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Study of PEMF to Evaluate VPT and Thermal Sensory in Subjects With Diabetic Peripheral Neuropathy

11 juillet 2019 mis à jour par: Regenesis Biomedical, Inc.

A Multi-Center, Sham-Controlled, Double-Blind Randomized Withdrawal Study of PEMF Therapy to Evaluate Vibration Perception Threshold and Thermal Sensory in Subjects With Diabetic Peripheral Neuropathy in the Lower Extremity

A study to demonstrate the effectiveness of PEMF treatment compared to sham treatment in changing Vibration Perception Threshold (VPT) and Thermal Sensory (QST) in patients with diabetic peripheral neuropathy (DPN) when treatment is administered twice daily through 120-day period.

Aperçu de l'étude

Description détaillée

Multi-center, sham-controlled, double-blind, enriched enrollment, randomized withdrawal clinical trial conducted on subjects with bilateral symmetrical diabetic peripheral neuropathy. Eligible subjects will include those between 22 and 80 years of age with Type 1 or Type 2 diabetes having persistent pain, numbness, tingling, or burning in both feet despite treatment. Eligible subjects will receive two active treatment devices (one for each foot, to allow simultaneous treatment) and treat at home, twice daily for 60 days after which they will return to the clinic at Day 61 for a response assessment. Subjects that are determined to be responders at Day 61 (subjects that achieve a 1-point decrease in the average pain score over the last 24 hours using the Numeric Pain Rating Scale (NPRS)) will be randomized 1:1 to either active treatment or inactive sham devices and will continue treating through Day 120. Subjects that are determined to be non-responders at Day 61 will continue treating with the active devices given at enrollment and will return to the clinic at Day 75 and Day 91 for a response assessment. If a subject is determined to be a responder at Day 75, they will be randomized 1:1 to receive either active treatment or inactive sham and will continue treating through Day 120. If a subject is determined to be a responder at Day 91, they will be randomized 1:1 to receive either active treatment or sham and will continue to treat through Day 120. If a subject continues to be a non-responder at Day 91 they will be terminated from the study.

Type d'étude

Interventionnel

Inscription (Réel)

44

Phase

  • N'est pas applicable

Contacts et emplacements

Cette section fournit les coordonnées de ceux qui mènent l'étude et des informations sur le lieu où cette étude est menée.

Lieux d'étude

    • Arizona
      • Phoenix, Arizona, États-Unis, 85015
        • Associated Foot & Ankle Specialists, LLC

Critères de participation

Les chercheurs recherchent des personnes qui correspondent à une certaine description, appelée critères d'éligibilité. Certains exemples de ces critères sont l'état de santé général d'une personne ou des traitements antérieurs.

Critère d'éligibilité

Âges éligibles pour étudier

22 ans à 80 ans (Adulte, Adulte plus âgé)

Accepte les volontaires sains

Non

Sexes éligibles pour l'étude

Tout

La description

Inclusion Criteria:

  1. Subject age is greater than or equal to 22 years and less than 80 years of age.
  2. Subject has documented Type 1 or Type 2 diabetes mellitus (receiving insulin, diet controlled, or taking parenteral hypoglycemic agents)
  3. Subject is on a stable antidiabetic regimen (medication and/or diet) to control their diabetes for at least 30 days prior to Screening.
  4. Subject has an HbA1c <10% at Screening or within 2 months of Screening.
  5. Subject has daily pain attributed to bilateral symmetrical Diabetic Peripheral Neuropathy with numbness, tingling, and/or burning based on clinical judgement for at least 6 months prior to screening.
  6. Subject's pain or discomfort from DPN is identifiable.
  7. Subject is in pain Phase 2, 3, or 4 as per the Phasing of Neuropathy Scale.
  8. Subjects average pain over the last 24 hours is ≥3 based on the 11-point Numeric Pain Rating Scale (NPRS) at the Screening Visit.
  9. Subject has adequate lower extremity pulse in both feet and no intermittent claudication.
  10. Subject is able to ambulate independently without assistive devices.
  11. Subject is willing and able to give written informed consent and to comply with all parts of the study protocol.
  12. Female subjects must be post-menopausal, surgically sterile, abstinent, or practicing (or agrees to practice) an effective method of birth control if they are sexually active for the duration of the study (Effective methods of birth control include prescription hormonal contraceptives, intrauterine devices, double-barrier methods, and/or male partner sterilization).

