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| ID | Type | Description | Link |
|---|---|---|---|
| NL81465.091.22 | Other Identifier | CCMO |
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The study was discontinued due to a departmental reorganization, combined with higher-than-expected screening dropout and insufficient eligible participants.
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| Name | Class |
|---|---|
| Radboud University Medical Center | OTHER |
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The goal of this exploratory randomized controlled trial is to assess the effect of a personalized training intervention during primary rehabilitation of 6 weeks on cardiorespiratory fitness in individuals with subacute (<6 months) spinal cord injury during primary rehabilitation and during follow-up. Secondary outcomes include the effect on gait assessments, pulmonary function, neurological status, muscle force, cardiometabolic risk factors, quality of life, functional independence and self-efficacy.
Participants in the intervention group will receive 2-3 personalized cardiorespiratory fitness-focused training sessions per week, for a period of 6 weeks. Participants in the control group will receive usual care.
Rationale:
Despite advances in medical care, spinal cord injury (SCI) patients have significantly lower survival rates compared to the general population. The 'Koepelproject', an unique world-leading multi-center research project, discovered that SCI patients have a decreased pulmonary function, which is linked to poor cardiorespiratory fitness (CRF). This leads to respiratory and cardiovascular diseases, which are important predictors of death in SCI patients. However, there are limitations of the 'Koepelproject' which highlight the need for the proposed project 'FIT@HOME'. Rehabilitation knowledge in SCI patients is primarily focused on those with a complete lesion, while there has been changes in the characteristics of the SCI population over the last few decades. The diagnosis of an incomplete SCI (iSCI) is more common and requires different insights and skills compared to patients with complete lesions. Therefore, insight in the effect of personalized rehabilitation strategies focussed on CRF during primary rehabilitation will provide important information to support healthy ageing in iSCI patients.
Objective:
The primary aim of this study is to assess the effect of a personalized training intervention on CRF during primary rehabilitation and at follow-up. Secondary aims of this study are to determine the effect of this training intervention on gait capacity, pulmonary function, neurological status, muscle force, cardiometabolic risk factors, quality of life (QoL), functional independence and exercise self-efficacy.
Study design:
The proposed study design is an explorative randomized controlled trial.
Study population:
This study will include 32 iSCI patients classified with an American Spinal Injury Association (ASIA) C or D in the subacute phase (< 6 months post injury), who are referred for a primary, inpatient rehabilitation program at the Sint Maartenskliniek.
Intervention:
The intervention includes 2-3 personalized CRF-focused training sessions per week. The control group receives usual care.
Main study parameters/endpoints:
The primary endpoint is the change in CRF (expressed as VO2peak) after the 6-weeks intervention period and at follow-up.
Secondary outcomes are gait assessments, pulmonary function, neurological status, muscle force, cardiometabolic risk factors, secondary complications, quality of life, functional independence and exercise self-efficacy.
Measurements will be performed at:
T0 - Baseline
T1 - Following the 6-weeks intervention period during the primary rehabilitation program at the Sint Maartenskliniek
T2* - At discharge from the primary rehabilitation program at the Sint Maartenskliniek (only if the period following T1 is more than 2 weeks)
T3 - After 2 weeks in the outpatient rehabilitation program at the Sint Maartenskliniek
T4 - At discharge from the outpatient rehabilitation program at the Sint Maartenskliniek
T5 - 2 weeks following discharge from the outpatient rehabilitation program at the Sint Maartenskliniek (2 weeks after T4)
T6 - 3 months following discharge from the outpatient rehabilitation program at the Sint Maartenskliniek (3 months after T4, 2.5 months after T5)
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Intervention group | Experimental | During the primary rehabilitation program, the intervention group will receive 2-3 individualized cardiorespiratory fitness training sessions per week. |
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| Control group | No Intervention | The control group will receive usual care. |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Cardiorespiratory fitness (CRF) training | Other | The CRF training will take place on an arm cycle ergometer, or on an recumbent cross trainer. The duration and intensity of these 2 CRF gait training sessions will be determined by scientific exercise guidelines. A practical way of increasing vigorous-intensity exercise is high-intensity interval training (HIIT). The HIIT intervention consist of 2-3 trainings per week, with each exercise session including a 5-minute warm-up, 30-second interval periods (with a power output up to 90% of the peak power output (PPO)), and 30-second recovery periods. There are 5 minutes of 50% of PPO between interval periods. The number of interval periods increases during the intervention period, resulting in a maximum total training time of 35 minutes. |
