- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04136743
Ultrasound-Guided Treatments for Shoulder Pain in Wheelchair Users With Spinal Cord Injury (MFAT-SCI)
Ultrasound-Guided Treatments for Chronic Shoulder Pain in Wheelchair Users With Spinal Cord Injury: A Randomized Controlled Trial
Study Overview
Status
Intervention / Treatment
Detailed Description
This is randomized controlled trial to determine the efficacy of autologous, micro-fragmented adipose tissue (MFAT) injection under ultrasound guidance for chronic, nonresponsive shoulder pain due to rotator cuff disease (i.e., rotator cuff tendinopathy) in persons with spinal cord injury (SCI). The control for this study, to which MFAT will be compared, is corticosteroid injection into the subacromial space. Twenty-four (24) persons with SCI who have chronic shoulder pain for longer than 6 months in spite of completing conservative treatment and who are diagnosed with rotator cuff disease on examination will be recruited.
MFAT Group: Micro-fragmented adipose tissue will be obtained by using a minimal manipulation technique in a closed system (Lipogems®), without the addition of enzymes or any additives. The final product will consist of micronized fat tissue yielding fat clusters with preserved vascular stroma of about 500 microns with intact stromal vascular niches and harboring regenerative cellular elements. Approximately 6 mL of micro-fragmented adipose will be injected into the tendon with a 22-gauge needle under continuous ultrasound guidance. No other biological or pharmacological agents will be used in combination with the micro-fragmented adipose.
Corticosteroid Group: In the corticosteroid group, participants will receive a corticosteroid injection (BMS, Kenacort-A 40 mg [triamcinolone acetonide]) into the subacromial space under direct ultrasound guidance by means of a 5-mL syringe with a 22-guage needle.
Both Groups: After 24 hours, participants will be given a standardized stretching protocol to follow for 4 weeks followed by a formal strengthening program. Participants will be followed for adverse events and changes in shoulder pain intensity on an 11-point numerical rating scale (NRS; 0-10, with anchors "no pain" and "pain as bad as you can imagine"); the Wheelchair User's Shoulder Pain Index (WUSPI; 15-item disease-specific functional measure of shoulder pain in persons with SCI); the PROMIS Physical Functioning short form; the Brief Pain Inventory interference items (BPI-I7; a subscale of 7 items measuring interference with general activity, sleep, mood, relationships, etc.); and a 5-point subject global impression of change (SGIC) scale. Subjects will be examined at 1 month, 2 months, 3 months, and 6 months after the treatment. In addition to subjective outcome measures, quantitative ultrasounds will be conducted at baseline, 1 month, 2 months, 3 months, and 6 months post-treatment.
Study Type
Enrollment (Anticipated)
Phase
- Phase 2
Contacts and Locations
Study Contact
- Name: Trevor A Dyson-Hudson, MD
- Phone Number: 973-324-3576
- Email: tdysonhudson@kesslerfoundation.org
Study Contact Backup
- Name: Gerard A Malanga, MD
- Phone Number: 973-998-8301
- Email: gmalangamd@hotmail.com
Study Locations
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New Jersey
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West Orange, New Jersey, United States, 07052
- Recruiting
- Kessler Foundation
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Contact:
- Trevor A Dyson-Hudson, MD
- Phone Number: 973-324-3576
- Email: tdysonhudson@kesslerfoundation.org
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Principal Investigator:
- Trevor A Dyson-Hudson, MD
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Sub-Investigator:
- Gerard A Malanga, MD
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Sub-Investigator:
- Nathan S Hogaboom, PhD
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Men and women, 18 to 70 years of age, inclusive
- Neurological impairment secondary to a spinal cord injury or disorder that occurred at least twelve (12) months prior to the Screening Visit and the level of the injury is between C6 and L5, inclusive
- Non-ambulatory except for exercise purposes and uses a manual or power wheelchair as his/her primary means of mobility (> 40 hours/week)
- Currently has chronic shoulder pain due to rotator cuff disease in spite of at least 6 months of conservative treatment
- Average shoulder pain intensity during the week leading up to the Screening Visit is at least 4 out of 10 on an 11-point numerical rating scale (NRS; 0, no pain; 10, maximum pain imaginable).
- Rotator cuff disease will be defined as pain over the anterior shoulder, with direct palpation and pain at the shoulder with provocative tests for rotator cuff disease that is confirmed by tendinopathic changes on ultrasound imaging.