Exclusion Criteria:

  1. Subject is in pain Phase 1 or 5 as per the Phasing of Neuropathy Scale.
  2. Subject has an active, open ulcer on the lower extremities.
  3. Subject has peripheral vascular disease defined as absence of more than one foot pulse per foot and/or ABI <0.8 and >1.4 and/or history of angioplasty or peripheral bypass surgery within 6 months of the Screening Visit.
  4. Subject has venous insufficiency as classified by the Venous Insufficiency Classification System of grade C6.
  5. Subject has undergone nerve decompression surgery on the lower extremities.
  6. Subject has a history of previous kidney, pancreas, cardiac transplantation, or severe renal disease.
  7. Subject has been diagnosed with non-diabetic chronic inflammatory neuropathic disease (e.g. end stage renal disease, hepatitis C, chemotherapy induced neuropathy, known connective tissue disease, systemic lupus).
  8. Subject has peripheral vascular disease requiring revascularization of lower limb or amputation or evidence of ulcer amputation.
  9. Subject has clinically significant cardiovascular disease within 6 months prior to screening (unstable or poorly controlled hypertension, transient ischemic attack, MI, unstable angina, arrhythmia, any heart surgery, stent placement, heart disease).
  10. Subject has a history of any uncontrolled medical illness that in the Investigators judgment places the subject at unacceptable risk for receipt of PEMF therapy.
  11. Subject requires or anticipates the need for surgery of any type or travel during the treatment period.
  12. Subject has a total foot depth (most inferior aspect of the medial malleolus to the plantar aspect of the foot when residing on a treatment pad) of >8 cm.
  13. Subject has received any investigational drug or device within 30 days prior to the Screening Visit or within 6 weeks prior to the Screening Visit for long acting lidocaine injection products.
  14. Subject has used systemic corticosteroids within 3 months of the Screening Visit.
  15. Subject has a history of malignancy within the past 5 years other than successfully treated non-metastatic basal cell or squamous cell carcinomas of the skin in the treatment area and/or localized in situ carcinoma of the cervix.
  16. Subject has a serious psychosocial co-morbidity.
  17. Subject has a history of drug or alcohol abuse, as confirmed by urine drug screen, within one year prior to the Screening Visit.
  18. Subject has an implanted pacemaker, defibrillator, neurostimulator, spinal cord stimulator, bone stimulator, cochlear implant, or other implanted device with an implanted metal lead(s).
  19. Subject is currently pregnant or planning on becoming pregnant prior to Day 121.
  20. Subject has previously treated with PROVANT® Therapy System within 60 days on the lower extremity.
  21. Subject is unwilling or unable to follow study instructions or comply with the treatment regimen, diary documentation, and study visits.
  22. Subject has pain from any other source that can confuse the assessment of the pain associated with DPN.
  23. Subject has a clinically significant foot deformity (Charcot's syndrome or club foot).
  24. Subject has received nerve blocks for neuropathic pain within 4 weeks of the Screening Visit.
  25. Subject has been diagnosed with mononeuropathy.
  26. Subject has a skin condition that could alter their sensation.
  27. Subject has had a previous surgery to the spine or lower extremity with residual symptoms of pain or difficulty with movement.
  28. Subject has moderate or severe arthropathy (RA, OA, Gout) that causes discomfort during casual walking or stair climbing.

Plan d'étude

Cette section fournit des détails sur le plan d'étude, y compris la façon dont l'étude est conçue et ce que l'étude mesure.

