- ICH GCP
- Rejestr badań klinicznych w USA
- Badanie kliniczne NCT01123382
Electrical Stimulation for Hemiplegic Shoulder Pain
26 grudnia 2017 zaktualizowane przez: John Chae, MD, MetroHealth Medical Center
Post-stroke shoulder pain is a major rehabilitation problem affecting moderate to severely impaired stroke survivors.
Surface electrical stimulation (ES) of muscles surrounding the hemiparetic shoulder has been demonstrated to be beneficial, but despite the evidence for therapeutic benefit, the clinical implementation of surface ES for poststroke shoulder pain has been difficult.
In order to address the limitations of surface ES, the investigative team pioneered the development of percutaneous intramuscular (IM) ES for the treatment of post-stroke shoulder pain.
However, prior to acceptance by the clinical community, additional gaps in the scientific and clinical knowledge need to be addressed.
This study begins to do so.
The primary objective is to estimate the relative pain reduction associated with IM ES vs. "usual care."
We hypothesize that the IM ES group will exhibit a larger effect size with respect to pain reduction compared to "usual care".
A secondary objective is to estimate the effect on health related QOL of IM ES vs. "usual care."
Demonstration of improvement in QOL will validate the clinical relevance of the intervention.
We hypothesize that the IM ES group will exhibit greater improvement in health related QOL compared to "usual care".
Przegląd badań
Status
Zakończony
Warunki
Interwencja / Leczenie
Typ studiów
Interwencyjne
Zapisy (Rzeczywisty)
25
Faza
- Nie dotyczy
Kontakty i lokalizacje
Ta sekcja zawiera dane kontaktowe osób prowadzących badanie oraz informacje o tym, gdzie badanie jest przeprowadzane.
Lokalizacje studiów
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Ohio
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Cleveland, Ohio, Stany Zjednoczone, 44109
- MetroHealth Medical Center
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Kryteria uczestnictwa
Badacze szukają osób, które pasują do określonego opisu, zwanego kryteriami kwalifikacyjnymi. Niektóre przykłady tych kryteriów to ogólny stan zdrowia danej osoby lub wcześniejsze leczenie.
Kryteria kwalifikacji
Wiek uprawniający do nauki
21 lat i starsze (Dorosły, Starszy dorosły)
Akceptuje zdrowych ochotników
Nie
Płeć kwalifikująca się do nauki
Wszystko
Opis
Inclusion Criteria:
- shoulder pain localized to the glenohumeral joint, subacromial area or deltoid insertion associated with any of the following conditions: a) rest; b) passive abduction or external rotation ROM; c) active abduction or external rotation ROM; or d) manual palpation
- weakness of shoulder abductors (≤4/5 on MRC if isolated movement is present)
- age ≥21-yrs
- time from stroke ≥ 3-mo
- shoulder pain onset after the most recent stroke
- duration of shoulder pain ≥ 3-mo
- severity of shoulder pain on BPI-SF 3 ≥4
- cognitive ability to fulfill study requirements [a) exhibit 3 object immediate and 30 minute recall; b) ability to use a numeric rating scale (using a 0-10 numeric rating scale) by correctly ranking the tightness they feel on the unaffected arm of 3 low-pressure inflations with a standard sphygmomanometer cuff which follow a predetermined sequence (20, 40 and 0 mm Hg); and c) ability to follow 3-stage commands]
- availability of a reliable adult who can check the skin and assist the participant with the treatment protocol
- willing and able to report severity of shoulder pain throughout the study period
- willing to make all scheduled study visits post-implantation.
Exclusion Criteria:
- evidence of joint or overlying skin infection
- insensate skin
- >1 opioid or nonopioid analgesics daily for shoulder pain
- daily intake of pain medications for any other chronic pain
- intra-articular or subacromial steroid injections to the shoulder in the previous 12-wks
- botulinum toxin injection to the trapezius, pectoralis or subscapularis muscle in the previous 12-wks
- receiving physical or occupational therapies for shoulder pain
- physician-diagnosed shoulder pathology symptomatic within the 5 yrs prior to CVA
- bleeding disorder
- INR>3.0 for those on warfarin [INR>3.0]
- poorly controlled diabetes [HbA1c>7.0]
- medical instability
- pregnancy
- uncontrolled seizures (>1/mo for 6-mo)
- uncompensated hemi-neglect
- severely impaired communication
- moderate to severe depression
- other confounding conditions such as ipsilateral upper limb lower motorneuron lesion, Parkinson's Disease, spinal cord injury, traumatic brain injury or multiple sclerosis
- other medical issues such as complex regional pain syndrome, bicipital tendonitis, myofacial pain syndrome, etc.