Exclusion Criteria:
- Report prior MFAT treatment
- Have a history of systemic disorders, such as diabetes or rheumatoid arthritis
- Have a contra-indication to the procedure, such as infection, coagulopathy, or currently taking anti-coagulant
- Report having a glucocorticoid injection in the past 4 weeks
- Are pregnant
- Have any medical condition, including psychiatric disease, which would interfere with the interpretation of the study results or the conduct of the study
Study Plan
How is the study designed?
Design Details
- Primary Purpose: TREATMENT
- Allocation: RANDOMIZED
- Interventional Model: PARALLEL
- Masking: SINGLE
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
ACTIVE_COMPARATOR: Corticosteroid
Participants will receive a corticosteroid injection (BMS, Kenacort-A 40 mg [triamcinolone acetonide]) into the subacromial space under direct ultrasound guidance by means of a 5-mL syringe with a 22-guage needle.
|
Triamcinolone Acetonide is a corticosteroid, which is a class of drugs that are commonly prescribed for shoulder pain.
They work to reduce pain by limiting inflammation.
They are typically injected into the subacromial space with or without ultrasound guidance.
Other Names:
|
EXPERIMENTAL: Micro-Fragmented Adipose Tissue
Participants will receive a single injection of micro-fragmented adipose tissue into the lesion (e.g.
tear, subacromial bursa, glenohumeral joint, acromioclavicular joint) under ultrasound guidance using an 18 gauge x 3.5 inch needle.
|
The Lipogems system (Lipogems International SpA, Milan, Italy) is designed to isolate autologous, micro-fragmented adipose tissue without enzymes or other additives.
It uses mild mechanical forces to break down adipose tissue that is extracted from the patient into a form that can be injected into the tendon lesion and other degenerated tissues in a sterile and safe manner.
The resulting product is rich in pericytes and mesenchymal stromal cells, retained within an intact stromal vascular niche, that is ready for use in clinical applications.
Other Names:
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Change in Numerical Rating Scale
Time Frame: 6 months
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Shoulder pain intensity will be assessed using an 11-point numerical rating scale (NRS; 0-10, ranging from 0 = "no pain" to a maximum of 10= "pain as bad as you can imagine".
Pain intensity is the most common pain domain assessed in research and clinical settings.
Although different rating scales have proven to be valid for assessing pain intensity, the 11-point NRS has the most strengths and fewest weaknesses of available measures.
An 11-point NRS measure of pain intensity allows for comparison across clinical trials of chronic pain treatment and has been recommended by the IMMPACT consensus group for use in pain clinical trials and by the 2006 NIDRR SCI Pain outcome measures consensus group.
We will evaluate changes in scores between baseline and 6 months.
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6 months
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Wheelchair User's Shoulder Pain Index
Time Frame: 6 months
|
Activity-dependent shoulder pain intensity will be assessed using the Wheelchair Users Shoulder Pain Index (WUSPI).
The WUSPI is a 15-item self-report instrument that measures shoulder pain intensity in wheelchair users during various ADLs over the past week; for example, transfers, loading a wheelchair into a car, wheelchair mobility, dressing, bathing, overhead lifting, driving, performing household chores, and sleeping.
Each item is scored using a 10cm visual analog scale (VAS) which is anchored at the ends with "no pain" and "worst pain ever experienced."
Individual item scores are summed to arrive at a total index score, which ranges from 0 to 150.
We will evaluate changes in scores between baseline and 6 months.
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6 months
|
Patient Global Impression of Change
Time Frame: 6 months
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The subject will be asked to rate on a 7-point scale his or her overall impression following treatment as compared to the previous measurement interval.
The 7-point PGIC scale (also referred to as the original Guy/Farrar-PGIC scale; anchored by "very much improved" and "very much worse") is used to measure global treatment effect and is recommended as a compliment to unidimensional pain intensity scales.
Although other versions of the PGIC scale exist, the SCI Measures Pain Committee recommends using the original Guy/Farrar-PGIC scale in clinical trials since it has been used extensively and been shown to be sensitive to change.
We will evaluate scores at 6 months.
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6 months
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Physical Examination of the Shoulder Scale
Time Frame: 6 months
|
The PESS will be derived from findings during the shoulder examination performed.
The PESS was developed to apply a grading system to commonly-used provocative tests for the diagnosis of shoulder soft-tissue disorders.
