- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04224961
Respiratory Muscle Training (RMT) in ALS
Moderate Intensity Respiratory Muscle Training (RMT) in ALS
Study Overview
Detailed Description
Twelve adults will participate in a single- subject A1-B-A2 study involving 4 visits to Duke over 24 weeks. The 6 week delayed start period (A1) will establish baseline status prior to initiation of RMT (B) and the follow-up period (A2) will determine detraining effects over 6 weeks of RMT withdrawal. Participants will complete four 3-week cycles of progressive RMT during the B phase. The investigators will measure MIP and MEP weekly. To reduce participant burden and enhance our ability to obtain repeated measures, the investigators will obtain 21 of 25 measurements of MIP and MEP during web-based telehealth visits.
Participants will complete a full assessment during the first study visit (M1) and receive training/instruction for obtaining MIP and MEP measurements at home with a portable, battery-powered digital pressure gauge manometer (MicroRPM Pressure Meter; Micro Direct). They will return to Duke for the pretest visit (M7), at which time a full assessment will be completed and RMT will commence. During the B phase, participants will complete 12-weeks of moderate intensity RMT, divided into four 3-week cycles, and participate in weekly web-based RMT therapy visits (M8-M18). Post-test assessment (M19) will occur immediately following completion of the 12-week RMT regimen. The investigators will measure MIP and MEP during RMT withdrawal via web-based telehealth visits (M20-24). Following the fourth and final on-site full assessment visit (M25), participants will return all equipment and will be offered the opportunity to initiate a clinical RMT regimen and receive follow-up care by Speech Pathology during future ALS Clinic visits.
Participants will be stratified into 2 groups based on baseline inspiratory muscle strength as determined by maximum inspiratory pressure (MIP): six participants with minimal to no respiratory weakness (i.e., MIP ≥ 70% predicted) and six participants with mild to moderate inspiratory weakness (i.e., MIP 40-70% predicted).
The primary outcomes are MIP and MEP. Secondary outcomes include peak cough flow (PCF) and sniff nasal inspiratory pressure (SNIP). Exploratory outcomes include the Amyotrophic Lateral Sclerosis Functional Rating Scale (ALSFRS), Eating Assessment Tool - 10 Item (EAT-10), 36-Item Short Form Survey (SF36), World Health Organization Quality of Life-BREF (WHOQOL-BREF), and Communicative Effectiveness Survey-Revised (CES-R). Clinical spirometry data will be extracted from the participant's electronic medical record if available from a coinciding ALS Clinic visit that occurs +/- 5 days from the assessment visit.
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Contacts and Locations
Study Locations
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North Carolina
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Durham, North Carolina, United States, 27705
- Duke University Medical Center
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Age ≥ 18 years
- Confirmed diagnosis of ALS
- Ability to follow directions for study participation
- Ability to successfully and independently complete RMT repetitions at a minimum pressure-threshold target equal to 30% of MIP or MEP
- Ability to complete telehealth visits using a smartphone or computer with video capabilities
- Ability to complete a home-RMT regimen
Exclusion Criteria:
- MIP < 40 cmH20
- Presence of a tracheostomy
- Use of non-invasive or invasive ventilation when awake
- Participant or caregiver(s) inability to manipulate respiratory pressure meter, the RMT device, or calibration equipment for home training
- Inability to complete RMT repetitions successfully
- Concomitant neurologic or neurodegenerative conditions (e.g. stroke, dementia) or other serious conditions that would prevent meaningful study participation as determined at the discretion of the principal investigator
- Inability to give legally effective consent
- Inability to read and understand English
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Supportive Care
- Allocation: Non-Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Minimal to No Respiratory Weakness
MIP ≥ 70% predicted Complete home-based RMT program and participate in weekly web-based RMT therapy sessions.
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Two commercially available pressure-threshold RMT devices that utilize a spring-loaded flange to provide resistance against inspiration and expiration independent of respiratory flow rate will be used to provide the necessary range of resistance.
Each participant will use two RMT devices, one for IMT and one for EMT.
