2. Test the usefulness of this data diary as a tool for objective evaluation of SCS efficacy on chronic pain.
  3. Investigate how the collected objective data relates to the subjective experience of the patient when evaluating the effects of SCS.

Materials/Methods:

Patients diagnosed with failed back surgery syndrome (FBSS) with chronic back and leg pain that have been evaluated as candidates for SCS will be included.

Gross daily activity is recorded using the Intellis neurostimulator (Medtronic Inc.) which contains a diary (AdaptiveStim™ Diary) that continuously stores data of seven different body positions: upright, upright mobile, recline and 4 lying positions. Recordings are performed for 4 weeks before the SCS trial (baseline) using an external Intellis device adhered to the skin of the abdomen and thereafter, in patients who responded to SCS during the SCS-trial period, utilizing the permanent Intellis implanted subcutaneously at the same site. Data will be extracted from the data diary at 3, 6 and 12 months after implantation of the SCS system and compared with changes in pain, quality of life and sleep as assessed by patient self-report questionnaires using validated tools.

Study Duration:

The estimated duration of the study from first enrolment to final report is 24 months, including a 10 months enrolment period. The estimated duration of a subject's participation in the study is approximately 12 months. Interim analyses will be performed after 3 and 6 months follow up.

BACKGROUND The use of spinal cord stimulation (SCS) for pain control has already a history of more than 50 years. During the last decades many articles have been published, indicating the effectiveness and safety of SCS in the pain management of chronic neuropathic pain, and in particular in patients with chronic back and leg pain due to persisting, new or recurrent pain after spinal surgery, so called failed back surgery syndrome (FBSS).1 In this patient group the interaction between chronic pain and physical functioning is a well-accepted paradigm, although objective data that shows how pain affects individuals' daily life is scanty. Correlation between reduction in pain intensity and sustained improvement in physical activity has previously been demonstrated using kinematical sensors.2.3 In SCS, most outcome data are based on patient questionnaires. The lack of tools for objective evaluation of the effects of SCS on chronic pain has posed a barrier for providing solid proof of the therapy. Currently, however, SCS-devices with an accelerator included are available on the market. The position orientation data provided by the neurostimulator therefore gives new possibilities for objective measurement of gross activity in daily life.

In an earlier single center pilot study with the first implantable neurostimulator with an accelerometer the potential of objective outcome measurements was explored in six patients with FBSS.4 A positive correlation between decrease in pain and increase in time spent in upright position has been demonstrated by the preliminary pilot study utilizing this neurostimulator in which position and upright/upright mobile changes were recorded based on 24-hour cycles. However, not all patients that experience good pain relief showed an increased activity level depending on which position that is painful.

With the new neurostimulator (Intellis), position changes and level of activity are recorded on an hour by hour basis, which makes it possible to differentiate between day and night activity. The goal of the current study is to repeat the pilot study on objective outcomes with the newly available neurostimulator with inbuilt accelerometer using a prospective, open-label, observational study design.

OBJECTIVES

  1. Utilize an existing neurostimulator-based data diary to measure gross daily activity in patients with CBLP.
  2. Test the usefulness of this data diary as a tool for objective evaluation of SCS efficacy on CBLP.
  3. Investigate how the collected objective data relates to the subjective experience of the patient when evaluating the effects of SCS.

Study Type

Study Type

Describes the nature of a clinical study. Study types include interventional studies (also called clinical trials), observational studies (including patient registries), and expanded access.
Observational

Enrollment (Actual)

Enrollment

The number of participants in a clinical study. The "anticipated" enrollment is the target number of participants that the researchers need for the study.
50

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

Study Contact

The name and contact information for the person who can answer enrollment questions for a clinical study. Each location where the study is being conducted may also have a specific contact, who may be better able to answer those questions.

Study Contact Backup

Study Locations

  • Belgium
      • Roeselare, Belgium
        • AZ Delta Hospital
  • Denmark
      • Aalborg, Denmark
        • Aalborg University Hospital
  • Netherlands
      • Arnhem, Netherlands
        • Rijnstate Hospital
      • Leeuwarden, Netherlands
        • MCL Leeuwarden
      • Roosendaal, Netherlands
        • Bravis Hospital
      • Zeist, Netherlands
        • Diakonissenhuis Hospital
  • Sweden
      • Gothenburg, Sweden
        • Sahlgrenska University Hospital

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Eligibility Criteria

The key requirements that people who want to participate in a clinical study must meet or the characteristics they must have. Eligibility criteria consist of both inclusion criteria (which are required for a person to participate in the study) and exclusion criteria (which prevent a person from participating). Types of eligibility criteria include whether a study accepts healthy volunteers, has age or age group requirements, or is limited by sex.

