- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04999904
A Proprioceptive Training Program Using an Uneven Terrain Treadmill for Patients With Ankle Instability (ROCKY REHAB)
March 30, 2022 updated by: Henry M. Jackson Foundation for the Advancement of Military Medicine
The ROCKY REHAB trial will provide a pragmatic approach to evaluate if incorporating a rocky, uneven terrain treadmill into the proprioceptive rehabilitation received during physical therapy can improve outcomes and reduce reinjury rates in patients with ankle instability.
Study Overview
Status
Recruiting
Intervention / Treatment
Detailed Description
Lower limb sprains and strains are three-times more prevalent than any other acute injury in the Armed Forces, with lateral ankle sprains being the most common injury sustained during active-duty.
Many individuals who experience an ankle sprain will go on to develop chronic ankle instability.
Training and rehabilitation programs that incorporate proprioceptive training are particularly effective at improving outcomes and reducing re-injury rate.
However, current programs do not help individuals "train to the tasks" that will be encountered once those individuals leave physical therapy.
The proposed intervention evaluates the use of a rocky, uneven terrain treadmill that specifically targets aspects of the real-world environment for restoring and improving short-term function and performance and reducing the long-term risk of re-injury.
This trial will randomly allocate 312 individuals with ankle sprains and chronic ankle instability to standard of care physical therapy or the standard of care supplemented with the uneven treadmill intervention.
Patient reported outcome, performance measures, and biomechanical measures of muscle activations and plantar pressures will be evaluated.
Patient reported outcomes and reinjury rates will be tracked for 18 months.
Study Type
Interventional
Enrollment (Anticipated)
312
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 Contact
- Name: Elizabeth Russell Esposito, PhD
- Phone Number: 206-277-6267
- Email: elizabeth.m.russell34.civ@mail.mil
Study Contact Backup
- Name: Elise Campbell, MS
- Phone Number: 206-764-2962
- Email: Elise.Campbell@va.gov
Study Locations
-
-
California
-
Oceanside, California, United States, 92055
- Recruiting
- Naval Hospital Camp Pendelton
-
Contact:
- Brian Green, PhD
- Phone Number: 814-574-6049
- Email: brian.s.green38.ctr@mail.mil
-
San Diego, California, United States, 92134
- Recruiting
- Naval Medical Center San Diego
-
Contact:
- Shawn Farrokhi, PT, PhD
- Phone Number: 619-532-8582
- Email: shawn.farrokhi.civ@mail.mil
-
Principal Investigator:
- Shawn Farrokhi, PT, PhD
-
-
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
18 years to 49 years (Adult)
Accepts Healthy Volunteers
No
Genders Eligible for Study
All
Description
Inclusion Criteria
- Aged 18-49.
- Score < 24 on the Cumberland Ankle Instability Tool.
- Foot and Ankle Ability Measure Activities of Daily Living score ≤ 90 and Sports score ≤ 80 indicating substantial ankle-foot impairment and activity limitation.
- Able to attend treatment sessions for approximately a 6-week period.
- Passed most recent physical fitness test (Active duty only).
Acute lateral ankle sprain specific inclusion criteria:
- history of a first-time ankle sprain that resulted in activity limitation that lasted at least one day.
- chronicity of 2-6 weeks prior to consent.
Chronic ankle instability specific inclusion criteria:
- history of at least one significant ankle sprain within the 12 months prior to enrollment that interrupted physical activity for 1+ days.
- most recent ankle sprain in the past 2-8 weeks.
- history of the previously injured ankle joint "giving way" and/or recurrent sprain and/or ''feelings of instability.''
- Individual is about to start care with physical therapy.
Exclusion Criteria
- Unable to walk at the point of study enrollment.
- Non-removable casting.
- History of previous surgeries to the musculoskeletal structures (i.e., bones, joint structures, nerves).
- History of fracture in either limb of the lower extremity requiring realignment.
- Acute injury to musculoskeletal structures of other joints of the lower extremity within the previous three months, which impacted joint integrity and function resulting in at least one interrupted day of physical activity.
- Pregnant.
- Self-reported disability due to neuromuscular impairment in the lower extremity, neurological or vestibular impairment that affected balance.
- Connective tissue disorder (e.g. Marfan Syndrome or Ehlers-Danlos syndrome).
