- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT06054165
Impact of a Clinical Pathway for Pelvic Fragility Fractures (PELVIC)
September 26, 2023 updated by: Dr. Daphne van Embden, Academisch Medisch Centrum - Universiteit van Amsterdam (AMC-UvA)
Impact of Regional Implementation of a Clinical Pathway for ELderly Patients With pelVIc Fragility fraCtures (PELVIC); a Multicenter, Stepped-wedge Randomized Controlled Trial
Patients with pelvic fragility fractures suffer from high morbidity and mortality rates.
Despite the high incidence of these injuries, there is currently no regional or nationwide treatment protocol which results in a wide variety of clinical practice.
New insights in treatment strategies, such as early diagnosis and minimal invasive operative treatment of these fragile patient population, has led to the development of several clinical pathways in recent literature.
The aim of this study is to implement an evidence and experience-based treatment clinical pathway to improve the outcomes in this fragile patient population that currently has multifactorial risks for poor outcome.
Study Overview
Status
Not yet recruiting
Intervention / Treatment
Study Type
Interventional
Enrollment (Estimated)
393
Phase
- Not Applicable
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
- Adult
- Older Adult
Accepts Healthy Volunteers
No
Description
Inclusion Criteria:
- Unilateral or bilateral sacral, iliac, ramus superior and/or ramus inferior fracture
- Pelvic fracture caused by low energetic trauma
- Patients presented at the emergency room or out-patient clinic of a participating hospital
Exclusion Criteria:
- Patients with high suspicion of a pelvic fracture due to a malignant tumor
- Patients who are unable to follow instructions due to severe cognitive decline (for example due to dementia or Alzheimer's disease)
- Patients who pre-trauma received palliative or terminal care
- Patients who pre-trauma were wheelchair bound or bedridden
- Patients who suffer from complications from previous pelvic ring fixation
- Patients with insufficient comprehension of the Dutch language to be able to carry out the physiotherapy instructions for early mobilization
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: Crossover Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
No Intervention: Standard-of-care
|
|
Active Comparator: Best-practice
|
Evidence-based and expert-opinion-based clinical pathway regarding the diagnostic and treatment strategy
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Mobility, using the Parker mobility score (PMS)
Time Frame: Change from baseline PMS at 2 weeks, 3 months, 6 months, and 1 year
|
Since there is no validated tool to measure mobility specifically after a pelvic fracture, the investigators choose to use The Parker mobility score as a primary outcome measurement.
The Parker mobility score is a valid and reliable score measuring mobility in hip fracture patients.
The Parker Mobility Score answers three questions, each valued 0-3 points, and is commonly used in clinical practice to monitor the mobility of geriatric patients.
A score of 0-3 is considered low, 4-6 moderate, and 7-9 reflects good mobility.
Furthermore, the Parker Mobility Score is a validated assessment tool for mortality in patients with reduced mobility after hip surgery.
|
Change from baseline PMS at 2 weeks, 3 months, 6 months, and 1 year
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Mobility, using the Elderly mobility scale (EMS)
Time Frame: At 2 weeks, 3 months, and 1 year
|
The Elderly Mobility Scale is a 20 point validated assessment tool to evaluate mobility specifically in elderly patients.
The investigators decided, despite the fact that this tool has an element of measurement in it which makes it harder to determine the pre-injury score, to add this tool since it does a better job distinguishing between patients who are able to sit up and go from sitting to standing.
The Elderly mobility scale ranges from 0-20 points, with high scores representing better outcome than low scores.
|
At 2 weeks, 3 months, and 1 year
|
Functional performance, using the Katz Index of Independence in Activities of Daily Living (KATZ ADL)
Time Frame: Change from baseline KATZ ADL at 3 months and 1 year
|
This index is one of the most commonly used scores to measure the functional status of elderly individuals.
It assesses the activities of daily living using six questions, each valued 0 or 1.
