Pivotal Study of VNS During Rehab After Stroke (VNS-REHAB) (VNS-REHAB)
|The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details.|
|ClinicalTrials.gov Identifier: NCT03131960|
Recruitment Status : Active, not recruiting
First Posted : April 27, 2017
Last Update Posted : September 25, 2019
|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|
|Estimated Primary Completion Date :||March 30, 2020|
|Estimated Study Completion Date :||June 30, 2021|
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 (FM-A) [ Time Frame: V5, One day after 6-weeks of therapy ]FM-A 1-day
- Fugl-Meyer Assessment, Upper Limb (FM-A) [ Time Frame: V7, 90 days after 6-weeks of therapy ]FM-A 90-day
- Fugl-Meyer Assessment, Upper Limb (FM-A) Response [ Time Frame: V7, 90 days after 6-weeks of therapy ]FM-A Response
- Wolf Motor Function Test [ Time Frame: V7, 90 days after 6-weeks of therapy ]WMFT 90-day
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
|United States, Arizona|
|Perseverance Research Center|
|Scottsdale, Arizona, United States, 85254|
|United States, California|
|Rancho Research Institute|
|Downey, California, United States, 90242|
|Providence St. John's Medical Center|
|Santa Monica, California, United States, 90404|
|United States, Florida|
|Mayo Jacksonville / Brooks Rehabilitation|
|Jacksonville, Florida, United States, 32224|
|United States, Georgia|
|Emory University Medical School|
|Atlanta, Georgia, United States, 30329|
|United States, Massachusetts|
|Massachusetts General Hospital|
|Boston, Massachusetts, United States, 02129|
|United States, Michigan|
|Grand Rapids, Michigan, United States, 49503|
|United States, New York|
|New York Presbyterian Hospital / Weill Cornell Medicine|
|New York, New York, United States, 10065|
|Burke Medical Research Institute|
|White Plains, New York, United States, 10605|
|United States, Ohio|
|Ohio State University - Neuroscience Research Institute|
|Columbus, Ohio, United States, 43210|
|United States, Pennsylvania|
|Philadelphia, Pennsylvania, United States, 19107|
|United States, South Carolina|
|Medical University of South Carolina|
|Charleston, South Carolina, United States, 29425|
|United States, Tennessee|
|Vanderbilt University Medical Center|
|Nashville, Tennessee, United States, 37240|
|United States, Texas|
|Dallas, Texas, United States, 75390|
|TIRR Memorial Hermann (UT Health Science Center at Houston)|
|Houston, Texas, United States, 77030|
|Royal Aberdeen Infirmary|
|Aberdeen, United Kingdom, AB25 2ZB|
|University of Glasgow, Queen Elizabeth University Hospital|
|Glasgow, United Kingdom, G51 4TF|
|London, United Kingdom, E15 4LZ|
|Newcastle (Royal Victoria Infirmary)|
|Newcastle Upon Tyne, United Kingdom, NE1 4LP|
|Royal Hallamshire Hospital|
|Sheffield, United Kingdom, S1 4DA|