- the following cardiac conditions: a) history of arrhythmia with hemodynamic instability, such as ventricular tachycardia, supraventricular tachycardia and rapid ventricular response atrial fibrillation; b) any implantable stimulator such as demand pacemakers or defibrillators; and c) valvular heart disease including artificial valves (due to risk of infection and endocarditis)
- likely non-compliance factors such as distance from the center, inadequate social support, or psychiatric/psychologic factors
Plan studiów
Ta sekcja zawiera szczegółowe informacje na temat planu badania, w tym sposób zaprojektowania badania i jego pomiary.
Jak projektuje się badanie?
Szczegóły projektu
- Główny cel: Leczenie
- Przydział: Randomizowane
- Model interwencyjny: Przydział równoległy
- Maskowanie: Pojedynczy
Broń i interwencje
Grupa uczestników / Arm |
Interwencja / Leczenie |
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Eksperymentalny: IM Electrical Stimulation (IM ES)
The IM ES Group will receive electrical stimulation treatment for three weeks (6 hrs daily) with an Intramuscular Electrical Stimulator following a one week electrode stabilization period.
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A sterile percutaneous IM electrode is implanted in the shoulder using a 20-gauge hypodermic needle and connected to an external cable.
The exit site and electrode are covered by a bandage, but the cable extends out.
After a one week stabilization period, the cable is connected to a stimulator.
A self-adhesive surface electrode serves as the indifferent electrode.
Stimulation intensity is set by the investigator.
The prescription for daily stimulation treatment will be 6 hrs.
The duty cycle and daily dose will remain constant throughout the treatment, but stimulus parameters may be adjusted by the research staff as deemed appropriate.
The treatment period will be 3 weeks, after which the electrode will be removed.
Total time of electrode implantation is no more than 29 days.
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Aktywny komparator: Usual Care (UC)
The Usual Care Group will receive outpatient therapy for four weeks, coupled with prescribed daily home exercises.
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Subjects will receive 8 hrs of outpatient therapy over a four week period from a treating therapist, coupled with prescribed daily home exercises.
The therapist will implement an individualized treatment plan consistent with the needs of the participant.
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Co mierzy badanie?
Podstawowe miary wyniku
Miara wyniku |
Opis środka |
Ramy czasowe |
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Brief Pain Inventory Short Form
Ramy czasowe: Baseline (Week 0); Start of Treatment (Week 1); End of Treatment (EOT, Week 4); EOT + 6 wks (Week 10); EOT + 12 wks (Week 16)
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The BPI is a pain questionnaire, which assesses both pain intensity (sensory dimension) and the interference (reactive dimension) of pain in daily activities.
Pain intensity is measured on a 0 - 10 scale, with 0 being no pain and 10 being worst possible.
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Baseline (Week 0); Start of Treatment (Week 1); End of Treatment (EOT, Week 4); EOT + 6 wks (Week 10); EOT + 12 wks (Week 16)
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Miary wyników drugorzędnych
Miara wyniku |
Opis środka |
Ramy czasowe |
---|---|---|
ShoulderQ VGRS Scale
Ramy czasowe: Baseline (Week 0); Start of Treatment (Week 1); End of Treatment (EOT, Week 4); EOT + 6 wks (Week 10); EOT + 12 wks (Week 16)
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The ShoulderQ Visual Graphics Rating Scale (VGRS) T is a structured questionnaire designed to assess severity of HSP at rest during the day, on movement, and at night on a 0-30 scale where higher numbers indicate greater pain.
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Baseline (Week 0); Start of Treatment (Week 1); End of Treatment (EOT, Week 4); EOT + 6 wks (Week 10); EOT + 12 wks (Week 16)
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SF-36 Bodily Pain Component
Ramy czasowe: Baseline (Week 0); Start of Treatment (Week 1); End of Treatment (EOT, Week 4); EOT + 6 wks (Week 10); EOT + 12 wks (Week 16)
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The SF-36v2 is a population-norm based health related quality of life measure, presented in T-scores where population average equals a score of 50 with a standard deviation of 10.
Maximum is 100, with higher score indicating greater health realated quality of life.
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Baseline (Week 0); Start of Treatment (Week 1); End of Treatment (EOT, Week 4); EOT + 6 wks (Week 10); EOT + 12 wks (Week 16)
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Pain-free External ROM, Degrees
Ramy czasowe: Baseline (Week 0); Start of Treatment (Week 1); End of Treatment (EOT, Week 4); EOT + 6 wks (Week 10); EOT + 12 wks (Week 16)
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Passive pain-free Externa ROM is a motor recovery measure.
The subject was supine with the shoulder adducted with hand resting on the abdomen, elbow flexed, and with the humerus supported by the mat.
The axis of a universal goniometer was centered on the olecranon process of the ulna projecting through the humeral shaft toward the humeral head.
