- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT01668953
Comparison of Platelet Rich Plasma and Alternative Therapies for the Treatment of Tennis Elbow (Lateral Epicondylitis) (IMPROVE)
Impact of Platelet Rich Plasma Over Alternative Therapies in Patients With Lateral Epicondylitis
"Tennis elbow" is the most common cause of lateral elbow pain, generally caused by either work or sports related repetitive strain. In this condition, a tendon along the outside of the elbow becomes inflamed leading to pain, especially with flexing and extending the elbow.
Many treatments have been attempted, including physiotherapy and steroids, with little success. One treatment which has been very effective is the injection of the patients own blood (taken from their other non-affected arm) into their abnormal tendon. The blood recruits the patients own healing factors and heals the damaged tendon. As platelets are thought to be largely responsible, injection of concentrated platelets, extracted from the patient's blood (platelet rich plasma) is a newer, but expensive, technique.
At this point, it is unclear whether whole blood, concentrated platelets, or simply passing a ultrasound-guided needle through the abnormal tendon as a means to stimulate tissue healing (tendon fenestration) is the better treatment.
The objective of this trial is to compare platelet rich plasma, whole blood, dry needle tendon fenestration, and sham injection (with physical therapy) to identify the best and most cost-effective therapy for this debilitating condition.
Study Overview
Status
Conditions
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Contacts and Locations
Study Locations
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Ontario
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Hamilton, Ontario, Canada, L8L 2X2
- Hamilton General Hospital
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Michigan
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Ann Arbor, Michigan, United States, 48109-5326
- University of Michigan
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- Adult man or woman aged 18 years or greater.
- Clinical diagnosis of lateral epicondylitis based on site of pain, pain elicited with active extension of the wrist in pronation and elbow extension.
- Documented sonographic diagnosis of common extensor tendinosis based on tendon thickening, areas of hypoechogenicity, and loss of the normal echotexture.
- Chronic symptoms (equal or greater than 3 months).
- Pain of at least 5 out of 10 on a visual analog scale (VAS).
- Provision of informed consent.
Exclusion Criteria:
- Acute symptom onset (less than 2 months).
- History of acute elbow trauma (less than one week).
- History of rheumatoid arthritis.
- History of malignancy.
- Pregnancy
- Patients requiring anti-platelet medication for the treatment of heart attack, stroke or other medical condition.
- Previous surgery for lateral epicondylitis.
- Previous local injections, including steroids within the past 6 months.
- Signs of other causes for lateral elbow pain (posterior interosseous nerve entrapment, osteochondral lesion).
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Single
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
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Experimental: Platelet Rich Plasma (PRP) Injection
Patients in this arm will receive a platelet rich plasma injection at the site of their lateral epicondylitis, followed by post-treatment physical therapy exercises.
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Active Comparator: Whole Blood Injection
Patients in this arm will receive a whole blood injection at the site of their lateral epicondylitis, followed by post-treatment physical therapy exercises.
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Active Comparator: Dry Needle Fenestration
Patients in this arm will receive 15-25 gentle strokes of dry needling (piercing of the tendon) at the site of their lateral epicondylitis, followed by post-treatment physical therapy exercises.
No blood will be injected into the tendon.
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Placebo Comparator: Sham Injection
Patients in this arm will receive a sham injection, followed by post-treatment physical therapy exercises.
No blood will be injected into the tendon.
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Pain Reduction
Time Frame: Baseline, 6 weeks, 3, 6, 12 months
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Pain reduction will be measured using the Visual Analog Scale (VAS), a subjective scale in which the patient rates their pain on a scale from 0 to 10 (0, no pain, 10, maximum possible pain).
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Baseline, 6 weeks, 3, 6, 12 months
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Functional Disability
Time Frame: Baseline, 6 weeks, 3, 6, 12, 24 months
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Functional disability will be measured using the Liverpool Elbow Score (LES) which is an assessment tool for evaluating function based on range of motion, ulnar nerve function, and ability to perform daily activities.
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Baseline, 6 weeks, 3, 6, 12, 24 months
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Psychological Impairment
Time Frame: Baseline, 6 weeks, 3, 6, 12, 24 months
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Psychological impairment (depression and anxiety) will be assessed using the Hospital Anxiety and Depression Scale (HADS) which is a reliable, validated, and practical tool for identifying and quantifying anxiety and depression.
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Baseline, 6 weeks, 3, 6, 12, 24 months
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Health-Related Quality of Life
Time Frame: Baseline, 6 weeks, 3, 6, 12, 24 months
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Health-related quality of life will be measured using the 12-Item Short Form Health Survey (SF-12).
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Baseline, 6 weeks, 3, 6, 12, 24 months
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Collaborators and Investigators
Sponsor
Collaborators
Investigators
- Principal Investigator: Mary M Chiavaras, MD, PhD, McMaster University
Publications and helpful links
General Publications
- Syrjala KL, Walsh CA, Yi JC, Leisenring WM, Rajotte EJ, Voutsinas J, Ganz PA, Jacobs LA, Palmer SC, Partridge A, Baker KS. Cancer survivorship care for young adults: a risk-stratified, multicenter randomized controlled trial to improve symptoms. J Cancer Surviv. 2022 Oct;16(5):1149-1164. doi: 10.1007/s11764-021-01105-8. Epub 2021 Sep 29.
- Hall AG, Syrjala KL, Ketterl TG, Ganz PA, Jacobs LA, Palmer SC, Partridge A, Rajotte EJ, Mueller BA, Baker KS. Socioeconomic Factors and Adherence to Health Care Recommendations in Adolescent and Young Adult Cancer Survivors. J Adolesc Young Adult Oncol. 2023 Feb 13. doi: 10.1089/jayao.2022.0109. Online ahead of print.
Study record dates
Study Major Dates
Study Start
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimate)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- IMPROVE-001
- Research Seed Grant # 1204 (Other Grant/Funding Number: Radiological Society of North America (RSNA))
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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