- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04688255
Mobile Subthreshold Exercise Program for Concussion--R01 (MSTEP-R01)
Randomized Controlled Trial Using Telehealth-delivered Rehabilitative Exercise to Treat Youth With Prolonged Concussion Recovery (Mobile Subthreshold Exercise Program, MSTEP-R01)
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
The investigators will recruit n=200 youth 11-18 years old with PPCS. Youth will be randomized to 6 weeks of either usual care plus M-STEP (intervention) or usual care plus stretching (control). Youth in M-STEP will be coached through gradual increases in intensity and duration of rehabilitative exercise via weekly video conferencing (Zoom) and will use Fitbits to guide their progress. Youth in the stretching group will act as attention controls. All youth will complete research-grade measures at multiple time points. Youth will be followed for a total of 6 months. Data will be analyzed using mixed effects models to examine differences between experimental groups in the primary outcome, trajectory of concussive symptoms, and the secondary outcome, changes over time in health-related quality of life, on an intention-to-treat basis. Potential mediators of the treatment effect will also be examined, including fear-avoidance of concussive symptoms and MVPA, and explore the impact of factors such as patient sex and parental protective behaviors.
The investigators thus assert the following hypotheses:
Hypothesis 1: M-STEP youth will have more rapid declines in HBI and improvement in PedsQL compared to control youth
Hypothesis 2: M-STEP youth will have greater increases in MVPA over time than control youth, and these increases will predict more rapid improvement in HBI and PedsQL.
Hypothesis 3: M-STEP youth will have steeper declines in fear-avoidance compared to control youth, and these declines will predict more rapid improvement in HBI and PedsQL.
IMPACT: The proposed study will definitively answer the question of whether a mobile sub-threshold exercise program (M-STEP) improves outcomes for youth with PPCS. It will also provide essential information about both the long-term impact of this intervention and potential mediators as well as biopsychosocial factors that influence treatment response. The study design uses a rigorous protocolized smartphone administered mHealth intervention that will be readily reproducible and generalizable to the majority of youth with PPCS. If successful, this will be one of the few evidenced-based interventions available to treat youth with PPCS.
Study Type
Enrollment (Estimated)
Phase
- Not Applicable
Contacts and Locations
Study Contact
- Name: Sara P Chrisman, MD MPH
- Phone Number: 206-884-1490
- Email: sara.chrisman@seattlechildrens.org
Study Locations
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Washington
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Seattle, Washington, United States, 98104
- Recruiting
- Seattle Childrens Hospital
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Contact:
- Sara P Chrisman, MD
- Phone Number: 206-884-1490
- Email: sara.chrisman@seattlechildrens.org
-
Contact:
- Beth Bollinger, PhD
- Phone Number: 206-659-8309
- Email: mstep@seattlechildrens.org
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-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- Youth 11-18 years
- Concussion occurring 1 week to 12 months prior to the start of the study and diagnosed by a clinician trained in concussion management consistent with the 2017 Berlin consensus definition of concussion ("A traumatic brain injury, induced by biomechanical forces")
- Persistent post-concussive symptoms as defined by the presence of at least 3 concussive symptoms rated at least 2 or greater on the Health and Behavior Inventory (HBI) and a total score of at least 10
- Can be located anywhere as all study procedures are remote
Exclusion Criteria:
- Youth not fluent in English or at least one Parent not fluent in English or Spanish
- Other injuries or medical conditions in addition to concussion that have prompted a clinician to recommend against MVPA, such as concerning abnormalities on routine brain imaging
- Youth who indicate that they are completing an average of 30 minutes per day or greater of physical activity that increases their heart rate (indicative of a minimal need for a physical activity intervention)
- Youth who have previously engaged with a Physical Therapist to increase aerobic activity
- Youth who have been fully cleared for sport
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Double
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Intervention group (MSTEP)
REHABILITATIVE EXERCISE: Participants will be asked to exercise at home daily for 6 weeks, meeting with an RA weekly via video conference to gradually increase the intensity and duration of exercise based on symptom tolerance.
The eventual goal will be to achieve 60 minutes of MVPA daily (US Federal recommendations).
They will wear a personal fitness device (Fitbit) to track whether they are achieving their HR goals.
|
Aerobic exercise that is advanced weekly
|
Active Comparator: Control group (Stretching)
STRETCHING: Participants will be asked to complete stretches daily.
They will initially be given two stretches, primarily focused on the neck and upper back.
Additional stretches will be added through weekly discussions with the study RA.
|
Stretching exercises that are advanced weekly
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Concussive symptoms (Health Behavior Inventory, HBI)--youth, a 21 item 0-3 likert scale with higher scores indicating more severe symptoms
Time Frame: Baseline, weekly during the intervention (x6 weeks), 3 months and 6 months.
|
Examine trajectory of concussive symptoms over time.