- Anyone separating from the military within 12 months (other than normal military retirement), pending a medical evaluation board, discharge from the military for medical reasons, or pending or undergoing any litigation for an injury.
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: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Single
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Uneven Treadmill Arm
Uneven Treadmill Intervention with up to twelve sessions over approximately six weeks and Standard of Care Physical Therapy with an 18 month follow-up period
|
Progressive proprioceptive training on the uneven treadmill with up to twelve training sessions.
Subjects will be advanced through activities with progression pragmatically assessed by the physical therapists for the benefit and tolerance of the individual subject.
Activities may include: slow walking, fast walking, inclined/declined walking, head turning, vision obstruction, dual task walking, fatigued walking, load carriage.
Standard of care physical therapy is still provided.
|
Active Comparator: Control Arm
Standard of Care Physical Therapy over approximately six weeks with an 18 month follow-up period
|
Standard of Care Physical Therapy
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Change in the Cumberland Ankle Instability Tool
Time Frame: Baseline assessment (0 weeks), first ( 2 weeks) and second (4 weeks) interim assessments, discharge assessment (6 weeks) and follow-up assessments at 3, 6, 9, 12, 15, and 18 months.
|
The Cumberland Ankle Instability Tool is a 9-item questionnaire, 30 points max score, with higher scores indicating better function.
The Cumberland Ankle Instability Tool evaluates the severity of ankle instability during sport and activities of daily living, as well as pain.
|
Baseline assessment (0 weeks), first ( 2 weeks) and second (4 weeks) interim assessments, discharge assessment (6 weeks) and follow-up assessments at 3, 6, 9, 12, 15, and 18 months.
|
Change in the Foot and Ankle Ability Measure, Activities of Daily Living Subscale
Time Frame: Baseline assessment (0 weeks), first ( 2 weeks) and second (4 weeks) interim assessments, discharge assessment (6 weeks) and follow-up assessments at 3, 6, 9, 12, 15, and 18 months.
|
The Foot and Ankle Ability Measure: Activities of Daily Living subscale is a 21-item questionnaire with 84 points max, with higher scores indicating better function.
The Activities of Daily Living Subscale is used to assess activity limitations and restrictions for individuals with foot and ankle disorders, including ankle sprains, during activities of daily living.
|
Baseline assessment (0 weeks), first ( 2 weeks) and second (4 weeks) interim assessments, discharge assessment (6 weeks) and follow-up assessments at 3, 6, 9, 12, 15, and 18 months.
|
Change in the Foot and Ankle Ability Measure, Sports Subscale
Time Frame: Baseline assessment (0 weeks), first ( 2 weeks) and second (4 weeks) interim assessments, discharge assessment (6 weeks) and follow-up assessments at 3, 6, 9, 12, 15, and 18 months.
|
The Foot and Ankle Ability Measure: Sports subscale is a 8-item questionnaire with 32 points max, with higher scores indicating better function.
The Sports Subscale is used to assess activity limitations and restrictions for individuals with foot and ankle disorders, including ankle sprains, during recreational/sport activities.
|
Baseline assessment (0 weeks), first ( 2 weeks) and second (4 weeks) interim assessments, discharge assessment (6 weeks) and follow-up assessments at 3, 6, 9, 12, 15, and 18 months.
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Change in the Lower Extremity Functional Scale
Time Frame: Baseline assessment (0 weeks), first ( 2 weeks) and second (4 weeks) interim assessments, discharge assessment (6 weeks) and follow-up assessments at 3, 6, 9, 12, 15, and 18 months.
|
The Lower Extremity Functional Scale is a 20-item questionnaire with 80 points max, with higher scores indicating better function.
The Lower Extremity Functional Scale is used for individuals with lower extremity musculoskeletal disorders and assesses activity limitations and participation restrictions.
|
Baseline assessment (0 weeks), first ( 2 weeks) and second (4 weeks) interim assessments, discharge assessment (6 weeks) and follow-up assessments at 3, 6, 9, 12, 15, and 18 months.
|
Change in the Tampa Scale of Kinesiophobia
Time Frame: Baseline assessment (0 weeks), first ( 2 weeks) and second (4 weeks) interim assessments, discharge assessment (6 weeks) and follow-up assessments at 3, 6, 9, 12, 15, and 18 months.
|
The Tampa Scale of Kinesiophobia is a 11-item questionnaire with scores between 11 and 44 points, with higher scores indicating greater kinesiophobia.