Comment l'étude est-elle conçue ?

Détails de conception

  • Objectif principal: Traitement
  • Répartition: Randomisé
  • Modèle interventionnel: Affectation parallèle
  • Masquage: Quadruple

Armes et Interventions

Groupe de participants / Bras
Intervention / Traitement
Expérimental: Groupe actif
Traitement avec le système actif de thérapie Provent
Traitement avec le système actif de thérapie Provent
Comparateur factice: Sham Group
Treatment with Inactive (sham) Provant Therapy System
Treatment with Inactive (sham) Provant Therapy System

Que mesure l'étude ?

Principaux critères de jugement

Mesure des résultats
Description de la mesure
Délai
Vibration Perception Threshold (VPT)
Délai: Baseline to End of Treatment (Day 121)
A non-invasive test used in quantifying sensation/sensitivity to vibration in evaluating sensory dysfunction associated with diabetic neuropathy
Baseline to End of Treatment (Day 121)
Quantitative Sensory Testing (QST)
Délai: Baseline to End of Treatment (Day 121)
QST is a noninvasive test used in peripheral nervous system disorders for thermal sensory testing.
Baseline to End of Treatment (Day 121)

Mesures de résultats secondaires

Mesure des résultats
Description de la mesure
Délai
Nerve Conduction Velocity (NCV) - Velocity
Délai: The sural nerve conduction velocity will be recorded at the Enrollment Visit and end of study visit (Day 121).
NC-stat® DPNCheck® will be used to record NCV at Baseline and Day 121. Outcome Measure Data table displays change in NCV from Baseline to Day 121.
The sural nerve conduction velocity will be recorded at the Enrollment Visit and end of study visit (Day 121).
Skin Perfusion Pressures (SPP)
Délai: SPP will be conducted at the Enrollment Visit, Day 61, and end of study visit (Day 121).
The Vasamed Sensilase PAD-IQ will be used to record SPP. This machine measures pressure (in mm Hg) of microcirculation using a laser Doppler sensor. Outcome Measure Data Table below displays change from Baseline to Day 121.
SPP will be conducted at the Enrollment Visit, Day 61, and end of study visit (Day 121).
Pain Intensity (PI)
Délai: Collected as patient-reported outcomes on a paper diary and at the Enrollment visit to obtain a baseline value and on Days 61, 75, and 91
Mean change from Baseline to Day 121, using a validated 11-point Numeric Pain Rating Scale (NPRS) with scores 0-10, where 0 = no pain and 10 = worst possible pain.
Collected as patient-reported outcomes on a paper diary and at the Enrollment visit to obtain a baseline value and on Days 61, 75, and 91
Brief Pain Inventory (BPI); Question on Pain Right Now.
Délai: Change in BPI, pain right now question, from Baseline to Day 121.
The BPI long form will be administered at the Enrollment Visit, Day 30, 61, 91, and end of study visit (Day 121). Results for question #15 on Pain Right Now displayed below. Subject were asked to rate pain right now on a scale from 0 (no pain) to 10 (pain as bad as you can imagine).
Change in BPI, pain right now question, from Baseline to Day 121.
Brief Fatigue Inventory (BFI)
Délai: Change from Baseline to Day 121 in BFI.
A 4-question assessment that assesses the level of fatigue and the impact of the fatigue on daily function over the last 24 hours. BFI is patient reported and collected at the Enrollment Visit, Days 30, 61, 91, and end of study visit (Day 121). A global fatigue score was calculated by averaging all of the values on the questionnaire and results for the change from Baseline to Day 121 are displayed below. The scale ranged from 0 (no fatigue/does not interfere) to 10 (as bad as you can imagine/completely interferes).
Change from Baseline to Day 121 in BFI.
Patient Global Impression of Change (PGIC)
Délai: PGIC results at Day 121 displayed below.
A 7-choice validated categorical scale of overall change in status since initiation of treatment with the study device.PGIC was collected every 7 days in the paper diary, immediately following the morning treatment. Subjects were asked: Since the start of the study, my overall status is? Choices on the scale included: Very much worse, much worse, minimally worse, no change, minimally improved, much improved and very much improved.
PGIC results at Day 121 displayed below.
Hospital Anxiety and Depression Scale (HADS)
Délai: Change in Depression and Anxiety from Baseline to Day 121.
A patient reported 14 question assessment that detects the status of depression and anxiety. Subjects completed the assessment at the Enrollment Visit, Days 30, 61, 91, and end of study visit (Day 121). The total score for anxiety and the total score for depression was calculated at Day 121. Low scores represent normal (0-7) while high scores represent abnormal (11-21).
Change in Depression and Anxiety from Baseline to Day 121.
Neuro-QoL
Délai: Change in each domain from Baseline to Day 121 is displayed below.