The score ranges from 0-6, and a score of 6 indicates full function while 4 indicates moderate impairment, and 2 or less indicates severe functional impairment
|
Change from baseline KATZ ADL at 3 months and 1 year
|
Quality of life, using the EuroQol (EQ-5D-5L) score
Time Frame: Change from baseline EQ-5D-5L at 3 months and 1 year
|
The EQ-5D-5L is a generic quality of life questionnaire which consists of a visual analogue scale and five questions about mobility, self-care, usual activities, pain or discomfort, and anxiety or depression.
Each question has three answer alternatives, with 1 indicating the optimal health state and 5 indicating severe problems.
There are 3,125 possible health states defined by combining one level from each dimension, ranging from 11111 (full health) to 55555 (worst health).
|
Change from baseline EQ-5D-5L at 3 months and 1 year
|
Return to home rate
Time Frame: Change from baseline place of residency at 3 months, 6 months and 1 year
|
The residencies will be grouped in 'living independently at home', 'assisted living', 'nursing home', 'rehabilitation centre', 'palliative care facility'.
|
Change from baseline place of residency at 3 months, 6 months and 1 year
|
Level of pain, using the Numerical Pain Rating Scale (NRS)
Time Frame: Baseline, one day post-operative (if patient underwent surgery), at 2 weeks, 6 weeks and 3 months
|
The Numerical Pain Rating Scale is an aspecific measurement tool from 0-10, with 0 reflecting no pain, 1-4 mild pain, 5-7 moderate pain, and 7-10 severe pain.
This tool is currently already used by nurses in all hospitals in the Netherlands.
|
Baseline, one day post-operative (if patient underwent surgery), at 2 weeks, 6 weeks and 3 months
|
Descriptive name and dosage of analgesic medications used
Time Frame: Baseline, 2 weeks, and 3 months
|
All analgesic medication that the patient is given will be recorded, and compared to the analgesic medication that the patient used prior to injury.
|
Baseline, 2 weeks, and 3 months
|
Number of falls after treatment, resulting in additional injury or without injury
Time Frame: At 6 weeks and 3 months
|
The investigators will differentiate between 'serious falls', defined as falls where the patient gets injured, and 'minor falls' where the patient did not get injured.
The investigators will ask the patients during follow-up at the out-patient clinic if they fell since the last visit.
The frequency of falling is related to an increased risk of mortality in elderly patients.
|
At 6 weeks and 3 months
|
Number of participants with (fracture related) complications
Time Frame: At 2 weeks, 3 months, 6 months, and 1 year
|
This includes general complications tot may occur during a period of reduced mobility or hospital admission (such as pneumonia, urinary tract infection, thromboembolic event, heart failure, cerebrovascular event, myocardial infarction).
Complications related to operative treatment will also be recorded.
These complications include but are not limited to: re-operation, delayed operation, infection, screw back out, malposition of screw, neurological damage.
All complications will be categorized for level of severity and the necessity for further treatment according to the Clavien-Dindo classification
|
At 2 weeks, 3 months, 6 months, and 1 year
|
1-year mortality
Time Frame: At 1 year
|
Including (presumed) cause of death
|
At 1 year
|
2-year mortality
Time Frame: At 2 year
|
Including (presumed) cause of death
|
At 2 year
|
Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Collaborators
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 (Estimated)
November 1, 2023
Primary Completion (Estimated)
May 5, 2025
Study Completion (Estimated)
May 5, 2026
Study Registration Dates
First Submitted
March 21, 2023
First Submitted That Met QC Criteria
September 19, 2023
First Posted (Actual)
September 26, 2023
Study Record Updates
Last Update Posted (Actual)
September 28, 2023
Last Update Submitted That Met QC Criteria
September 26, 2023
Last Verified
September 1, 2023
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- W22_279
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
YES
IPD Plan Description
Individual participant data that underlie the results reported in this article, after deidentification (text, tables, figures, and appendices)
IPD Sharing Time Frame
Beginning 9 months and ending 36 months following article publication
IPD Sharing Access Criteria
Investigators whose proposed use of the data has been approved by an independent review committee ("learned intermediary") identified for this purpose
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.
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