Other Names:
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Experimental: Mild to Moderate Inspiratory Weakness
MIP 40-70% predicted Complete home-based RMT program and participate in weekly web-based RMT therapy sessions.
|
Two commercially available pressure-threshold RMT devices that utilize a spring-loaded flange to provide resistance against inspiration and expiration independent of respiratory flow rate will be used to provide the necessary range of resistance.
Each participant will use two RMT devices, one for IMT and one for EMT.
Other Names:
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Percentage of Patients with Safe, Well-tolerated Moderate Intensity Respiratory Muscle Training (RMT)
Time Frame: 12 weeks
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Safe, well-tolerated moderate intensity Respiratory Muscle Training (RMT) is defined as:
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12 weeks
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Percentage of Patients Able to Complete Respiratory Muscle Training (RMT)
Time Frame: 12 weeks
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Feasibility will be determined by the percent of patients able to complete the Respiratory Muscle Training
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12 weeks
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Magnitude of Change in Maximum Expiratory Pressure from Pre-test to Post-test
Time Frame: Baseline, 12 weeks
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Magnitude of change for our primary outcome measures will be determined using Cohen's measure of effect size (d) as defined by the first equation for single-subject d provided by Busk and Serlin (1992).
Simply stated, d is obtained by subtracting the mean of the first assessment from the mean of the second assessment, divided by the standard deviation of the first assessment.
Effect size calculations will be determined to compare results from pre-test (M7) to post-test (M18).
The investigators will use conservative interpretation guidelines for effect size calculations in which d < 0.6 is negligible, d ≥ 0.6 modest, d ≥ 1.0 large, and d ≥ 2.0 very large.
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Baseline, 12 weeks
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Magnitude of Change in Maximum Expiratory Pressure from Baseline to Withdrawal
Time Frame: Baseline, 24 weeks
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Magnitude of change for our primary outcome measures will be determined using Cohen's measure of effect size (d) as defined by the first equation for single-subject d provided by Busk and Serlin (1992).
Simply stated, d is obtained by subtracting the mean of the first assessment from the mean of the second assessment, divided by the standard deviation of the first assessment.
Effect size calculations will be determined to compare results from (M0-M5) to withdrawal (M19-M24).
The investigators will use conservative interpretation guidelines for effect size calculations in which d < 0.6 is negligible, d ≥ 0.6 modest, d ≥ 1.0 large, and d ≥ 2.0 very large.
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Baseline, 24 weeks
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Magnitude of Change in Maximum Inspiratory Pressure from Pre-test to Post-test
Time Frame: Baseline, 12 weeks
|
Magnitude of change for our primary outcome measures will be determined using Cohen's measure of effect size (d) as defined by the first equation for single-subject d provided by Busk and Serlin (1992).
Simply stated, d is obtained by subtracting the mean of the first assessment from the mean of the second assessment, divided by the standard deviation of the first assessment.
Effect size calculations will be determined to compare results from pre-test (M7) to post-test (M18).
The investigators will use conservative interpretation guidelines for effect size calculations in which d < 0.6 is negligible, d ≥ 0.6 modest, d ≥ 1.0 large, and d ≥ 2.0 very large.
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Baseline, 12 weeks
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Change in Peak Cough Flow in L/min
Time Frame: Baseline, 7 weeks, 18 weeks, 24 weeks
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Effective peak cough flow in healthy subjects exceeds values of 360 to 400 L/min.
PCF is measured at baseline, visit 7, visit 18 and visit 24.
The overall change from baseline to visit 24 will be measured.
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Baseline, 7 weeks, 18 weeks, 24 weeks
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Change in Sniff Nasal Inspiratory Pressure
Time Frame: Baseline, 7 weeks, 18 weeks, 24 weeks
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The sniff nasal inspiratory pressure (SNIP) consists in the measurement of pressure through an occluded nostril during sniffs performed through the contralateral nostril.
SNIP is measured through a plug occluding one nostril during sniffs through the contralateral nostril.
A plateau in pressure is reached after 5-10 sniffs in most individuals 1.
For SNIP measurement, 10 sniffs are usually performed.
The SNIP is measured at baseline, visit 7, visit 18 and visit 24.
The overall change from baseline to visit 24 will be measured.
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Baseline, 7 weeks, 18 weeks, 24 weeks
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Collaborators and Investigators
Sponsor
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
Other Study ID Numbers
- Pro00103777
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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