The Tampa Scale of Kinesiophobia is used to assess subjective ratings of fear-related concepts.
|
Baseline assessment (0 weeks), first ( 2 weeks) and second (4 weeks) interim assessments, discharge assessment (6 weeks) and follow-up assessments at 3, 6, 9, 12, 15, and 18 months.
|
Change in the Numeric Pain Rating Scale
Time Frame: Baseline assessment (0 weeks), first ( 2 weeks) and second (4 weeks) interim assessments, discharge assessment (6 weeks) and follow-up assessments at 3, 6, 9, 12, 15, and 18 months.
|
The Numeric Pain Rating Scale is a 4-item questionnaire with scores between 0 and 40 points, with higher scores indicating greater pain.
In the Numeric Pain Rating Scale subjects select a value that is most in line with the intensity of pain they have experienced in the past 24 hours.
|
Baseline assessment (0 weeks), first ( 2 weeks) and second (4 weeks) interim assessments, discharge assessment (6 weeks) and follow-up assessments at 3, 6, 9, 12, 15, and 18 months.
|
Change in the Godin Leisure-Time Physical Activity Questionnaire
Time Frame: Baseline assessment (0 weeks), first ( 2 weeks) and second (4 weeks) interim assessments, discharge assessment (6 weeks) and follow-up assessments at 3, 6, 9, 12, 15, and 18 months.
|
The Godin Leisure-Time Physical Activity Questionnaire measures the number of instances where subjects engaged in mild, moderate, and strenuous physical activity for greater than 15 minutes.
Modified to account over the previous week rather than a typical week.
Higher scores indicate more physical activity where 3, 5, and 9 points are given for each time a mild, moderate, or strenuous activity is engaged.
|
Baseline assessment (0 weeks), first ( 2 weeks) and second (4 weeks) interim assessments, discharge assessment (6 weeks) and follow-up assessments at 3, 6, 9, 12, 15, and 18 months.
|
Change in the Y Balance Test
Time Frame: Baseline assessment (0 weeks) and discharge assessment (6 weeks).
|
The Y Balance Test measures the distance a subject can reach in three directions, anterior, posteromedial and posterolateral without moving a support foot or touching the reach foot to the floor.
The Y Balance Test is scored based on the composite reach distance normalized by the subject's leg length.
|
Baseline assessment (0 weeks) and discharge assessment (6 weeks).
|
Change in the Side Hop Test
Time Frame: Baseline assessment (0 weeks) and discharge assessment (6 weeks).
|
The Side Hop Test measures the how long in seconds it takes for a subject can hop on one foot across two lines spaced 30 cm apart.
|
Baseline assessment (0 weeks) and discharge assessment (6 weeks).
|
Change in the Edgren Side Step Test
Time Frame: Baseline assessment (0 weeks) and discharge assessment (6 weeks).
|
The Edgren Side Step Test measures the distance in meters a subject sidestep across in 10 seconds traversing 5 lines 1 meter apart before reversing direction.
|
Baseline assessment (0 weeks) and discharge assessment (6 weeks).
|
Change in the T-Test
Time Frame: Baseline assessment (0 weeks) and discharge assessment (6 weeks).
|
The T-Test measures the time it takes for a subject to traverse a 40m course in the shape of a "T" consisting of 10m each of forward motion, right side shuffle, left side-shuffle, and backwards motion.
|
Baseline assessment (0 weeks) and discharge assessment (6 weeks).
|
Change in Electromyography (EMG)
Time Frame: Baseline assessment (0 weeks) and discharge assessment (6 weeks).
|
EMG will be collected during walking to examine muscle activation timings and magnitudes.
|
Baseline assessment (0 weeks) and discharge assessment (6 weeks).
|
Change in the Plantar Pressures
Time Frame: Baseline assessment (0 weeks) and discharge assessment (6 weeks).
|
Plantar Pressures will be collected during walking to examine pressure distribution and progression of the center of pressure during stance phase.
|
Baseline assessment (0 weeks) and discharge assessment (6 weeks).
|
Ankle Reinjury Status
Time Frame: Over an 18 month follow-up period.
|
Timing of any ankle reinjuries during the follow-up period period will be recorded.
|
Over an 18 month follow-up period.
|
Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Collaborators
Investigators
- Principal Investigator: John Fraser, PhD, Naval Health Research Center
Publications and helpful links
The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.
