- ICH GCP
- US Clinical Trials Registry
- Klinisk utprøving NCT02766075
A STEP for Patients Prior to Undergoing TAVR: A Pilot Study (STEP)
A Supervised TAVR Exercise Program (STEP) for Patients Prior to Undergoing Transcatheter Aortic Valve Replacement (TAVR): A Pilot Study
Studieoversikt
Status
Forhold
Intervensjon / Behandling
Detaljert beskrivelse
TAVR is an approved alternative therapy for patients with severe aortic valve stenosis who are deemed inoperable or high-risk for surgical aortic valve replacement (SAVR). Despite a very high procedural success rate (>95%), mortality rates after TAVR at 1- and 2-year follow-up remain ≥25% and ≥34%, respectively. It is becoming increasingly evident that frailty, as a clinical syndrome, has a large impact on this long term mortality. In a study by Green, et al. frailty status was independently associated with increased 1-year mortality (OR=3.5) after TAVR. The investigators' own retrospective analysis showed that impaired mobility and malnutrition were significantly associated with a longer hospital length of stay (5 days vs. 3 days), and increased total cost (on average, an additional $10,000 per patient). Given the phenotype of frailty is characterized by reductions in muscle mass, strength, endurance and activity level, a STEP is ideally suited to counteract these impairments. This pilot study aims to establish whether a STEP can safely improve the frailty score in patients with symptomatic severe aortic valve stenosis prior to undergoing TAVR.
This single-center pilot study will be conducted in partnership between Heart Care Midwest (HCMW), OSF St. Francis Medical Center (OSF SFMC), and University of Illinois College of Medicine at Peoria (UICOMP). UICOMP Center of Outcomes Research will provide analytical support. The study will be funded by an operational research grant from OSF SFMC.
Studietype
Registrering (Faktiske)
Fase
- Ikke aktuelt
Kontakter og plasseringer
Studiesteder
-
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Illinois
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Peoria, Illinois, Forente stater, 61630
- OSF St. Francis Medical Center
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Deltakelseskriterier
Kvalifikasjonskriterier
Alder som er kvalifisert for studier
Tar imot friske frivillige
Kjønn som er kvalifisert for studier
Beskrivelse
Inclusion Criteria:
- All adult patients scheduled to undergo first-time elective TAVR
Exclusion Criteria:
- Vulnerable populations including prisoners, pregnant females and patients less than 18 years age.
- Patients with history of unstable angina, myocardial infarction, or decompensated heart failure in the week prior to screening
- Patients with physical limitations (i.e. debilitating stroke, amputation, unable to complete initial screening frailty profile)
- Patients with advanced dementia or cognitive deficits (i.e. unable to follow instructions of initial screening frailty profile)
- Exercise-induced arrhythmias
Studieplan
Hvordan er studiet utformet?
Designdetaljer
- Primært formål: Støttende omsorg
- Tildeling: Randomisert
- Intervensjonsmodell: Parallell tildeling
- Masking: Enkelt
Våpen og intervensjoner
Deltakergruppe / Arm |
Intervensjon / Behandling |
---|---|
Eksperimentell: Supervised TAVR Exercise Program (STEP)
Subjects in the experimental arm will participate in an individualized 4-week STEP prior to undergoing TAVR.
All subjects will undergo serial frailty assessments by a blinded research assistant at baseline, pre-TAVR, and 30-days post-TAVR.
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Individualized exercise program designed and implemented by licensed physical therapy clinicians in three 60-minute sessions per week for four weeks.
Upon randomization, subjects in the Intervention Group will undergo an initial Dynamic Gait & Balance Assessment by a licensed physical therapy clinician.
The physical therapy clinician will use this assessment to design and implement an individualized STEP in three 60-minute sessions per week for four weeks.
Subjects will proceed with their pre-TAVR testing in conjunction with the STEP sessions.
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Ingen inngripen: Standard of Care
Subjects in the no intervention arm will proceed with their TAVR after a minimum 4 weeks without an exercise intervention.
All subjects will undergo serial frailty assessments by a blinded research assistant at baseline, pre-TAVR, and 30-days post-TAVR.
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Hva måler studien?
Primære resultatmål
Resultatmål |
Tidsramme |
---|---|
Change in Frailty Score from Baseline to post-STEP
Tidsramme: Baseline, 6-weeks
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Baseline, 6-weeks
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Sekundære resultatmål
Resultatmål |
Tidsramme |
---|---|
Adverse Events
Tidsramme: 6-weeks
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6-weeks
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Change in Frailty Score from Baseline to 30-days post-TAVR
Tidsramme: Baseline, 30-days post-TAVR
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Baseline, 30-days post-TAVR
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Change in Gait Speed (5-Meter Walk Test) from Baseline to post-STEP
Tidsramme: Baseline, 6-weeks
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Baseline, 6-weeks
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Change in Gait Speed (5-Meter Walk Test) from Baseline to 30-days post-TAVR
Tidsramme: Baseline, 30-days post-TAVR
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Baseline, 30-days post-TAVR
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Change in Grip Strength (Dynamometer) from Baseline to post-STEP
Tidsramme: Baseline, 6-weeks
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Baseline, 6-weeks
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Change in Grip Strength (Dynamometer) from Baseline to 30-days post-TAVR
Tidsramme: Baseline, 30-days post-TAVR
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Baseline, 30-days post-TAVR
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Change in Independent Activity (Katz Activities of Daily Living Survey) from Baseline to post-STEP
Tidsramme: Baseline, 6-weeks
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Baseline, 6-weeks
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Change in Independent Activity (Katz Activities of Daily Living Survey) from Baseline to to 30-days post-TAVR
Tidsramme: Baseline, 30-days post-TAVR
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Baseline, 30-days post-TAVR
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Change in Malnutrition (Serum Albumin Level) from Baseline to 30-days post-TAVR
Tidsramme: Baseline, 30-days post-TAVR
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Baseline, 30-days post-TAVR
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Samarbeidspartnere og etterforskere
Sponsor
Etterforskere
- Hovedetterforsker: Jay N Patel, MD, OSF Healthcare System
Studierekorddatoer
Studer hoveddatoer
Studiestart (Faktiske)
Primær fullføring (Faktiske)
Studiet fullført (Faktiske)
Datoer for studieregistrering
Først innsendt
Først innsendt som oppfylte QC-kriteriene
Først lagt ut (Anslag)
Oppdateringer av studieposter
Sist oppdatering lagt ut (Faktiske)
Siste oppdatering sendt inn som oppfylte QC-kriteriene
Sist bekreftet
Mer informasjon
Begreper knyttet til denne studien
Ytterligere relevante MeSH-vilkår
Andre studie-ID-numre
- 837484
Plan for individuelle deltakerdata (IPD)
Planlegger du å dele individuelle deltakerdata (IPD)?
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