- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT02572011
Transtibial Amputee Balance Training: A Randomised Controlled Trial
March 12, 2019 updated by: Dr. Cleveland T. Barnett, Nottingham Trent University
A Games-console Based Balance Training Intervention for Transtibial Amputees: A Randomised Controlled Trial
Lower limb amputees have reduced joint mobility and strength which negatively influence an individual's ability to maintain balance.
Individuals with lower limb amputation also have an increased fear of falling and reduced social participation because of this fear.
Improving balance ability, reducing falls and fear of falling through effective balance training interventions would have a number of socio-economic benefits.
The aim of the current study is to investigate whether taking part in a games console based-balance intervention, improves balance ability in individuals with lower limb amputation.
Study Overview
Status
Terminated
Conditions
Intervention / Treatment
Detailed Description
Lower limb amputation (LLA) results in the loss of the biological joint structures such as the ankle and knee, along with the associated musculature.
This reduces joint mobility and strength and thus adversely affects amputees' ability to maintain balance.
As a result, individuals with a LLA have been shown to fall more often when compared to age-matched and otherwise healthy individuals.
In addition, individuals with LLA also have an increased fear of falling and reduced social participation because of this fear.
Improving balance ability, reducing falls and fear of falling in this patient group through effective balance training interventions would have a number of socio-economic benefits.
Such benefits may include but are not limited to reduced care costs, reduced burden on healthcare services and an improved sense of patient well-being.
Therefore, the main aim of the current randomised control trial (RCT) is to investigate whether taking part in a games console based-balance intervention, improves experienced LLAs balance ability.
The RCT also aims to assess how this intervention affects an amputee's falls rate, fear of falling and quality of life.
After providing informed consent, unilateral lower limb amputees will be randomly allocated to one of two groups; an experimental group (12-week balance training intervention) or a control group (no intervention).
Amputees in the experimental group will be loaned the use of a games console for the duration of the home-based intervention.
Balance ability, falls rate, fear of falling and quality of life will be assessed prior to and post the intervention period as well as after three months following the end of the intervention period.
Falls rate will also assessed one year post the intervention period.
Results from the current study will provide evidence for the use of games-console based balance interventions in improving balance and falls outcomes for LLA.
Study Type
Interventional
Enrollment (Actual)
2
Phase
- Not Applicable
Contacts and Locations
This section provides the contact details for those conducting the study, and information on where this study is being conducted.
Study Locations
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Notts
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Nottingham, Notts, United Kingdom, NG11 8NS
- The Biomechanics Lab, CELS Building, Nottingham Trent University
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Nottingham, Notts, United Kingdom, NG5 1PB
- The Mobility Centre, City Hospital, NUH NHS Trust
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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
Ages Eligible for Study
16 years and older (Adult, Older Adult)
Accepts Healthy Volunteers
No
Genders Eligible for Study
All
Description
Inclusion Criteria:
- Unilateral transtibial amputee to fit research design and must have at least 12 months experience using their prosthetic limb independently following discharge from in-patient treatment
- Minimum of 18 years old. There are no gender requirements - Age requirements in order to self-consent to participate, thus no child protection issues.
- Able to travel - Data collection takes place at University campus where participants will attend data collection sessions.
- Able to use prosthesis without pain or discomfort for a minimum of two hours at a time - Must be able to use prosthesis in order to complete tasks required for this research.
- Able to stand for periods of up to 2 minutes, unaided and without walking aid to complete tasks required for assessment where participants are required to stand on a force platform and perform some volitional postural movements.
Exclusion Criteria:
- Current musculoskeletal injury - Risk of further injury could be increased.
- Unable to follow instruction or cognitive deficits - Risk of further injury whilst completing tasks incorrectly.
- Bilateral amputation - In order to have a homogenous group of amputees in terms of categorisation of amputation.
- Unable to perform tasks due to current medical condition e.g. rheumatoid arthritis - Risk of worsening current condition and/or causing further injury.
- Experience pain or discomfort whilst wearing prosthesis - Risk of further injury and/or worsening of current condition. To be assessed by clinical team when individual is informed of study.
- Does not use prosthesis regularly.
- Not able to understand written and verbal English - All communication will be in English as the University does not have a service available that will be able to cope with translation demands.
- Currently taking medication known to affect balance adversely - Risk of falling during balance training and/or data collection sessions.
- Current Training - Participants must not be currently using the Nintendo Wii or similar systems in a structured balance training program.
- Inability to provide informed consent
- Substantial changes to the physical condition of the lower limb - If after consenting and participating in the study, individuals are referred to mobility services due to a degradation of the physical condition of either lower limb, they will be excluded from the study.
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
- Primary Purpose: Other
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
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No Intervention: Control
Participants in the control (CON) group will not complete any formalised balance training as part of the current study.
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Experimental: Experimental
Participants in the experimental group will complete the Home-based Games Console Balance Training intervention.
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The balance training intervention involves completing prescribed balance tasks for a minimum of 60 minutes per session, three times a week for 12 weeks (minimum intervention time of 2160 minutes) in their own home.
Participants will perform the balance related Wii Fit games that have been suggested previously by professional bodies and amputee therapists (BACPAR Ossur Wii Fit Exercise Recommendations).
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Limits of Stability Test Protocol Directional Control Score
Time Frame: Baseline to 3 Month Follow-Up
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Participants will also be required to complete the Limits of Stability test (LOS) which measures a participant's ability to perform postural movements in order to voluntarily move their centre of gravity (COG) as they stand on a force platform.
