- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT05966636
LASER Pilot Project (LASER)
The LASER Pilot Project: Laser Therapy in Amputee Skin Care to Enhance Rehabilitation. A Preliminary InvestigationA
Study Overview
Status
Intervention / Treatment
Detailed Description
Many Veterans with lower limb amputation who use prostheses suffer from skin related prosthetic fit issues such as scars. Problematic scars may be managed with surgical excision that can yield a larger, more sensitive scar. Massage and desensitization techniques are also options. These current interventions yield widely varied results based on many factors including clinician skill, which modality is selected, patient compliance and others. Prosthetic use, walking, training, scar steroid injection and other therapies are options for scar management today. Current scar management treatments are limited due to high variance in effectiveness. Fractionated CO2 laser treatment however is a proven intervention for scar treatment in non-amputee patients, such as those with limb salvage or burns. The overall goal of this preliminary study is to determine if fractionated CO2 laser therapy, may potentially improve outcomes in Veterans who use prostheses who have limitations due to problematic scars.
In this preliminary investigation, the investigators will study the potential of fractionated CO2 laser therapy to decrease scar related discomfort, improve mobility and comfort otherwise restricted from problematic stump scarring and thus to improve quality of life. The investigators anticipate this will be a high-impact rapid translation intervention with the potential to restore functionality to individuals with lower limb amputation and transform the role of dermatologic care in lower limb prosthetics. The objective of this preliminary study is to explore the ability to recruit a sample of lower limb prosthesis users, coordinate laser therapy, collect outcomes and assure coordination and data fidelity between sites and facilitate determination of parameters for a future, more definitive clinical study of fractionated CO2 laser in the lower limb amputee population burdened with problematic scarring. The investigators' clinical hypothesis is fractionated CO2 laser treatment will provide considerable improvements in comfort, pain reduction, mobility and quality of life in lower limb prosthesis users. Further, it's hypothesize the investigators will be able to recruit a sample, assure data fidelity and be able to use the outcomes to estimate the power and sample to support a future clinical investigation and VA Merit application.
Six to eight subjects will be recruited from the Tampa VA. They will receive a pre-procedural assessment including subjective and objective measures ultimately to measure functional mobility, socket comfort, prosthetic history, health related quality of life and residual limb measures (i.e. volumetrics, range of motion, muscle testing and others). Subjects will then be evaluated (including dermatologic outcome measures) by and receive laser therapy from a credentialed dermatologist and then return to the Tampa VA to repeat the aforementioned outcomes at 6 week, 3 months and 6 months follow ups. Following laser therapy, outcomes data will be analyzed to determine the treatment effect, power and ultimately, the necessary sample size for a future VA Merit proposal. Additionally, the study will provide preliminary evidence of efficacy of laser therapy in this population. It will also permit selection of the most ideal outcome measures and facilitate optimization of a protocol for the configuration of an optimized, more definitive study to determine efficacy of laser therapy in Veterans with lower limb amputation who use prostheses.
Study Type
Enrollment (Estimated)
Phase
- Not Applicable
Contacts and Locations
Study Contact
- Name: Jeffrey T Heckman, DO
- Phone Number: 7506 (813) 972-2000
- Email: Jeffrey.T.Heckman@va.gov
Study Contact Backup
- Name: Meghan E Kern, DPT
- Phone Number: (813) 585-1802
- Email: meghan.kern@va.gov
Study Locations
-
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Florida
-
Miami, Florida, United States, 33125
- Not yet recruiting
- Miami VA Healthcare System, Miami, FL
-
Contact:
- Ignacio Gaunaurd, PhD
- Phone Number: 305-206-2441
- Email: ignacio.gaunaurd@va.gov
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Contact:
- Luis Gonzalez, MBA
- Phone Number: 7867608959
- Email: Luis.Gonzalez2@va.gov
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Tampa, Florida, United States, 33612
- Recruiting
- James A. Haley Veterans' Hospital, Tampa, FL
-
Contact:
- Margaret R Covar
- Phone Number: (813) 903-4407
- Email: Margaret.Covar@va.gov
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Principal Investigator:
- Jeffrey T Heckman, DO
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Contact:
- Briana N Chilton
- Phone Number: 813-558-7610
- Email: Briana.Chilton@va.gov
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-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
- Adult
- Older Adult
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- Age 21-70 years.
- Lower extremity amputation at the transtibial or transfemoral levels.
- Lower extremity amputee who has regular and compliant use of a lower extremity prosthesis.
- Lower extremity prosthesis use is disrupted or complicated by scarring and other skin maladies treatable with fractional CO2 laser therapy.