A validated set of health-related quality of life measures that are domain specific.Subjects will completed 6 domains: (1) Pain, (2) Lost/Reduced Feeling, (3) Diffuse Sensory Motor Symptoms, (4) Restrictions in Activities of Daily Living, (5) Disruptions in Social Relationships, and (6) Emotional Distress.The short forms were completed by the subject at the Enrollment Visit and end of study visit (Day 121). Each question in the domain was rated on a symptom scale from 1 (never) to 5 (all the time) and a bothersome scale from 1 (none) to 3 (very much).

The total score for the domain was calculated by multiplying the symptom score by the bothersome score. The scale range is from 1 to 15 where the minimum (best/least symptomatic) score is 1 and the maximum (worst/most symptomatic) score is 15.

Change in each domain from Baseline to Day 121 is displayed below.
Nerve Conduction Velocity (NCV) - Amplitude
Délai: The sural nerve conduction amplitude will be recorded at the Enrollment Visit and end of study visit (Day 121).
NC-stat® DPNCheck® will be used to record NCV at Baseline and Day 121. Outcome Measure Data table displays change in NCV from Baseline to Day 121.
The sural nerve conduction amplitude will be recorded at the Enrollment Visit and end of study visit (Day 121).

Collaborateurs et enquêteurs

C'est ici que vous trouverez les personnes et les organisations impliquées dans cette étude.

Les enquêteurs

  • Chercheur principal: Arthur Tallas, DPM, Associated Foot & Ankle Specialists, LLC

Dates d'enregistrement des études

Ces dates suivent la progression des dossiers d'étude et des soumissions de résultats sommaires à ClinicalTrials.gov. Les dossiers d'étude et les résultats rapportés sont examinés par la Bibliothèque nationale de médecine (NLM) pour s'assurer qu'ils répondent à des normes de contrôle de qualité spécifiques avant d'être publiés sur le site Web public.

Dates principales de l'étude

Début de l'étude (Réel)

9 mars 2017

Achèvement primaire (Réel)

26 décembre 2017

Achèvement de l'étude (Réel)

26 décembre 2017

Dates d'inscription aux études

Première soumission

28 février 2017

Première soumission répondant aux critères de contrôle qualité

7 mars 2017

Première publication (Réel)

13 mars 2017

Mises à jour des dossiers d'étude

Dernière mise à jour publiée (Réel)

30 juillet 2019

Dernière mise à jour soumise répondant aux critères de contrôle qualité

11 juillet 2019

Dernière vérification

1 mai 2019

Plus d'information

Termes liés à cette étude

Plan pour les données individuelles des participants (IPD)

Prévoyez-vous de partager les données individuelles des participants (DPI) ?

Non

Informations sur les médicaments et les dispositifs, documents d'étude

Étudie un produit pharmaceutique réglementé par la FDA américaine

Non

Étudie un produit d'appareil réglementé par la FDA américaine

Oui

produit fabriqué et exporté des États-Unis.

Non

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