Pivotal Study of VNS During Rehab After Stroke (VNS-REHAB) (VNS-REHAB)
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|ClinicalTrials.gov Identifier: NCT03131960|
Recruitment Status : Completed
First Posted : April 27, 2017
Results First Posted : June 14, 2021
Last Update Posted : July 20, 2022
|Condition or disease||Intervention/treatment||Phase|
|Cerebrovascular Stroke Upper Extremity Paresis||Device: Paired Vagus Nerve Stimulation Other: Rehabilitation||Not Applicable|
This study has three distinct stages: Stage I, an acute blinded stage, Stage II, an unblinded stage through one year of standard VNS, and Stage III, an unblinded stage for yearly follow-up after one year of VNS. The Control group crosses over to VNS treatment at Stage II.
For Stage I, subjects have:
- consent and evaluation (screening),
- one pre-implant evaluation,
- surgical implant of the device system and randomization into one of the treatment arms,
- one baseline evaluation after device implant surgery but before initiation of treatment,
- 6 weeks of treatment (standard-of-care rehabilitation + standard VNS or standard-of-care rehabilitation + active control VNS), and then
- post-acute therapy evaluations at 1, 30 and 90 days after the 6 weeks of treatment.
- Between Day 1 (V5) and Day 30 (V6) post-acute therapy, both groups will receive in-home, self-directed rehabilitation (30 minutes of daily rehabilitation as assigned by the therapist) with either in-home activated VNS (VNS group) or no VNS (Control group). This means that the control subjects will not have the in-home activated VNS until they complete the second 6-week session of in-clinic rehabilitation with follow-up assessments as described below in Stage II. At this point (Day 30) subjects start scheduling for their continuing long-term follow-up.
- Between Day 30 and Day 90 post-acute therapy, both groups continue in-home, self-directed rehabilitation (30 minutes of daily rehabilitation as assigned by the therapist). The VNS group continues to receive in-home VNS with magnet use; the Control group continues to use the magnet but does not receive any VNS. The Day 90 post-acute therapy visit is V7; it is the first quarterly visit (3 months after study therapy) for the VNS group and is the re-baseline visit (visit just prior to the initiation of standard VNS therapy) for the Control group.
- VNS subjects will continue to have quarterly assessments through the end of the first year (6m, 9m, 12m).
- Subjects in the control group will crossover for a second 6-week in-clinic rehabilitation period where they will now receive rehabilitation with standard VNS.
- Control subjects will then have the three post therapy assessments (1, 30 and 90 days after therapy ends); in-home VNS initiated by a magnet swipe starts at the Post-1 visit (LT1). Thereafter, control subjects will follow the same schedule as VNS subjects for the remainder of the study (6m, 9m, 12m follow-ups, plus yearly visits thereafter).
- Subjects in both groups will receive "booster" in-clinic rehabilitation plus VNS therapy sessions one month prior to their 6- and 12-month assessment visits. These sessions occur on three days over a one-week period (typically Mon, Wed, Fri).
• After one year of standard VNS therapy (~13.5 months after implant for VNS group subjects and ~18 months after implant for Control group subjects), subjects who wish to keep their device for further use will have annual follow-up assessments until commercial approval.
|Study Type :||Interventional (Clinical Trial)|
|Actual Enrollment :||108 participants|
|Intervention Model:||Parallel Assignment|
|Intervention Model Description:||Double blind, randomized, parallel study with partial crossover (control subjects crossover to treatment after randomized portion)|
|Masking:||Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)|
|Masking Description:||Participants, therapists (care providers), investigators, and outcomes assessors do not know which group (VNS or control VNS) the patients are randomized. Only one person at the site - the programmer who programs the device settings - knows which group the subject is randomized into.|
|Official Title:||A Pivotal Randomized Study Assessing Vagus Nerve Stimulation (VNS) During Rehabilitation for Improved Upper Limb Motor Function After Stroke (VNS-REHAB)|
|Actual Study Start Date :||July 1, 2017|
|Actual Primary Completion Date :||April 30, 2020|
|Actual Study Completion Date :||June 30, 2022|
Experimental: VNS + Rehabilitation (1)
Study treatment is vagus nerve stimulation (VNS) delivered during rehabilitation.
Device: Paired Vagus Nerve Stimulation
Stimulation of the vagus nerve that is paired with upper limb rehabilitation movements.
Rehabilitation movements to improve upper limb function after stroke
Active Comparator: Control VNS
Active control treatment is rehabilitation (standard-of-care treatment) with only a minimal amount of VNS at the start of each session intended to support blinding.
Rehabilitation movements to improve upper limb function after stroke
- Fugl-Meyer Assessment, Upper Limb (FMA-UE) Average Change [ Time Frame: V5, One day after 6-weeks of therapy ]The Fugl-Meyer Assessment, Upper Limb (FMA-UE) was analyzed for difference in average change at 1-day after 6-weeks of therapy compared to baseline (Difference in average change in FM-A from baseline [V4] to one day after therapy [V5]). The upper extremity portion of the Fugl-Meyer Assessment (FMA-UE) was collected at each visit. The FMA-UE is a common scale used to measure motor impairment after a stroke. The range is 0 (more impairment) to 66 (no impairment).
- Fugl-Meyer Assessment, Upper Limb (FMA-UE) Average Change [ Time Frame: V7, 90 days after 6-weeks of therapy ]The Fugl-Meyer Assessment, Upper Limb (FMA-UE) was analyzed for change in average score at 90-days after 6-weeks of therapy (change in average FMA-UE from baseline [V4] to 90 days after therapy [V7]). The upper extremity portion of the Fugl-Meyer Assessment (FMA-UE) was collected at each visit. The FMA-UE is a common scale used to measure motor impairment after a stroke. The range is 0 (more impairment) to 66 (no impairment).
- Fugl-Meyer Assessment, Upper Limb (FMA-UE) Response [ Time Frame: V7, 90 days after 6-weeks of therapy ]The Fugl-Meyer Assessment, Upper Limb (FMA-UE) Response is the percent of patients with a 6 point or greater improvement on the (FMA-UE). The percent of patients with the 6-point change is calculated at 90-days after 6-weeks of therapy compared to baseline (V4). The upper extremity portion of the Fugl-Meyer Assessment (FMA-UE) was collected at each visit. The FMA-UE is a common scale used to measure motor impairment after a stroke. The range is 0 (more impairment) to 66 (no impairment).
- Wolf Motor Function Test (WMFT) Average Change [ Time Frame: V7, 90 days after 6-weeks of therapy ]The Wolf Motor Function Test (WMFT) is an assessment scale of upper extremity functional level after stroke. The functional assessment range is an average of 15 sub-items with a range from 0 to 5, with 0 (meaning did not attempt) to 5 (meaning normal). WMFT 90-day - is a measure of the functional assessment change from baseline to 90 days after 6-weeks of therapy.
To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.
Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT03131960