通过锻炼和康复减少 COVID-19 后的疲劳(前言):随机可行性试验 (PREFACER)
研究概览
详细说明
研究人员提出了一项 Zelen 随机、单中心试验,有两个平行组(干预组与标准护理组)。 建议使用 Zelen 设计来评估不完全依从条件下的现实干预效果,因此非常适合测试 PC19S 的康复干预。 参与者将从帕克伍德研究所圣约瑟夫急性后 COVID-19 门诊项目中确定和招募。 一旦临床医生和研究人员确定了资格,他们将登录基于网络的计算机生成的随机化系统。 随机化方案将使用不同的排列块构建,按性别和住院状态分层(1 = 住院,0 = 其他)。 由于这是一项 Zelen 试验,参与者在获得同意之前将被随机分组。 随机分配到 COVIDEx 的参与者将被告知,他们是比较 COVIDEx 与标准护理 (SoC) 的随机对照试验的一部分,并且他们被随机分配到 COVIDEx 组。 他们将被要求参与并签署同意书。 治疗期为 8 周,每周 2 次新冠肺炎治疗。
随机分配到 SoC 组的参与者将被要求同意参加一项观察性研究,以追踪 PC19S 的自然史以及与 SoC 相关的 COVID-19 后治疗费用。 通过让 SoC 患者对实验组的存在视而不见,Zelen 设计将减轻因被分配 SoC 而感到失望、沮丧或气馁的影响,考虑到主要结果是主观的、患者报告的结果测量(检测偏差),这一点很重要)。 这种方法还将减少 SoC 组中的患者开始尝试模仿干预(表现偏差)的自我激励计划的可能性,因为该人群没有护理标准。 研究完成后,对照组将参加披露访谈,其中将揭示研究的随机性质,将提供这种欺骗/治疗延迟的理由,并寻求将其数据用于 RCT 的充分知情同意。 然后,SoC 患者将接受 COVIDEx 干预。 如果对照组参与者选择参与 COVIDEx 干预,研究团队将不会收集他们的数据。
将在评估会议期间在基线、4、8、12 和 24 周随访时收集结果。 定性焦点小组将探讨干预措施的可接受性以及干预措施依从性和学习保留的障碍/促进因素。 只有随机分配到 COVIDEx 组的参与者才会被要求参加焦点小组。
研究类型
注册 (估计的)
阶段
- 不适用
联系人和位置
学习联系方式
- 姓名:Arden Lawson, BMSc
- 电话号码:42570 519-646-6100
- 邮箱:arden.lawson@sjhc.london.on.ca
参与标准
资格标准
适合学习的年龄
- 成人
- 年长者
接受健康志愿者
描述
纳入标准:
- 年满 18 岁的成年人
- 能够提供知情同意
- 有记录的 SARS-CoV-2 感染史(急性疾病期间 PCR/抗原检测呈阳性或急性疾病期间或之后由医生进行临床诊断)
- COVID-19 感染后 3 个月内出现疲劳症状,持续至少 2 个月
- 疲劳症状不能用其他诊断来解释
- 疲劳症状可能是在新冠肺炎 (COVID-19) 急性发作恢复后新出现的,也可能是初次患病后持续存在的。
- 疲劳症状可能会随着时间的推移而波动或复发。
排除标准:
- 活动性 SARS-CoV-2 感染
- 无法说或听不懂英语
- 可能导致认知障碍或与 COVID-19 后出现的症状类似的既存疾病(例如,严重的神经认知障碍、精神分裂症、慢性疲劳综合症)
- 无法遵循学习程序
- 目前存在酒精或物质使用障碍
- 身体、认知或语言障碍足以对认知评估得出的数据产生不利影响
- 诊断出阅读障碍或阅读障碍
- 有临床意义的学习障碍史
- 怀孕和/或哺乳期
- 在筛选访视后 30 天内接受研究药物作为单独研究的一部分
- 活动性癫痫/癫痫,无法通过药物控制
- 存在任何不稳定的医疗状况
学习计划
研究是如何设计的?
设计细节
- 主要用途:治疗
- 分配:随机化
- 介入模型:并行分配
- 屏蔽:单身的
武器和干预
参与者组/臂 |
干预/治疗 |
---|---|
实验性的:新冠肺炎快递
该手臂每周将接受 2 次每次 50 分钟的康复训练,持续 8 周。
|
该计划由物理治疗师提供,每周包括两次每次 50 分钟的课程,为期八周。
它设计为由物理治疗师以 6 名患者为一组进行面对面或远程授课。
该计划的组成部分为:(i) 热身(1 分钟)、(ii) 有氧训练(5 分钟)、(iii) 休息(3 分钟)、(iv) 平衡训练(5 分钟)、(v)呼吸练习(3 分钟)、(vi)认知训练(5 分钟)、(vii)力量训练(5 分钟)和(viii)伸展运动(10 分钟)。
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无干预:护理标准
该手臂将在 8 周的干预期内接受标准护理(无干预)。
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研究衡量的是什么?