The central hypothesis is that the intervention group will have a more rapid decline in concussive symptoms..
|
Baseline, weekly during the intervention (x6 weeks), 3 months and 6 months.
|
Pediatric Quality of Life (PEDsQL, parent and youth), a 23 item 0-4 likert scale that is scaled to 0-100 with higher scores indicating better function
Time Frame: Baseline, 6 weeks, 3 months and 6 months.
|
Examine trajectory of concussive symptoms over time.
The central hypothesis is that the intervention group will have a more rapid improvement in health-related quality of life.
|
Baseline, 6 weeks, 3 months and 6 months.
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Fear of Pain Questionnaire (FOPQ, parent and youth), adapted for concussive symptoms, 24 item (child) and 23 item (parent) 0-4 likert scales with higher scores indicating greater fear-avoidance
Time Frame: Baseline, 6 weeks, 3 months and 6 months.
|
Examine trajectory of fear-avoidance over time and assess for mediation of change in concussive symptoms.
The central hypothesis is that decreases in fear-avoidance of concussive symptoms will partially mediate the decline in concussive symptoms.
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Baseline, 6 weeks, 3 months and 6 months.
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Moderate-Vigorous Physical Activity (MVPA), measured with hip-mounted actigraphy
Time Frame: Baseline, 6 weeks, 3 months
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Examine trajectory of MVPA over time and assess for mediation of change in concussive symptoms.
The central hypothesis is that increases in MVPA will partially mediate the decline in concussive symptoms.
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Baseline, 6 weeks, 3 months
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Other Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Patient Health Questionnaire-9 (PHQ-9), standardized measure of depressive symptoms, a 9-item 0-3 likert scale with higher scores indicating more severe symptoms
Time Frame: Baseline, 6 weeks, 3 months, 6 months
|
Explore trajectory of depressive symptoms during the intervention.
The central hypothesis is that depressive symptoms will decline during the intervention.
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Baseline, 6 weeks, 3 months, 6 months
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Generalized Anxiety Disorder Scale-7 (GAD-7), standardized measure of anxiety symptoms, a 7-item 0-3 likert scale with higher scores indicating more severe symptoms
Time Frame: Baseline, 6 weeks, 3 months, 6 months
|
Explore trajectory of anxiety symptoms during the intervention.
The central hypothesis is that anxiety symptoms will decline during the intervention.
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Baseline, 6 weeks, 3 months, 6 months
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Adolescent Sleep Wake Scale (ASWS)-10, standardized survey (self-report) regarding sleep quality, a 10-item 0-5 likert scale reported as the mean with higher scores indicating improved sleep quality
Time Frame: Baseline, 6 weeks, 3 months, 6 months
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Explore trajectory of self-reported sleep quality during the intervention.
The central hypothesis is that sleep quality will improve during the intervention.
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Baseline, 6 weeks, 3 months, 6 months
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Collaborators and Investigators
Sponsor
Collaborators
Investigators
- Principal Investigator: Sara P Chrisman, MD MPH, University of Washington and Seattle Children's Hospital
Publications and helpful links
General Publications
- Chrisman SPD, Whitlock KB, Mendoza JA, Burton MS, Somers E, Hsu A, Fay L, Palermo TM, Rivara FP. Pilot Randomized Controlled Trial of an Exercise Program Requiring Minimal In-person Visits for Youth With Persistent Sport-Related Concussion. Front Neurol. 2019 Jun 17;10:623. doi: 10.3389/fneur.2019.00623. eCollection 2019. Erratum In: Front Neurol. 2020 Feb 21;11:6.
- Chrisman SPD, Whitlock KB, Somers E, Burton MS, Herring SA, Rowhani-Rahbar A, Rivara FP. Pilot study of the Sub-Symptom Threshold Exercise Program (SSTEP) for persistent concussion symptoms in youth. NeuroRehabilitation. 2017;40(4):493-499. doi: 10.3233/NRE-161436.
- Chrisman SPD, Bollinger BJ, Mendoza JA, Palermo TM, Zhou C, Brooks MA, Rivara FP. Mobile Subthreshold Exercise Program (MSTEP) for concussion: study protocol for a randomized controlled trial. Trials. 2022 Apr 26;23(1):355. doi: 10.1186/s13063-022-06239-3.
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 (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
- Pathologic Processes
- Brain Diseases
- Central Nervous System Diseases
- Nervous System Diseases
- Pain
- Neurologic Manifestations
- Wounds and Injuries
- Disease
- Craniocerebral Trauma
- Trauma, Nervous System
- Headache Disorders
- Head Injuries, Closed
- Wounds, Nonpenetrating
- Headache Disorders, Secondary
- Syndrome
- Brain Injuries
- Brain Injuries, Traumatic
- Headache
- Post-Concussion Syndrome
- Brain Concussion
- Post-Traumatic Headache
Other Study ID Numbers
- 00002697
- 1R01HD094722-01A1 (U.S. NIH Grant/Contract)
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
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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