Ages Eligible for Study

18 years to 70 years (Adult, Older Adult)

Accepts Healthy Volunteers

No

Sampling Method

Probability Sample

Study Population

Patients diagnosed with failed back surgery syndrome (FBSS) with chronic back and leg pain that have been evaluated as candidates for SCS will be included.

Description

Inclusion Criteria:

  • Refractory chronic pain in low-back and/or legs that persists for at least 6 months following the most recent spinal surgery
  • 18-70 years of age. Patients >70 years will not be included due to the reduction in general activity level that is usually seen in older patient cohorts.
  • Mean pain intensity should be 5 or higher measured on a Visual Analogue Scale (VAS).
  • Patient has been informed of the study procedures and has given written informed consent.

Exclusion Criteria:

  • Expected inability of patients to receive or properly operate the spinal cord stimulation system
  • History of coagulation disorders, lupus erythematosus, rheumatoid arthritis
  • Addiction to drugs, alcohol (5E/day) and/or medication
  • Evidence of an active disruptive psychiatric disorder or other known condition significant enough to impact perception of pain, compliance to intervention and/or ability to evaluate treatment outcome as determined by investigator
  • Active malignancy
  • Life expectancy < 1 year
  • Local infection or other skin disorder at site of incision
  • Pregnancy

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Observational Models: Cohort
  • Time Perspectives: Prospective

Cohorts and Interventions

Group / Cohort

Group / Cohort

A group or subgroup of participants in an observational study that is assessed for biomedical or health outcomes.
Intervention / Treatment

Intervention / Treatment

A process or action that is the focus of a clinical study. Interventions include drugs, medical devices, procedures, vaccines, and other products that are either investigational or already available. Interventions can also include noninvasive approaches, such as education or modifying diet and exercise.
Chronic pain
Failed back surgery syndrome
Device: Spinal cord stimulation
Adhesion of Intellis spinal cord stimulator to the skin of the abdomen for 4 weeks for baseline recording of activity level prior to trial with spinal cord stimulation.

What is the study measuring?

Primary Outcome Measures

Primary Outcome Measures

In a clinical study's protocol, the planned outcome measure that is the most important for evaluating the effect of an intervention/treatment. Most clinical studies have one primary outcome measure, but some have more than one.
Outcome Measure
Measure Description
Time Frame
Position reporting: Intellis SnapShot Reporting
Time Frame: Change from baseline Intellis SnapShot Reporting at 12 months
The Intellis neurostimulator provides reports (extracted with the physician programmer) on the position of the patient over a certain time-period. The built-in software provides summary reports over periods of weeks.
Change from baseline Intellis SnapShot Reporting at 12 months

Secondary Outcome Measures

Secondary Outcome Measures

In a clinical study's protocol, a planned outcome measure that is not as important as the primary outcome measure for evaluating the effect of an intervention but is still of interest. Most clinical studies have more than one secondary outcome measure.
Outcome Measure
Measure Description
Time Frame
Pain: Visual Analogue Scale (VAS)
Time Frame: Change from baseline VAS at 12 months
The VAS questionnaire is a standardized instrument that tries to measure the amount of pain that a patient feels across a continuum from none to an extreme amount of pain. Operationally a VAS is a horizontal line, 100 mm in length, anchored by word descriptors at each end. A score of 0 (zero) is "no pain" while a score of 10 (ten) is "worst possible pain". The patient marks on the line the point that they feel represents their perception of their current state.
Change from baseline VAS at 12 months
Health Related Quality of Life: EuroQoL Group - 5 Dimensional (EQ-5D)
Time Frame: Change from baseline EQ-5D at 12 months
The EuroQoL EQ-5D is a generic measure of self-rated health status, where health is characterized on five dimensions: mobility, self-care, ability to undertake usual activities, pain and anxiety/ depression. Patients are asked to indicate their level of health on each dimension using one of three levels: "no health problems", "moderate health problems", and "severe health problems". Designed for self-completion, this scale provides a simple descriptive profile and a single index value for health status.
Change from baseline EQ-5D at 12 months
Disability: Oswestry Disability Index (ODI)
Time Frame: Change from baseline ODI at 12 months
ODI is an index derived from the Oswestry Low Back Pain Questionnaire used by clinicians and researchers to quantify disability for low back pain. The self-completed questionnaire contains ten topics concerning intensity of pain, lifting, ability to care for oneself, ability to walk, ability to sit, sexual function, ability to stand, social life, sleep quality, and ability to travel. Each topic category is followed by 6 statements describing different potential scenarios in the patient's life relating to the topic. The patient then checks the statement which most closely resembles their situation. Each question is scored on a scale of 0-5 with the first statement being zero and indicating the least amount of disability and the last statement is scored 5 indicating most severe disability. The scores for all questions answered are summed, then multiplied by two to obtain the index (range 0 to 100). Zero is equated with no disability and 100 is the maximum disability possible.
Change from baseline ODI at 12 months
Sleep: Pain and Sleep Questionnaire eight item index (PSQ-8)
Time Frame: Change from baseline PSQI at 12 months
The Pain and Sleep Questionnaire (PSQI) is a self-report questionnaire that assesses the impact of pain on sleep in patients with chronic non-malignant pain of various etiologies The measure consists of 8 individual items that produce one global score.
Change from baseline PSQI at 12 months

