Extracorporeal Shockwave Therapy (ESWT) to Improve Function in Chronic ASIA-A Patients
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|ClinicalTrials.gov Identifier: NCT03399968|
Recruitment Status : Recruiting
First Posted : January 17, 2018
Last Update Posted : January 23, 2018
The global prevalence of spinal cord injury is estimated between 236 to 4187/Million. A spontaneous recovery of the sense-motoric function is decreasing with the time after injury and is only seen sporadically after 1 to 2 years. Treatment options are mainly limited to improvement of the quality of life.
The present prospective randomized study is intended as a double-blind, placebo controlled multi-center investigation. Patients suffering from chronic paraplegia (lesion between THII and THX, ASIA A = complete central lesion) at least for 1 year after the initial trauma without spontaneous remission of the last 6 months are considered to be included in the study. Meeting the inclusion criteria and signing the informed consent, patients are treated in one of the two study centers. At study inclusion, a baseline evaluation comprising neurological, neurophysiological, functional and clinical investigation is performed. Patients dedicated to the ESWT intervention group will be treated once a week over 6 weeks with local non-invasive low energy extracorporeal shockwave therapy (=6 treatments with an electrohydraulic device). The follow-up will include neurological, neurophysiological, clinical as well as functional evaluation at the time points 6 weeks, 3 months and 6 months. Additionally, patients will be provided with a diary for documentation of drug adaptation, grade of spasticity and pain. Those patients dedicated to the Placebo ESWT group, will receive the identical scheme in treatment (but without application of shockwaves) and follow-up as the patients in the ESWT group. However, after positive completion of the study, these patients will be offered ESWT as well.
|Condition or disease||Intervention/treatment||Phase|
|Spinal Cord Injuries||Device: ESWT Device: Placebo ESWT||Not Applicable|
|Study Type :||Interventional (Clinical Trial)|
|Estimated Enrollment :||25 participants|
|Intervention Model:||Parallel Assignment|
|Intervention Model Description:||prospective randomized controlled double blinded clinical intervention study|
|Masking:||Triple (Participant, Investigator, Outcomes Assessor)|
|Official Title:||Extracorporeal Shockwave Therapy (ESWT) in Patients Suffering From Complete Paraplegia at the Thoracic Level|
|Actual Study Start Date :||March 26, 2015|
|Estimated Primary Completion Date :||December 31, 2018|
|Estimated Study Completion Date :||May 31, 2019|
Application of shockwaves non-invasively at the level of injury
at low energy, shockwaves are applied non-invasively at the injury level and 5 segments up and down of the spinal cord paravertebrally left and right
Other Name: Extracorporeal shockwave therapy
Placebo Comparator: Placebo ESWT
Positioning of the therapy head at the injury level without application of shockwaves
Device: Placebo ESWT
the ESWT therapy head is positioned at the level of injury and is moved up and down identically as described in the Verum intervention group (ESWT) but without application of shockwaves. The sound which is normally produced by shockwave generation is played by high quality sound recordings in the same amount as in the Verum group
- Motor function [ Time Frame: 24 weeks ]Motor function of the lower limbs assessed by gait analysis tool (Lokomat (R))
- Sensitivity and Motor function [ Time Frame: 24 weeks ]
Assessment of levels by the ASIA score ASIA score - a neurologic assessment for patients with spinal cord injury developed by the American Spinal Injury Association.
Examination includes the pin-prick discrimination assessment at 28 specific sensory locations bilaterally but also 10 muscles bilaterally.
Sensory levels for each dermatome (nt...not testable, 0...absent sensation, 1...present sensation but impaired, 2...normal) Motor function of 5 upper extremity and 5 lower extremity key muscles (0...complete paralysis, 1...palpable or visible contraction, 2...active movement, full range of motion, gravity eliminated, 3...active movement, full range of motion, against gravity, 4...active movement, full range of motion, against gravity and provides some resistance, 5...active movement, full range of motion, against gravity and provides normal resistance, nt...not testable)
- Spasticity [ Time Frame: 24 weeks ]
Evaluation of spasticity degree assessed by the Tardieu test (muscle resistance to passive movement at both slow and fast speed) 2 measurements are performed:
- Quality of muscle reaction
- Angle of muscle reaction 3 speed definitions:
1) V1 is slow as possible 2) V2 speed of limb falling under gravity 3) V3 moving as fast as possible Quality of Muscle Reaction (scored 0-5); 0 is no resistance to passive ROM to 5 indicating joint is immobile (Some versions scored 0-4).
- Trunk control [ Time Frame: 24 weeks ]evaluation of trunk control by the modified functional reach test and Ott test
- Lung function [ Time Frame: 24 weeks ]Assessment of lung function by peak flow measurements
- Quality of life [ Time Frame: 24 weeks ]Assessed by the disability scale SCIM (spinal cord independence measure); Subscores include self-care (range von 0-20 points), respiration and sphincter management (range from 0-40), and mobility (range from 0-40); In total scale range from 0-100 (0 = total dependence, 100 = complete independence).
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): NCT03399968
|Contact: Wolfgang Schaden, MDfirstname.lastname@example.org|
|Contact: Rainer Mittermayr, MD||+435939345000||Rainer.Mittermayr@auva.at|
|AUVA Rehabilitation Center Weisser Hof||Recruiting|
|Klosterneuburg, Lower Austria, Austria, 3400|
|Contact: Karin Gstaltner, MD +435939351000|
|Principal Investigator: Josef Hufgard, MD|
|AUVA Rehabilitation Center Tobelbad||Recruiting|
|Haselsdorf, Styria, Austria, 8144|
|Contact: Renate Wildburger, MD +435939353000|
|Principal Investigator: Anja Grazer-Horacek, MD|