- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT03317145
Lower Limb Blood Flow Geko vs Foot Pump
Intermittent Pneumatic Compression (IPC) of the Foot Versus Geko™ Neuromuscular Electrostimulation (NMES): Comparison of Lower Limb Circulation Following Elective Total Hip Replacement (THR)
Study Overview
Status
Conditions
Detailed Description
Ethical approval was obtained from the National Research Ethics Service (Edgbaston), reference 13/WM/0139. Upon admission to hospital for THA, eligible patients were invited to participate in the study. Inclusion criteria were: patients undergoing primary THA, in good general health and fitness, age 18 years or over and the ability to provide written informed consent. Patients were taken to the ultrasound suite within the first three days following surgery.
Baseline ultrasound Patients lay in bed, the back supported at approximately 45 degrees, legs lying horizontal with their knees extended. Duplex ultrasound was then performed on the superficial femoral vein (Acuson S2000, Siemens). Baseline bilateral venous assessments of peak velocity, mean velocity, volume flow and vessel diameter were taken in triplicate. All scans were performed by the same ultrasonographer for consistency. Gate size was adjusted to just within the vessel wall.
Randomisation Following baseline measurements, patients were fitted with either the NMES device or an IPC device, the order determined by randomisation using online software. A representative from the study sponsor provided sealed envelopes containing the arm to be randomised which was opened on the day of testing.
Patients were randomised into arm A (NMES first, IPC second) or arm B (IPC first, NMES second). Blinding was not possible because the obvious physical differences between the two devices. Following testing of the first device, a 30-minute rest period was then given. The second device was then tested. All devices were fitted by the first author. All patients underwent scanning by the same sonographer to ensure consistency in data recording.
NMES application The NMES device (Geko T-1, Firstkind Ltd., High Wycombe, United Kingdom) was applied to both legs as per the manufacturer's instructions. The skin over the fibula head was prepared with an exfoliation pad, followed by an alcohol wipe. The device was applied to the skin using an adhesive strip and positioned so that the built-in electrodes were positioned over the common peroneal nerve. An overlay strip was then used to improve skin contact. A charge balanced short single pulse with a current of 27mA was delivered at a frequency of once per second. The pulse width adjustment has seven selectable stimulation settings ranging from 70 - 560 μs and was increased until a visible foot twitch was produced. Following successful application of the device for ten minutes, venous blood flow measurements were repeated.
IPC application
An IPC device (Vadoplex, OPED UK, UK) was fitted to each foot as per the manufacturer's instructions and activated for ten minutes prior to recording venous flow. The IPC provides a pump inflation pressure of 120mmHg, inflating once every 20 seconds. Each inflation was maintained for approximately 1 second, before deflation occurred. The maximum recording duration of the ultrasound scanner was 14 seconds. In order to capture 20 seconds of data, two contiguous measurements of 14 and 6 seconds were made. The machine records flow within the vessel. Since flow varies within the vessel, the machine is able to use a complex algorithm to sample velocities and flow over time and hence calculate the mean. In order to calculate mean velocity and volume flow over a complete 20 second cycle, we used the following equation:
- Measure the blood flow during inflation (F1) and record the time duration of this flow (A).
- Measure the blood flow during the opposite, deflated, part of the cycle (F2) and record the total cycle duration (B).
The calculation below provides a summated value for flow.
Total flow = [(A/B) x F1)] + [(1-(A/B)) x F2]
Device acceptability Patients were asked to rate comfort of the devices using a verbal rating score: 1 extremely comfortable, 2 comfortable, 3 uncomfortable, 4 very uncomfortable, 5 extremely uncomfortable.
Power analysis and statistical analysis Data from an unpublished study in healthy volunteers of the NMES device verses IPC comparing venous flow parameters, showed a significant benefit of NMES, with an effect size of 1.4 (Cohen's d). Sample size calculation based on this effect size gave a power in excess of 90% for a design of ten subjects per site.
We checked for significant association (p<0.05) of device, measurement order and leg on blood flow parameters of interest using generalized linear latent and mixed model with a random effects term to account for repeated measures on a given subject using Stata10 (Stata Corp, college station, TX). Blood flow parameters are reported as mean and 95% confidence intervals (CI). A Wilcoxon signed rank test was used to analyse the verbal rating scores for patient comfort.
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- patients undergoing primary THA,
- in good general health and fitness,
- age 18 years or over
- able to provide written informed consent.
Exclusion Criteria:
- Are requiring hip revision surgery
- Previous or current diagnosis of deep vein thrombosis (DVT) or pulmonary embolism (PE).
- History or signs of significant haematological disorders (especially in relation to clotting or coagulation) or thrombophlebitis.
- Peripheral arterial disease, clinically significant varicose veins or lower limb ulceration or ischemia.
- Recent surgery within the last 3 months (such as abdominal, gynaecological, hip or knee replacement).
- Recent trauma to lower limb.
- Chronic Obesity (BMI Index >40kg/m2).
- Pregnancy.
