- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT05727930
Variable Intensive Early Walking Post-Stroke - 2 (VIEWS-2) (VIEWS-2)
March 15, 2024 updated by: George Hornby, Indiana University
Variable Intensive Early Walking Post-Stroke -2 (VIEWS-2)
The proposed research will evaluate the individual and combined effects of task-specificity and intensity of rehabilitation interventions on locomotor function, community mobility and quality of life in patients with subacute (1-6 months) post-stroke.
Study Overview
Status
Recruiting
Conditions
Intervention / Treatment
Detailed Description
The objective of this Phase II clinical trial is to identify how exercise training parameters, particularly the specificity and intensity of stepping practice, influence long-term mobility outcomes in patients with subacute stroke.
Previous work indicates these variables can influence the efficacy of training interventions in individuals without neurological injury, with some data to support their utility in chronic stroke.
However, studies that systematically assess the independent and combined effects of these principles in individuals early following stroke are sparse.
This critical research gap impedes clinical translation, and current clinical practices remain adherent to traditional theories of rehabilitation, including lower intensity interventions focused on underlying impairments.
Additional concerns of providing only high-intensity walking training revolve around the lack of attention toward movement quality will result in use of compensatory movement strategies that could be reinforced with repeated practice, or that other risks of cardiovascular events should preclude high-intensity training.
Unfortunately, there is little data to support these hypotheses, and our studies suggest that application of these training parameters can strongly influence walking function, as well as improve underlying impairments and improve gait kinematics.
Our approach is to characterize the effects of these training variables on recovery of locomotor function and quality, as well as changes in impairments and other mobility tasks in patients early post-stroke, in an effort to evaluate whether such training influences neurological recovery or whether patients utilize compensatory strategies.
In this 2x2 factorial RCT design, Aim 1 of the study will characterize changes in mobility function associated with manipulation of specific and intensity of exercise interventions.
We will evaluate functional measures of gait speed and endurance, spatiotemporal symmetry, as well as measures of cardiopulmonary fitness.
We postulate that combined application of high-intensity, task specific stepping practice will result in significantly greater increases in locomotor measures as compared to lower intensity or non-specific training paradigms.
In Aim 2, we will characterize the changes in impairments (strength) and other mobility tasks (balance, sit-to-stand transfers) to determine whether stepping intervention can mitigate the major impairments underlying post-stroke impairments.
Quantitative measures of volitional strength will be the primary outcomes.
In Aim 3, we will characterize changes in community mobility and quality of life, the later of which can inform us about cost-effectiveness.
Overall, these results have potential implications on the delivery of effective exercise interventions in person with subacute stroke.
Study Type
Interventional
Enrollment (Estimated)
100
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: Chris Henderson
- Phone Number: 317-329-2353
- Email: henderce@iu.edu
Study Contact Backup
- Name: George Hornby
- Phone Number: 317-329-2353
- Email: tghornby@iu.edu
Study Locations
-
-
Indiana
-
Indianapolis, Indiana, United States, 46254
- Recruiting
- Rehabilitation Hospital of Indiana
-
Contact:
- George Hornby
- Phone Number: 317-329-2353
- Email: tghornby@iu.edu
-
-
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 85 years (Adult, Older Adult)
Accepts Healthy Volunteers
No
Description
Inclusion Criteria:
- Sub-acute stroke (1-6 months)
- Hemiparesis (Fugl-Meyer <34) without cerebellar deficits
- Ability to ambulate with or without physical assistance over 10 meters but < 1.0 m/s and assistive devices and below-knee bracing is allowed.