The subject's shoulder was externally rotated passively to the pain threshold, defined as the start of any pain.
Pain at rest was recorded as 0 degrees.
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Baseline (Week 0); Start of Treatment (Week 1); End of Treatment (EOT, Week 4); EOT + 6 wks (Week 10); EOT + 12 wks (Week 16)
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Fugl-Myer Motor Assessment (FMA) - Upper Extremity
Ramy czasowe: Baseline (Week 0); Start of Treatment (Week 1); End of Treatment (EOT, Week 4); EOT + 6 wks (Week 10); EOT + 12 wks (Week 16)
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The Fugl-Myer Motor Assessment (FMA) is a motor recovery measure.
Volitional movement of the upper limb (shoulder, elbow, forearm, wrist, and hand) is examined in and out of synergies.
Each item was graded on a 3-point ordinal scale and summed to provide a maximum score of 66, with higher scores indicating lower impairment.
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Baseline (Week 0); Start of Treatment (Week 1); End of Treatment (EOT, Week 4); EOT + 6 wks (Week 10); EOT + 12 wks (Week 16)
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Pain Interference Questionnaire
Ramy czasowe: Baseline (Week 0); Start of Treatment (Week 1); End of Treatment (EOT, Week 4); EOT + 6 wks (Week 10); EOT + 12 wks (Week 16)
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BPI-9 from Brief Pain Inventory, Short Form.
Pain interference is on a 0 - 10 scale, with 0 being no interference, and 10 being complete interference.
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Baseline (Week 0); Start of Treatment (Week 1); End of Treatment (EOT, Week 4); EOT + 6 wks (Week 10); EOT + 12 wks (Week 16)
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Isometric Shoulder Abduction Moment, Ratio Affected to Unaffected
Ramy czasowe: Baseline (Week 0); Start of Treatment (Week 1); End of Treatment (EOT, Week 4); EOT + 6 wks (Week 10); EOT + 12 wks (Week 16)
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A measure of isometric strength in response to audio cue.
Isometric shoulder abduction moment was measured with a Biodex Biomechanical Measurement System (Biodex Medical Systems, Shirley, NY).
The average moment during the last second of the audible tone was calculated for each trial and those values were averaged over the three trials.
Subjects underwent testing of both shoulders, non-paretic side first, and the results are presented as the ratio of the paretic shoulder to the non-paretic shoulder to decrease the influence of intra-subject variability between measurements.
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Baseline (Week 0); Start of Treatment (Week 1); End of Treatment (EOT, Week 4); EOT + 6 wks (Week 10); EOT + 12 wks (Week 16)
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Delay in Initiation of Shoulder Abduction EMG Activity
Ramy czasowe: Baseline (Week 0); Start of Treatment (Week 1); End of Treatment (EOT, Week 4); EOT + 6 wks (Week 10); EOT + 12 wks (Week 16)
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Electromyographic activity from the deltoid was also measured during the isometric abduction moment trials.
Surface EMG recording electrodes (2 cm x 2 cm) were placed over the deltoid muscle and spaced approximately 4 cm apart.
The EMG amplifier gain was adjusted to record as high-fidelity an EMG signal as possible during shoulder abduction.
Delay of initiation (DOI) was defined as the duration between onset of the audibe tone and the onset of EMG signal.
Raw EMG signals were analyzed visually to determine the earliest rise in EMG activity relative to steady state for delay of initiation.
The mean DOI of the three trials were calculated, and the ratio of the paretic to non-paretic shoulder DOI were used as summary metrics.
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Baseline (Week 0); Start of Treatment (Week 1); End of Treatment (EOT, Week 4); EOT + 6 wks (Week 10); EOT + 12 wks (Week 16)
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Delay in Termination of Shoulder Abduction EMG Activity
Ramy czasowe: Baseline (Week 0); Start of Treatment (Week 1); End of Treatment (EOT, Week 4); EOT + 6 wks (Week 10); EOT + 12 wks (Week 16)
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Electromyographic activity from the deltoid was also measured during the isometric abduction moment trials.
Surface EMG recording electrodes (2 cm x 2 cm) were placed over the deltoid muscle and spaced approximately 4 cm apart.
The EMG amplifier gain was adjusted to record as high-fidelity an EMG signal as possible during shoulder abduction.
Delay of termination (DOT) was defined as the duration between cessation of the audible tone and return of the EMG signal to baseline.
Raw EMG signals were analyzed visually to determine the earliest rise in EMG activity relative to steady state for delay of initiation, and return to steady for delay of termination.
The mean DOT of the three trials were calculated, and the ratio of the paretic to non-paretic shoulder DOT were used as summary metrics.