主要结果指标
结果测量 |
措施说明 |
大体时间 |
---|---|---|
招聘
大体时间:基线
|
符合筛选条件的患者人数、同意的符合条件患者的比例、每月入组的患者人数、未入组的原因。
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基线
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干预保真度
大体时间:第24周
|
达到可接受的干预保真度水平的参与者比例 (>80%)。
将使用保真度检查表来评估可行性,包括依从性(即干预的每个关键组成部分的实施——缺席/存在)、剂量(实施的干预量、完成的疗程数量、疗程的总持续时间)、干预质量交付(即 COVIDEx 的交付方式)和参与者的可接受性(干预组中的参与者认为干预有用的程度)。
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第24周
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保留
大体时间:第24周
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错过评估和不完整结果测量数据的比例,以及退出试验的参与者的比例。
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第24周
|
Zelen 设计可接受性
大体时间:第24周
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标准治疗组中同意在披露访视后将其数据纳入随机对照试验的患者比例。
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第24周
|
次要结果测量
结果测量 |
措施说明 |
大体时间 |
---|---|---|
致盲成功率
大体时间:第24周
|
结果评估者的盲法成功率将使用詹姆斯盲法指数量表进行评估。
James Blinding Index (BI) 是一个连续值,0 <= James BI <= 1。
如果索引为 1,则所有响应都是不正确的,并且推断出完全盲法,尽管这可能表明相反方向的揭盲(例如,
相反的猜测)。
如果索引为0,则所有响应都是正确的,并且推断完全揭盲。
如果指数为0.5,则一半的猜测是正确的,一半的猜测是错误的,推断是随机猜测。
如果两侧置信区间的上限< 0.5,则可以声明揭盲。
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第24周
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结果负担衡量完整性
大体时间:第24周
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缺失就诊的比例、缺失结果/数据以及缺失原因。
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第24周
|
患者的看法
大体时间:第24周
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研究方案完成后,研究人员将要求参与者和治疗物理治疗师参加定性评估,以了解他们对干预措施可接受性的看法以及他们对 Zelen 设计的体验。
为了实现这一目标,研究团队将开展由经验丰富的定性研究人员领导的参与者和治疗物理治疗师焦点小组,使用解释性描述方法重点关注具有临床意义的发现,帮助我们了解干预措施的可接受性、感知的益处、依从性的障碍/促进因素和实施挑战。
研究人员将组织 2-3 个焦点小组,其中包括 5-8 名参与者和 5-8 名参与试验的物理治疗师,这些样本在人口和临床上具有不同的样本。
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第24周
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疲劳的变化
大体时间:基线至第 8 周
|
PROMIS-疲劳量表将用于测量参与者在基线以及第 4、8、12 和 24 周时的 5 点李克特量表疲劳水平。
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基线至第 8 周
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疼痛的变化
大体时间:基线至第 8 周
|
将在基线、第 4、8、12 和 24 周通过视觉模拟量表 (VAS-Pain) 测量疼痛水平。
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基线至第 8 周
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COVID-19 后功能状态的变化
大体时间:基线至第 8 周
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COVID-19 对功能状态的影响按 5 级评分,从 0(无功能限制)到 4(严重功能限制)。
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基线至第 8 周
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感知体力消耗博格量表的变化
大体时间:基线至第 8 周
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参与者对运动/活动的困难程度进行评分,范围为 6(完全没有用力)到 20(最大用力)。
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基线至第 8 周
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全球变化等级评级的变化
大体时间:基线至第 8 周
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参与者将对症状的变化进行评分,范围从 -5(更差)到 +5(好得多)。
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基线至第 8 周
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德保罗症状问卷的变化
大体时间:基线至第 8 周
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身体症状按照频率(0=没有,4=所有时间)和严重程度(0=无症状,4=非常严重)分为五级。
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基线至第 8 周
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医院焦虑和抑郁量表的变化
大体时间:基线至第 8 周
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陈述对于参与者来说的真实程度按照 0 到 3 的等级进行评分。
分数越高表示结果越差。
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基线至第 8 周
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EuroQoL-5D 的变化
大体时间:基线至 8 周
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EuroQol 5 维度 5 级别 (EQ-5D-5L) 是一项自我报告调查,衡量 5 个领域的生活质量:行动能力、自我护理、日常活动、疼痛/不适和焦虑/抑郁。
每个维度均按照从“没有问题”到“极端问题”的 3 级严重性排名进行评分。
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基线至 8 周
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30 秒坐站测试的变化
大体时间:基线至第 8 周
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参与者的计时时间为 30 秒,并记录他们在 30 秒时间内站起来和坐在椅子上的次数。
重复次数越多表明功能能力越高。
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基线至第 8 周
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合作者和调查者
调查人员
- 首席研究员:Pavlos Bobos, PhD、Western University
出版物和有用的链接
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研究记录日期
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研究完成 (估计的)
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首次提交
首先提交符合 QC 标准的
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