- Significant history of following diseases i. Cardiovascular: Recent MI (< 6 months) ii. Percutaneous Coronary Intervention (PCI) with stent (< 3 months for Bare metal stent (BMS) and < 12 months for Drug Eluding Stent (DES) iii. Moderate to severe CCF, uncontrolled AF iv. Neurological: Stroke, Hemiplegia/Paraplegia, Myopathies v. Renal: Moderate to severely impaired renal function vi. Hepatic: Moderate to severely impaired hepatic function vii. Psychiatric disorders viii. Dermatological conditions affecting lower limbs
- On LMWH/Heparin (Prophylactic/therapeutic doses) or Warfarin or warfarin stopped recently and replaced by LMWH/ Heparin
- Long term steroid use with dermatological changes
- A pulse rate of less than 40 beats/minute
- A sitting systolic blood pressure >180 and <100 mmHg and/or a sitting diastolic pressure of >100 mmHg.
- Participation in any clinical study during the eight (8) weeks preceding the screening period
- THR done for hip fracture
Study Plan
How is the study designed?
Design Details
- Primary Purpose: PREVENTION
- Allocation: RANDOMIZED
- Interventional Model: SEQUENTIAL
- Masking: NONE
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
ACTIVE_COMPARATOR: Arm A (NMES followed by IPC)
Arm A (NMES followed by IPC).
Following baseline blood flow measurements using ultrasound, the neuromuscular electrostimulation (NMES) device will be fitted and allowed to operate for 10 minutes.
Blood flow measurements will then be repeated.
The NMES device will be removed.
After a 30 minute rest period, the intermittent pneumatic compression (IPC) device will be fitted, activated for 10 minutes and then blood flow measurements repeated.
|
A mobile peroneal nerve stimulator
Other Names:
A foot pump or foot compression device
Other Names:
|
ACTIVE_COMPARATOR: Arm B (IPC followed by NMES)
Arm B (IPC followed by NMES).
Following baseline blood flow measurements using ultrasound, the intermittent pneumatic compression device (IPC) will be fitted and allowed to operate for 10 minutes.
Blood flow measurements will then be repeated.
The IPC device will be removed.
After a 30 minute rest period, the neuromuscular electrostimulation (NMES) device will then be fitted, activated for 10 minutes and then blood flow measurements repeated
|
A mobile peroneal nerve stimulator
Other Names:
A foot pump or foot compression device
Other Names:
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Venous flow at baseline
Time Frame: "t0" - 30 minutes to include the ultrasound assessment, performed between days 1 and 4 post operatively
|
Measured within the superficial femoral vein using ultrasound
|
"t0" - 30 minutes to include the ultrasound assessment, performed between days 1 and 4 post operatively
|
Venous flow after application of device 1
Time Frame: "t1" - 90 minutes to include the ultrasound assessment
|
Measured within the superficial femoral vein using ultrasound
|
"t1" - 90 minutes to include the ultrasound assessment
|
Venous flow after application of device 2
Time Frame: "t2" - 150 minutes to include the ultrasound assessment
|
Measured within the superficial femoral vein using ultrasound
|
"t2" - 150 minutes to include the ultrasound assessment
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Patient satisfaction with device 1
Time Frame: Immediately after completion of the ultrasound assessment for device 1, at "t1" - 90 minutes
|
verbal rating score: 1 extremely comfortable, 2 comfortable, 3 uncomfortable, 4 very uncomfortable, 5 extremely uncomfortable.
|
Immediately after completion of the ultrasound assessment for device 1, at "t1" - 90 minutes
|
Patient satisfaction with device 2
Time Frame: Immediately after completion of the ultrasound assessment for device 2, at "t2" - 150 minutes
|
verbal rating score: 1 extremely comfortable, 2 comfortable, 3 uncomfortable, 4 very uncomfortable, 5 extremely uncomfortable.
|
Immediately after completion of the ultrasound assessment for device 2, at "t2" - 150 minutes
|
Collaborators and Investigators
Collaborators
Investigators
- Principal Investigator: Geoff Stranks, FRCS, North Hampshire Hospital, Basingstoke
Publications and helpful links
General Publications
- Warwick DJ, Shaikh A, Gadola S, Stokes M, Worsley P, Bain D, Tucker AT, Gadola SD. Neuromuscular electrostimulation viathe common peroneal nerve promotes lower limb blood flow in a below-kneecast: A potential for thromboprophylaxis. Bone Joint Res. 2013 Sep 2;2(9):179-85. doi: 10.1302/2046-3758.29.2000176. Print 2013.
- Williams KJ, Moore HM, Davies AH. Haemodynamic changes with the use of neuromuscular electrical stimulation compared to intermittent pneumatic compression. Phlebology. 2015 Jun;30(5):365-72. doi: 10.1177/0268355514531255. Epub 2014 Apr 10.
Study record dates
Study Major Dates
Study Start (ACTUAL)
Primary Completion (ACTUAL)
Study Completion (ACTUAL)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (ACTUAL)
Study Record Updates
Last Update Posted (ACTUAL)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- FSK-FP-001
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
IPD Plan Description
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.
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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