The LOS requires participants to move their COG in the direction of eight pre-determined target directions as quickly and as accurately as possible.
The eight pre-determined target directions will be representative of an individuals' 100% limit of stability based upon their height.
Assuming that the body acts as an inverted pendulum with rotation about the ankle, this relates to the amount of movement possible before the COG position necessitates adjustment of the base of support by stepping.
The directional control score (%) will be produced from this test protocol.
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Baseline to 3 Month Follow-Up
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The Berg Balance Scale
Time Frame: Baseline to 3 Month Follow-Up
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Participants will complete the Berg Balance Scale, which involves the assessment of participants' ability to perform a number of functional tasks such as moving from standing to sitting, which are scored on a five point scale e.g.
Needs assistance to sit (0) to sits safely with minimal use of hands (4).
A total Berg Balance Scale score is calculated from this assessment.
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Baseline to 3 Month Follow-Up
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Falling
Time Frame: Baseline to 1 Year Follow-Up
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Falls, defined as an unexpected event in which the participant comes to rest on the ground, floor or lower level' will be recorded using prospective daily recording procedure with participants recording the occurrence of falls in a falls log book.
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Baseline to 1 Year Follow-Up
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Falls Efficacy
Time Frame: Baseline to 3 Month Follow-Up
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Participants will complete the Modified Falls Efficacy scale in order to assess their falls efficacy.
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Baseline to 3 Month Follow-Up
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The Prosthesis Evaluation Questionnaire
Time Frame: Baseline to 3 Month Follow-Up
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Participants will complete the Prosthesis Evaluation Questionnaire in order to assess their satisfaction with aspects concerning their prosthesis and their associated function.
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Baseline to 3 Month Follow-Up
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The Short form-36 Questionnaire
Time Frame: Baseline to 3 Month Follow-Up
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Participants will complete the Short form-36 questionnaire to assess their quality of life.
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Baseline to 3 Month Follow-Up
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The Activities and Balance Confidence Scale
Time Frame: Baseline to 3 Month Follow-Up
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Participants will complete the Activities and Balance Confidence Scale in order to assess their confidence in maintaining balance during activities of daily living.
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Baseline to 3 Month Follow-Up
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Centre of Mass Dynamics
Time Frame: Baseline to 3 Month Follow-Up
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Participants biomechanical function, specifically the dynamics (movement) of their centre of mass, during the Limits of Stability Test protocol will be assessed in order to understanding the underpinning mechanisms of balance in this population.
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Baseline to 3 Month Follow-Up
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Limits of Stability Test Protocol Maximal Excursion Score
Time Frame: Baseline to 3 Month Follow-Up
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Participants will also be required to complete the Limits of Stability test (LOS) which measures a participant's ability to perform postural movements in order to voluntarily move their centre of gravity (COG) as they stand on a force platform.
The LOS requires participants to move their COG in the direction of eight pre-determined target directions as quickly and as accurately as possible.
The eight pre-determined target directions will be representative of an individuals' 100% limit of stability based upon their height.
Assuming that the body acts as an inverted pendulum with rotation about the ankle, this relates to the amount of movement possible before the COG position necessitates adjustment of the base of support by stepping.
The maximal excursion score (%) will be produced from this test protocol.
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Baseline to 3 Month Follow-Up
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Limits of Stability Test Protocol Reaction Time Score
Time Frame: Baseline to 3 Month Follow-Up
|
Participants will also be required to complete the Limits of Stability test (LOS) which measures a participant's ability to perform postural movements in order to voluntarily move their centre of gravity (COG) as they stand on a force platform.
The LOS requires participants to move their COG in the direction of eight pre-determined target directions as quickly and as accurately as possible.
The eight pre-determined target directions will be representative of an individuals' 100% limit of stability based upon their height.
Assuming that the body acts as an inverted pendulum with rotation about the ankle, this relates to the amount of movement possible before the COG position necessitates adjustment of the base of support by stepping.
The reaction time score (s) will be produced from this test protocol.
|
Baseline to 3 Month Follow-Up
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Limits of Stability Test Protocol Movement Velocity Score
Time Frame: Baseline to 3 Month Follow-Up
|
Participants will also be required to complete the Limits of Stability test (LOS) which measures a participant's ability to perform postural movements in order to voluntarily move their centre of gravity (COG) as they stand on a force platform.
The LOS requires participants to move their COG in the direction of eight pre-determined target directions as quickly and as accurately as possible.
The eight pre-determined target directions will be representative of an individuals' 100% limit of stability based upon their height.
Assuming that the body acts as an inverted pendulum with rotation about the ankle, this relates to the amount of movement possible before the COG position necessitates adjustment of the base of support by stepping.
The movement velocity score (degrees/second) will be produced from this test protocol.
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Baseline to 3 Month Follow-Up
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Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Sponsor
Collaborators
Investigators
- Principal Investigator: Cleveland T Barnett, Ph.D, Nottingham Trent University
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
December 1, 2015
Primary Completion (Actual)
December 1, 2018
Study Completion (Actual)
December 1, 2018
Study Registration Dates
First Submitted
October 6, 2015
First Submitted That Met QC Criteria
October 7, 2015
First Posted (Estimate)
October 8, 2015
Study Record Updates
Last Update Posted (Actual)
March 14, 2019
Last Update Submitted That Met QC Criteria
March 12, 2019
Last Verified
March 1, 2019
More Information
Terms related to this study
Keywords
Other Study ID Numbers
- NTU127818
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
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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