- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT03695042
Blood Flow Restriction Concussion
The Utilization of Blood Flow Restriction Training in Post Concussion Recovery
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
This is a prospective randomized proof of concept trial comparing the efficacy of the novel application of blood flow restriction to improve exercise tolerance in patients with post-concussion syndrome. Blood flow restriction training is commonly used in combination with low intensity/load exercise to facilitate exercise tolerance in those that would not tolerate high intensity/load exercises. While this intervention has been clinically employed in patients with concussion, research is needed to establish it's efficacy in a meaningful and prospective way. Subjects in this study will be randomly assigned to one of two groups. One group will perform exercises with BFR and then without BFR. The other group will perform the exercises without BFR first and then perform them with BFR. Each subject will undergo a single physical therapy session in each condition. Subjects meeting study criteria will be randomly allocated to each group. Because concussion symptoms can change quickly over time, it will be important to vary the timing of when the blood flow restriction is performed to better understand if improvement is due to intervention or passage of time. Randomization will be performed via sealed envelope to ensure even distribution into both groups.
Patients presenting to physical therapy for treatment of concussion symptoms will undergo a physical therapy concussion evaluation that includes orthostatic measurements, cervical screen, and vestibular-oculomotor screen. Patients will report a Global Function Rating and complete a Post-concussion Symptom Score, Neck Disability Index, and Dizziness Handicap Inventory at initial visit. Heart rate variability will also be assessed at initial visit. The measurements and questionnaires collected at the initial evaluation are part of the standard of care at this clinic. Subjects will be recruited after the initial visit and will have already completed these measurements/questionnaires. It is also standard of care to continue to administer these questionnaires as symptom status changes throughout the course of treatment until discharge. At the subsequent visit, subjects will undergo cardiovascular testing on a stationary bike to identify symptom provocation and exercise tolerance with aerobic exercise. The above evaluative tools and interventions are standard of practice for concussion patients being treated by physical therapy at the Duke Sports Concussion Clinic.
Intervention Procedure (BFR):
A blood flow restriction (BFR) cuff is applied to dominant leg and limb occlusion pressure (LOP) and personalized tourniquet pressure (PTP) at 80% is determined with the patient in supine.
Using an established BFR protocol of 4 sets of exercises with repetitions of 30-15-15-15, the patient will perform the exercises of double leg squat and forward lunge under occlusion. There will be a 30 second break between each set and 1 minute break between exercises.
Then, the physical therapist will move BFR cuff to opposite leg and reassess LOP/PTP 80%. The patient will repeat squat and forward lunge exercises as above.
The treatment will be discontinued if there is a greater than 3 point change in subjective symptom report. If the patient reports leg pain/discomfort, the pressure will be decreased by 10%. If still unable to complete the exercise due to leg discomfort, the intervention will be discontinued.
The following will be recorded:
Heart rate range during each set Maximum heart rate during the recovery period Rate of Perceived Exertion (RPE) and symptom report will be obtained during each recovery period.
Total time under occlusion upon completion of the round.
Intervention Procedure (No BFR):
Subjects will perform the 4 sets of each exercise with repetitions of 30-15-15-15. There will be a 30 second break between each set and 1 minute break between exercises.
The exercises will include double leg squat, dominant leg forward lunge, repeat double leg squat, and non-dominant leg forward lunge
The following will be recorded:
Heart rate range during each set Maximum heart rate during the recovery period Rate of Perceived Exertion (RPE) and symptom report will be obtained during each recovery period.
Study Type
Enrollment (Estimated)
Phase
- Not Applicable
Contacts and Locations
Study Locations
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North Carolina
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Durham, North Carolina, United States, 27710
- Duke Sports Science Institute
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-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Description
Inclusion Criteria:
Ability to read, write, and speak the English language Diagnosis of Post-Concussion Syndrome (medical diagnosis of concussion with symptoms lasting greater than four weeks.
Increased symptoms with physical activity Ages 14-30 years old
Exclusion Criteria:
Focal neurological deficits Exclusion criteria for Blood Flow Restriction (open wounds or fracture, history of clot, impaired circulation or venous compromise, sickle cell anemia, extremity infection, tumor distal to tourniquet placement, cancer, lymphectomy) Migraine history Positive image findings on MRI Benign Positional Paroxysmal Vertigo
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Crossover Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: BFR THEN without BFR
Will perform exercises with BFR at the first visit and without BFR at the second visit
|
The addition of BFR training to an exercise program prescribed for a patient participating in physical therapy for concussion treatment.
BFR training partially occludes blood flow to extremities during exercise.
This allows one to exercise at lower loads and still gain benefits similar to exercise at higher loads
|
Experimental: Without BFR THEN with BFR
Will perform exercises without BFR at the first visit and with BFR at the second visit
|
The addition of BFR training to an exercise program prescribed for a patient participating in physical therapy for concussion treatment.
BFR training partially occludes blood flow to extremities during exercise.
This allows one to exercise at lower loads and still gain benefits similar to exercise at higher loads
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Change in Post Concussion Symptom Score
Time Frame: Baseline and 8 weeks
|
The Post Concussion Symptoms Score is a self-reported measurement of symptoms associated with concussion with items ranked from 0 (no symptoms) to 6 (severe symptoms)
|
Baseline and 8 weeks
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Change in Global Function Rating
Time Frame: Baseline and 8 weeks
|
The subject will be asked to report his/her function rating on a scale of 0-100%
|
Baseline and 8 weeks
|
Change in Heart Rate Variability
Time Frame: 1 week, 3 weeks, 6 weeks, 8 weeks
|
Heart Rate Variability will be compared, over time, to the baseline variability measured at the initial evaluation
|
1 week, 3 weeks, 6 weeks, 8 weeks
|
Change in Presence of Orthostatic Tachycardia
Time Frame: Baseline, 1 week, 2 weeks
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Orthostatic Tachycardia will be recorded as either present or absent
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Baseline, 1 week, 2 weeks
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Change in Presence of Orthostatic Symptoms (Headache)
Time Frame: Baseline, 1 week, 2 weeks
|
Symptom of headache onset during a orthostatic position change will be recorded as present or not present
|
Baseline, 1 week, 2 weeks
|
Change in Presence of Orthostatic Symptoms (dizziness/light headedness)
Time Frame: Baseline, 1 week, 2 weeks
|
Symptom of dizziness/light headedness onset during a orthostatic position change will be recorded as present or absent
|
Baseline, 1 week, 2 weeks
|
Collaborators and Investigators
Sponsor
Investigators
- Principal Investigator: Laura Pietrosimone, Duke University
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Estimated)
Study Completion (Estimated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Estimated)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- Pro00100185
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.
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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