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 (Actual)
November 23, 2021
Primary Completion (Anticipated)
March 1, 2023
Study Completion (Anticipated)
September 1, 2024
Study Registration Dates
First Submitted
July 20, 2021
First Submitted That Met QC Criteria
August 3, 2021
First Posted (Actual)
August 11, 2021
Study Record Updates
Last Update Posted (Actual)
March 31, 2022
Last Update Submitted That Met QC Criteria
March 30, 2022
Last Verified
March 1, 2022
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- 937017
- W81XWH-20-2-0056 (Other Grant/Funding Number: Congressionally Directed Medical Research Program (CDMRP): Peer Reviewed Orthopedic Research Program (PRORP))
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Yes
IPD Plan Description
De-identified primary outcome data will be published.
Additional outcome data may also be included.
IPD Sharing Time Frame
Roughly 12 months after data collection completion as part of study publications.
IPD Sharing Supporting Information Type
- Study Protocol
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
No
Studies a U.S. FDA-regulated device product
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.
Clinical Trials on Instability; Ankle (Ligaments) (Old Injury)
-
University of North Carolina, CharlotteMid-Atlantic Athletic Trainers' AssociationCompletedAnkle (Ligaments); Instability (Old Injury)United States
-
Istanbul University - Cerrahpasa (IUC)Bezmialem Vakif University; Acıbadem Atunizade HospitalRecruitingInstability; Ankle (Ligaments) (Old Injury)Turkey
-
University Medical Centre LjubljanaUnknownInstability; Ankle (Ligaments) (Old Injury) | Ankle Arthritis | Osteochondral Lesion of Talus | Impingement Syndrome of AnkleSlovenia
-
Hacettepe UniversityRecruitingAnkle Injuries | Instability; Ankle (Ligaments) (Old Injury) | Athlete Foot | Radiological Devices Associated With Adverse Incidents, Diagnostic and Monitoring DevicesTurkey
-
University of Southern DenmarkAalborg University; Copenhagen University Hospital, Hvidovre; Metropolitan University... and other collaboratorsWithdrawnChronic Ankle InstabilityDenmark
-
University of BolognaCompletedAnkle Injuries | Sport Injury | Ankle Sprains | Instability, Joint | Chronic Instability of Joint | Chronic Instability, Capsular Ligament | Ankle Inversion SprainItaly
-
Sewon Cellontech Co., Ltd.UnknownDefect of Articular Cartilage | Degenerative Joint Disease of Ankle and/or Foot | Ankle (Ligaments); Instability, FamilialKorea, Republic of
-
Peking University Third HospitalRecruitingChronic Instability of Ankle Joint | Lateral Ligament Complex Injury of AnkleChina
-
Federal University of São PauloRecruitingSurgery | Ligament Injury | Ankle Sprains | Instability, JointBrazil
-
University GhentCompletedFunctional Ankle InstabilityBelgium
Clinical Trials on Uneven Treadmill Intervention
-
University of ArkansasCompleted
-
Istituto Nazionale di Ricovero e Cura per AnzianiRecruitingHip Fractures | Frail Elderly | Robotic RehabilitationItaly
-
University of Missouri-ColumbiaNational Cattlemen's Beef AssociationCompletedObesity | Poor Glycemic Control | Dietary Interventions
-
VA Office of Research and DevelopmentCompletedStroke | Cerebrovascular AccidentUnited States
-
University of Nevada, Las VegasRecruitingAmputationUnited States
-
California State University, SacramentoSeattle Children's Hospital; Thrasher Research Fund; University of Puget SoundCompletedIntensive Home-based Treadmill Training and Walking Attainment in Young Children With Cerebral PalsyCerebral PalsyUnited States
-
University of MinnesotaCompletedSedentary Lifestyle | Risk Factor, CardiovascularUnited States
-
Marquette UniversityEunice Kennedy Shriver National Institute of Child Health and Human Development... and other collaboratorsRecruitingMultiple SclerosisUnited States
-
Imam Abdulrahman Bin Faisal UniversityNot yet recruitingCerebral PalsySaudi Arabia