- Ability to sit > 30 seconds without upper-extremity support or physical assistance
- Ability to follow 3-step commands
- Provision of informed consent and medical clearance from a supervising physician or medical provider to participate
- Must have the ability to consent or have a legal health care power of attorney or legally authorized representative to consent for participation on their behalf
Exclusion Criteria:
- Significant cardiovascular, metabolic, or respiratory disease that limits exercise participation (e.g. previous myocardial infarction < 3 months prior, uncompensated congestive heart failure, resting blood pressure > 210/110 mmHg, uncontrolled diabetes, end-stage renal disease, severe infectious or psychiatry disease, or advanced malignancy)
- If during the graded-treadmill exercise evaluation, the participant presents with absolute criteria for termination of exercise testing during initial testing (e.g. moderate to severe angina, ST elevation > 1.0mm without preexisting Q wave secondary to prior MI, signs of poor perfusion, etc).
- Any orthopedic or neurological disorders that limited walking to <50m prior to stroke onset.
- Cannot receive physical therapy once baseline testing begins
- If patients are prescribed botulinum toxin for their lower extremities will be excluded only if the dosage for any specific muscle is >50 units in leg muscles above the knee. If doses are > than 50 units in leg muscles below the knee, the participant will use an ankle-foot orthosis to minimze contributions of those mscles to locomotor function.
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: Factorial Assignment
- Masking: Single
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Active Comparator: High-intensity, non-specific physical therapy interventions
30 1-hr sessions of general physical therapy interventions (strengthening, balance training, aerobic cycling, transfers, walking) targeting higher cardiovascular intensities over approximately 2 months
|
Up to 30 1-hr sessions of training focused on varied physical interventions trying to achieve higher cardiovascular intensities
|
Active Comparator: Low-intensity, task-specific physical therapy interventions
30 1-hr sessions of general physical therapy interventions (strengthening, balance training, aerobic cycling, transfers, walking) targeting lower cardiovascular intensities over approximately 2 months
|
Up to 30 1-hr sessions of training focused on walking trying to achieve lower cardiovascular intensities
|
Active Comparator: Low-intensity, non-specific physical therapy interventions
30 1-hr sessions of general physical therapy interventions (strengthening, balance training, aerobic cycling, transfers, walking) targeting lower cardiovascular intensities over approximately 2 months
|
Up to 30 1-hr sessions of training focused on varied physical interventions trying to achieve lower cardiovascular intensities
|
Experimental: High-intensity, task-specific (i.e., walking) interventions
30 1-hour (hr) sessions of walking training targeting higher cardiovascular intensities over approximately 2 months
|
Up to 30 1-hr sessions of training focused on walking trying to achieve higher cardiovascular intensities
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Changes in gait speed
Time Frame: Approximately 8-10 weeks
|
Changes in gait speed over 6 m from baseline to post-training
|
Approximately 8-10 weeks
|
Changes in 6 minute walk test
Time Frame: Approximately 8-10 weeks
|
Changes in 6 min walk test from baseline to post-training
|
Approximately 8-10 weeks
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Changes in community mobility
Time Frame: Approximately 8-10 weeks
|
Changes in daily stepping (steps/day) from baseline to post-training
|
Approximately 8-10 weeks
|
Changes in measures of physical participation
Time Frame: Approximately 8-10 weeks
|
Changes in Medical Outcomes Short Form -36 questions from baseline to post-training
|
Approximately 8-10 weeks
|
Changes in gait biomechanics
Time Frame: Approximately 8-10 weeks
|
Changes in gait biomechanics (spatiotemporal and joint kinematics and kinetics) from baseline to post-training
|
Approximately 8-10 weeks
|
Changes in peak metabolic capacity (VO2peak) during peak treadmill speed
Time Frame: Approximately 8-10 weeks
|
Changes in peak metabolic capacity (VO2peak) during peak treadmill speed from baseline to post-training
|
Approximately 8-10 weeks
|
Changes in peak treadmill speed during the graded-exercise test
Time Frame: Approximately 8-10 weeks
|
Changes in peak treadmill speed during the graded-exercise test from baseline to post-testing
|
Approximately 8-10 weeks
|
Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Sponsor
Collaborators
Investigators
- Principal Investigator: George Hornby, Indiana University
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.