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Sponsor

The organization or person who initiates the study and who has authority and control over the study.
Sahlgrenska University Hospital

Investigators

Investigators

A researcher involved in a clinical study. Related terms include site principal investigator, site sub-investigator, study chair, study director, and study principal investigator.
  • Principal Investigator: Kliment Gatzinsky, MD, PhD, Sahlgrenska University Hospital

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

Study Start

The actual date on which the first participant was enrolled in a clinical study. The "anticipated" study start date is the date that the researchers think will be the study start date.
August 1, 2020

Primary Completion (Actual)

Primary Completion

The date on which the last participant in a clinical study was examined or received an intervention to collect final data for the primary outcome measure. Whether the clinical study ended according to the protocol or was terminated does not affect this date. For clinical studies with more than one primary outcome measure with different completion dates, this term refers to the date on which data collection is completed for all the primary outcome measures. The "anticipated" primary completion date is the date that the researchers think will be the primary completion date for the study.
July 31, 2024

Study Completion (Actual)

Study Completion

The date on which the last participant in a clinical study was examined or received an intervention/treatment to collect final data for the primary outcome measures, secondary outcome measures, and adverse events (that is, the last participant's last visit). The "anticipated" study completion date is the date that the researchers think will be the study completion date.
July 31, 2024

Study Registration Dates

First Submitted

First Submitted

The date on which the study sponsor or investigator first submitted a study record to ClinicalTrials.gov. There is typically a delay of a few days between the first submitted date and the record's availability on ClinicalTrials.gov (the first posted date).
January 12, 2021

First Submitted That Met QC Criteria

First Submitted That Met QC Criteria

The date on which the study sponsor or investigator first submits a study record that is consistent with National Library of Medicine (NLM) quality control (QC) review criteria. The sponsor or investigator may need to revise and submit a study record one or more times before NLM's QC review criteria are met. It is the responsibility of the sponsor or investigator to ensure that the study record is consistent with the NLM QC review criteria.
January 12, 2021

First Posted (Actual)

First Posted

The date on which the study record was first available on ClinicalTrials.gov after National Library of Medicine (NLM) quality control (QC) review has concluded. There is typically a delay of a few days between the date the study sponsor or investigator submitted the study record and the first posted date.
January 14, 2021

Study Record Updates

Last Update Posted (Actual)

Last Update Posted

The most recent date on which changes to a study record were made available on ClinicalTrials.gov. There may be a delay between when the changes were submitted to ClinicalTrials.gov by the study's sponsor or investigator (the last update submitted date) and the last update posted date.
March 25, 2025

Last Update Submitted That Met QC Criteria

Last Update Submitted That Met QC Criteria

The most recent date on which the study sponsor or investigator submitted changes to a study record that are consistent with National Library of Medicine (NLM) quality control (QC) review criteria. It is the responsibility of the sponsor or investigator to ensure that the study record is consistent with the NLM QC review criteria.
January 14, 2025

Last Verified

Last Verified

The most recent date on which the study sponsor or investigator confirmed the information about a clinical study on ClinicalTrials.gov as accurate and current. If a study with a recruitment status of recruiting; not yet recruiting; or active, not recruiting has not been confirmed within the past 2 years, the study's recruitment status is shown as unknown.
January 1, 2025

More Information

Terms related to this study

Additional Relevant MeSH Terms

Other Study ID Numbers

Other Study ID Numbers

Identifiers or ID numbers other than the NCT number that are assigned to a clinical study by the study's sponsor, funders, or others. These numbers may include unique identifiers from other trial registries and National Institutes of Health grant numbers.
  • Dnr 2020-00785

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

product manufactured in and exported from the U.S.

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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