- Cognitive ability to understand and willingness to provide informed consent and follow the study protocol.
- Willing and able to attend pre and post procedural assessment sessions.
- Willing and able to attend dermatologic and laser therapy sessions.
Exclusion Criteria:
- Does not have lower extremity amputation.
- Lower extremity amputee who does not use a prosthesis.
- Lower extremity prosthetic use is not disrupted due to scarring or other skin maladies.
- Residual limb has an open wound or active infection.
- Has any of the following; open residual limb wound, cultured epithelial autographts, active infection, presence of unstable epithelium within the early weeks of injury
- Otherwise not a candidate for laser therapy.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: N/A
- Interventional Model: Single Group Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Other: Observational Single Arm
All subjects will have scars, quality of life, function assessed pre and post laser treatment
|
Fractional lasers stimulate scar improvement through production of microscopic patterns of dermal injury, vaporizing scar tissue and inducing neocollagenesis, subsequently improving scar tissue texture and range of motion, and decreasing symptoms such as pain and pruritis.
Current clinical consensus is supportive that fractionated lasers are the most effective option for the treatment of scars.
Other laser wavelengths and modalities used for vascular deformities and hair removal for instance, have an adjunctive role in improving scars and may be used in the same laser session.
Case reports provide evidence of substantial improvement in sensory symptoms and physical mobility within days to weeks after each treatment.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Change in Prosthesis Evaluation Questionnaire
Time Frame: Baseline and post Treatment LASER Visit (week 6), and 3 and 6 month follow up visits
|
Patient Reported Outcome Measure with score from 0-100 with increased score demonstrated patient reported improvement
|
Baseline and post Treatment LASER Visit (week 6), and 3 and 6 month follow up visits
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Change in 2 minute walk test
Time Frame: Baseline and post Treatment LASER Visit (week 6), and 3 and 6 month follow up visits
|
Functional performance with score from 0 - 999 feet with increased score demonstrating increased velocity in walking
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Baseline and post Treatment LASER Visit (week 6), and 3 and 6 month follow up visits
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Change in The Patient and Observer Scar Assessment Scale
Time Frame: Baseline and post Treatment LASER Visit (week 6), and 3 and 6 month follow up visits
|
Dermatologic Survey on a scale of 1-10 with increased number demonstrating worsening of scar appearance
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Baseline and post Treatment LASER Visit (week 6), and 3 and 6 month follow up visits
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Change in Optical Coherence Tomography
Time Frame: Baseline and post Treatment LASER Visit (week 6), and 3 and 6 month follow up visits
|
Observational Measure for documentation of scar characteristics
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Baseline and post Treatment LASER Visit (week 6), and 3 and 6 month follow up visits
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Change in Manchester Scar Scale
Time Frame: Baseline and post Treatment LASER Visit (week 6), and 3 and 6 month follow up visits
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Dermatologic survey on a scale of 1-4 with higher numbers representing worsening of conditions of scar
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Baseline and post Treatment LASER Visit (week 6), and 3 and 6 month follow up visits
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Change in Dermatology Life Quality Index
Time Frame: Baseline and post Treatment LASER Visit (week 6), and 3 and 6 month follow up visits
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Dermatologic survey using a scale from scar problems resulting in very much, a lot, a little or not at all impacts to quality of life
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Baseline and post Treatment LASER Visit (week 6), and 3 and 6 month follow up visits
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Change in Dermal Torque Meter
Time Frame: Baseline and post Treatment LASER Visit (week 6), and 3 and 6 month follow up visits
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Observational Measure for documentation of scar characteristics
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Baseline and post Treatment LASER Visit (week 6), and 3 and 6 month follow up visits
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Change in Scar Photography
Time Frame: Baseline and post Treatment LASER Visit (week 6), and 3 and 6 month follow up visits
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Observational Measure for documentation of scar characteristics
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Baseline and post Treatment LASER Visit (week 6), and 3 and 6 month follow up visits
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Change in Prosthesis Limb User Survey - Mobility
Time Frame: Baseline and post Treatment LASER Visit (week 6), and 3 and 6 month follow up visits
|
Patient reported outcome measure with scores from 20-80 with increase in score demonstrating increase in self reported functional mobility
|
Baseline and post Treatment LASER Visit (week 6), and 3 and 6 month follow up visits
|
Collaborators and Investigators
Investigators
- Principal Investigator: Jeffrey T Heckman, DO, James A. Haley Veterans' Hospital, Tampa, FL
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
- A4110-P
- 1I21RX004110-01A1 (U.S. NIH Grant/Contract: VA RR&D)
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
IPD Plan Description
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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