General Publications
- Lotter JK, Henderson CE, Plawecki A, Holthus ME, Lucas EH, Ardestani MM, Schmit BD, Hornby TG. Task-Specific Versus Impairment-Based Training on Locomotor Performance in Individuals With Chronic Spinal Cord Injury: A Randomized Crossover Study. Neurorehabil Neural Repair. 2020 Jul;34(7):627-639. doi: 10.1177/1545968320927384. Epub 2020 Jun 1.
- Hornby TG, Henderson CE, Plawecki A, Lucas E, Lotter J, Holthus M, Brazg G, Fahey M, Woodward J, Ardestani M, Roth EJ. Contributions of Stepping Intensity and Variability to Mobility in Individuals Poststroke. Stroke. 2019 Sep;50(9):2492-2499. doi: 10.1161/STROKEAHA.119.026254. Epub 2019 Aug 22.
- Holleran CL, Straube DD, Kinnaird CR, Leddy AL, Hornby TG. Feasibility and potential efficacy of high-intensity stepping training in variable contexts in subacute and chronic stroke. Neurorehabil Neural Repair. 2014 Sep;28(7):643-51. doi: 10.1177/1545968314521001. Epub 2014 Feb 10.
- Hornby TG, Holleran CL, Hennessy PW, Leddy AL, Connolly M, Camardo J, Woodward J, Mahtani G, Lovell L, Roth EJ. Variable Intensive Early Walking Poststroke (VIEWS): A Randomized Controlled Trial. Neurorehabil Neural Repair. 2016 Jun;30(5):440-50. doi: 10.1177/1545968315604396. Epub 2015 Sep 3.
- Boyne P, Dunning K, Carl D, Gerson M, Khoury J, Rockwell B, Keeton G, Westover J, Williams A, McCarthy M, Kissela B. High-Intensity Interval Training and Moderate-Intensity Continuous Training in Ambulatory Chronic Stroke: Feasibility Study. Phys Ther. 2016 Oct;96(10):1533-1544. doi: 10.2522/ptj.20150277. Epub 2016 Apr 21.
- Moore JL, Nordvik JE, Erichsen A, Rosseland I, Bo E, Hornby TG; FIRST-Oslo Team. Implementation of High-Intensity Stepping Training During Inpatient Stroke Rehabilitation Improves Functional Outcomes. Stroke. 2020 Feb;51(2):563-570. doi: 10.1161/STROKEAHA.119.027450. Epub 2019 Dec 30.
- Leddy AL, Connolly M, Holleran CL, Hennessy PW, Woodward J, Arena RA, Roth EJ, Hornby TG. Alterations in Aerobic Exercise Performance and Gait Economy Following High-Intensity Dynamic Stepping Training in Persons With Subacute Stroke. J Neurol Phys Ther. 2016 Oct;40(4):239-48. doi: 10.1097/NPT.0000000000000147.
- Moore JL, Roth EJ, Killian C, Hornby TG. Locomotor training improves daily stepping activity and gait efficiency in individuals poststroke who have reached a "plateau" in recovery. Stroke. 2010 Jan;41(1):129-35. doi: 10.1161/STROKEAHA.109.563247. Epub 2009 Nov 12.
- Straube DD, Holleran CL, Kinnaird CR, Leddy AL, Hennessy PW, Hornby TG. Effects of dynamic stepping training on nonlocomotor tasks in individuals poststroke. Phys Ther. 2014 Jul;94(7):921-33. doi: 10.2522/ptj.20130544. Epub 2014 Mar 13.
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)
January 11, 2023
Primary Completion (Estimated)
December 31, 2028
Study Completion (Estimated)
December 31, 2028
Study Registration Dates
First Submitted
February 6, 2023
First Submitted That Met QC Criteria
February 6, 2023
First Posted (Actual)
February 14, 2023
Study Record Updates
Last Update Posted (Actual)
March 19, 2024
Last Update Submitted That Met QC Criteria
March 15, 2024
Last Verified
July 1, 2023
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- IU-16767
- 1R01HD108622 (U.S. NIH Grant/Contract)
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
UNDECIDED
IPD Plan Description
Currently Undecided
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.
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