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Baseline (Week 0); Start of Treatment (Week 1); End of Treatment (EOT, Week 4); EOT + 6 wks (Week 10); EOT + 12 wks (Week 16)
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Współpracownicy i badacze
Tutaj znajdziesz osoby i organizacje zaangażowane w to badanie.
Sponsor
Współpracownicy
Śledczy
- Główny śledczy: John Chae, MD, MetroHealth Medical Center
Publikacje i pomocne linki
Osoba odpowiedzialna za wprowadzenie informacji o badaniu dobrowolnie udostępnia te publikacje. Mogą one dotyczyć wszystkiego, co jest związane z badaniem.
Publikacje ogólne
- Yu DT, Chae J, Walker ME, Fang ZP. Percutaneous intramuscular neuromuscular electric stimulation for the treatment of shoulder subluxation and pain in patients with chronic hemiplegia: a pilot study. Arch Phys Med Rehabil. 2001 Jan;82(1):20-5. doi: 10.1053/apmr.2001.18666.
- Yu DT, Chae J, Walker ME, Kirsteins A, Elovic EP, Flanagan SR, Harvey RL, Zorowitz RD, Frost FS, Grill JH, Feldstein M, Fang ZP. Intramuscular neuromuscular electric stimulation for poststroke shoulder pain: a multicenter randomized clinical trial. Arch Phys Med Rehabil. 2004 May;85(5):695-704. doi: 10.1016/j.apmr.2003.07.015.
- Chae J, Yu DT, Walker ME, Kirsteins A, Elovic EP, Flanagan SR, Harvey RL, Zorowitz RD, Frost FS, Grill JH, Fang ZP. Intramuscular electrical stimulation for hemiplegic shoulder pain: a 12-month follow-up of a multiple-center, randomized clinical trial. Am J Phys Med Rehabil. 2005 Nov;84(11):832-42. doi: 10.1097/01.phm.0000184154.01880.72.
- Chae J, Ng A, Yu DT, Kirsteins A, Elovic EP, Flanagan SR, Harvey RL, Zorowitz RD, Fang ZP. Intramuscular electrical stimulation for shoulder pain in hemiplegia: does time from stroke onset predict treatment success? Neurorehabil Neural Repair. 2007 Nov-Dec;21(6):561-7. doi: 10.1177/1545968306298412. Epub 2007 Mar 16.
- Wilson RD, Gunzler DD, Bennett ME, Chae J. Peripheral nerve stimulation compared with usual care for pain relief of hemiplegic shoulder pain: a randomized controlled trial. Am J Phys Med Rehabil. 2014 Jan;93(1):17-28. doi: 10.1097/PHM.0000000000000011. Erratum In: Am J Phys Med Rehabil. 2016 Feb;95(2):e29.
Przydatne linki
Daty zapisu na studia
Daty te śledzą postęp w przesyłaniu rekordów badań i podsumowań wyników do ClinicalTrials.gov. Zapisy badań i zgłoszone wyniki są przeglądane przez National Library of Medicine (NLM), aby upewnić się, że spełniają określone standardy kontroli jakości, zanim zostaną opublikowane na publicznej stronie internetowej.
Główne daty studiów
Rozpoczęcie studiów
1 stycznia 2010
Zakończenie podstawowe (Rzeczywisty)
1 lutego 2013
Ukończenie studiów (Rzeczywisty)
1 lutego 2013
Daty rejestracji na studia
Pierwszy przesłany
12 maja 2010
Pierwszy przesłany, który spełnia kryteria kontroli jakości
12 maja 2010
Pierwszy wysłany (Oszacować)
14 maja 2010
Aktualizacje rekordów badań
Ostatnia wysłana aktualizacja (Rzeczywisty)
23 stycznia 2018
Ostatnia przesłana aktualizacja, która spełniała kryteria kontroli jakości
26 grudnia 2017
Ostatnia weryfikacja
1 grudnia 2017
Więcej informacji
Terminy związane z tym badaniem
Słowa kluczowe
Dodatkowe istotne warunki MeSH
Inne numery identyfikacyjne badania
- R01HD059777 (Grant/umowa NIH USA)
Plan dla danych uczestnika indywidualnego (IPD)
Planujesz udostępniać dane poszczególnych uczestników (IPD)?
Nie
Informacje o lekach i urządzeniach, dokumenty badawcze
Bada produkt leczniczy regulowany przez amerykańską FDA
Nie
Te informacje zostały pobrane bezpośrednio ze strony internetowej clinicaltrials.gov bez żadnych zmian. Jeśli chcesz zmienić, usunąć lub zaktualizować dane swojego badania, skontaktuj się z register@clinicaltrials.gov. Gdy tylko zmiana zostanie wprowadzona na stronie clinicaltrials.gov, zostanie ona automatycznie zaktualizowana również na naszej stronie internetowej .
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