Eleven physical examination maneuvers are given a score dependent upon the pain elicited: 0 (no pain), 1 (equivocal for pain), or 2 (pain present).
The scores are summed for a total between 0 and 22.
The physical examination maneuvers include: biceps tendon/bicipital groove tenderness; supraspinatus tendon/greater tuberosity tenderness; acromioclavicular joint tenderness; resisted external rotation; resisted internal rotation; supraspinatus test; painful arc test; Neer impingement sign; Hawkins-Kennedy impingement sign; O'Brien active compression test for acromioclavicular joint and labral pathology.
We will evaluate changes in scores between baseline and 6 months.
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6 months
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Ultrasound Shoulder Pathology Rating Scale
Time Frame: 6 months
|
All participants will undergo a clinical ultrasound examination.
The ultrasound will be performed by a physiatrist with musculoskeletal ultrasound training.
The Ultrasound Shoulder Pathology Rating Scale (USPRS) applies a grade to seven ultrasound findings for shoulder pathology.
The scale is designed to give an impression of global shoulder pathology associated with overuse.
A score of 0 indicates no observable pathology, up to a maximum of 23.
The exams include biceps tendinosis/tendinopathy; supraspinatus tendinosis/tendinopathy; greater tuberosity cortical surface irregularities; bursal thickening; joint edema; dynamic supraspinatus and subscapularis impingement.
We will evaluate changes in scores between baseline and 6 months.
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6 months
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Quantitative Ultrasound of the Supraspinatus Tendon
Time Frame: 6 months
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Quantitative ultrasound protocols will be used to evaluate changes in morphological and structural characteristics of the supraspinatus tendon after treatment.
We will collect conventional B-mode ultrasound images alongside shear wave elastography images and apply custom image analysis algorithms to quantify the parameters of interest.
Greyscale parameters of interest include tendon thickness and mean echogenicity (i.e.
"brightness"), which are reflective of inflammation and edema.
This method will be adapted based on a previously-validated technique that has been used in wheelchair users with SCI.
The primary elastography parameter of interest is strain ratio; that is, the strain within the ROI relative to a reference point in the deltoid muscle immediately outside the tendon.
We will evaluate changes in greyscale and shear wave parameters between baseline and 6 months.
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6 months
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Collaborators and Investigators
Sponsor
Publications and helpful links
General Publications
- Cherian C, Malanga GA, Hogaboom N, Pollack MA, Dyson-Hudson TA. Autologous, micro-fragmented adipose tissue as a treatment for chronic shoulder pain in a wheelchair using individual with spinal cord injury: a case report. Spinal Cord Ser Cases. 2019 May 13;5:46. doi: 10.1038/s41394-019-0186-8. eCollection 2019.
- Randelli P, Menon A, Ragone V, Creo P, Bergante S, Randelli F, De Girolamo L, Alfieri Montrasio U, Banfi G, Cabitza P, Tettamanti G, Anastasia L. Lipogems Product Treatment Increases the Proliferation Rate of Human Tendon Stem Cells without Affecting Their Stemness and Differentiation Capability. Stem Cells Int. 2016;2016:4373410. doi: 10.1155/2016/4373410. Epub 2016 Jan 6.
Study record dates
Study Major Dates
Study Start (ACTUAL)
Primary Completion (ANTICIPATED)
Study Completion (ANTICIPATED)
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
Additional Relevant MeSH Terms
- Central Nervous System Diseases
- Nervous System Diseases
- Pain
- Neurologic Manifestations
- Joint Diseases
- Musculoskeletal Diseases
- Muscular Diseases
- Rupture
- Shoulder Injuries
- Tendon Injuries
- Trauma, Nervous System
- Spinal Cord Diseases
- Arthralgia
- Rotator Cuff Injuries
- Tendinopathy
- Wounds and Injuries
- Shoulder Pain
- Spinal Cord Injuries
- Physiological Effects of Drugs
- Autonomic Agents
- Peripheral Nervous System Agents
- Anti-Inflammatory Agents
- Antineoplastic Agents
- Antiemetics
- Gastrointestinal Agents
- Glucocorticoids
- Hormones
- Hormones, Hormone Substitutes, and Hormone Antagonists
- Antineoplastic Agents, Hormonal
- Dexamethasone
Other Study ID Numbers
- R-1066-19
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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