| Measure | Description | Time Frame |
|---|---|---|
| Change in cardiorespiratory fitness | Defined as VO2peak in ml/kg/min | Baseline (T0), 6 weeks after T0 (T1), end of inpatient rehab (T2)* (average 3 months after T0), end of outpatient rehab (T4) (average 3 months after T2) , 3 months after end of outpatient rehab (T6) |
| Measure | Description | Time Frame |
|---|---|---|
| Gait assessments - Walking ability | Measured by Walking Index of Spinal Cord Injury (WISCI II), which is an ordinal scale (0-20) consisting of 21 items reflecting various levels of walking ability, taking into account the use of assistive devices, orthotic devices and physical assistance. | Baseline (T0), 6 weeks after T0 (T1), end of inpatient rehab (T2)* (average 3 months after T0), 2 weeks after T2 (T3), end of outpatient rehab (T4) (average 3 months after T2) , 2 weeks after T4 (T5), 3 months after end of outpatient rehab (T6) |
| Measure | Description | Time Frame |
|---|---|---|
| Age (years) | Descriptive outcome measure | Baseline (T0) |
| Sex (male / female) | Descriptive outcome measure | Baseline (T0) |
Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Ilse van Nes, Dr. | Sint Maartenskliniek | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Sint Maartenskliniek | Ubbergen | 6574 NA | Netherlands |
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| ID | Term |
|---|---|
| D000072599 | Cardiorespiratory Fitness |
| D003346 | Corticotropin-Releasing Hormone |
| ID | Term |
|---|---|
| D010809 | Physical Fitness |
| D009142 | Musculoskeletal Physiological Phenomena |
| D055687 | Musculoskeletal and Neural Physiological Phenomena |
| D006262 | Health |
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| Gait assessments - Gait capacity | Measured by the self-paced 2-Minute-Walk-Test (2MWT). Participants will be instructed to walk as far as possible at a comfortable walking speed in two minutes. The total distance walked in meters will be recorded. Furthermore, participants will be fitted with a facemask that will allow for the collection of respiratory gasses. Oxygen uptake and heart rate will be measured during the 2MWT (walking efficiency). | Baseline (T0), 6 weeks after T0 (T1), end of inpatient rehab (T2)* (average 3 months after T0), 2 weeks after T2 (T3), end of outpatient rehab (T4) (average 3 months after T2) , 2 weeks after T4 (T5), 3 months after end of outpatient rehab (T6) |
| Gait assessments - Gait performance | Daily life gait performance is measured by inertial measurements units (IMU), determining spatiotemporal parameters. Furthermore, the Activ8 activity monitor will be used. | Baseline (T0), 6 weeks after T0 (T1), end of inpatient rehab (T2)* (average 3 months after T0), 2 weeks after T2 (T3), end of outpatient rehab (T4) (average 3 months after T2) , 2 weeks after T4 (T5), 3 months after end of outpatient rehab (T6) |
| Pulmonary function - Forced Vital Capacity (FVC) | Measured by simple spirometry and defined as the total volume of air that a person can forcibly exhale during a maximal expiratory effort in liters. | Baseline (T0), 6 weeks after T0 (T1), end of inpatient rehab (T2)* (average 3 months after T0), end of outpatient rehab (T4) (average 3 months after T2) , 3 months after end of outpatient rehab (T6) |
| Pulmonary function - Forced Expiratory Volume in 1 second (FEV1) | Measured by simple spirometry and defined as the volume expired in the first second of the FVC maneuver in liters. | Baseline (T0), 6 weeks after T0 (T1), end of inpatient rehab (T2)* (average 3 months after T0), end of outpatient rehab (T4) (average 3 months after T2) , 3 months after end of outpatient rehab (T6) |
| Pulmonary function - Peak Expiratory Flow (PEF) | Measured by simple spirometry and defined as the maximal expiratory flow rate achieved during the FVC maneuver and is defined in liters/minute. | Baseline (T0), 6 weeks after T0 (T1), end of inpatient rehab (T2)* (average 3 months after T0), end of outpatient rehab (T4) (average 3 months after T2) , 3 months after end of outpatient rehab (T6) |
| Neurological status | Measured by the ASIA impairment scale will be used for both a motor and sensory examination. The ASIA impairment scale consists of a 5-point ordinal scale, which classifies individuals from "A" (complete SCI) to "E" (normal sensory and motor function). | Baseline (T0), 6 weeks after T0 (T1), end of inpatient rehab (T2)* (average 3 months after T0), end of outpatient rehab (T4) (average 3 months after T2) , 3 months after end of outpatient rehab (T6) |
| Muscle force - Grip force | Measured by handgrip strength of the dominant hand. This will be assessed with a hydraulic, analogue hand dynamometer adjusted to the hand size of every participant. | Baseline (T0), 6 weeks after T0 (T1), end of inpatient rehab (T2)* (average 3 months after T0), end of outpatient rehab (T4) (average 3 months after T2) , 3 months after end of outpatient rehab (T6) |
| Muscle force - Voluntary muscle strength | Voluntary muscle strength of 5 key muscles of both lower extremities and key muscles of both upper extremities in accordance with standard neurological assessment (ASIA). A six-point scale is used for scoring with 0 being total paralysis and 5 is normal active moment, full range of motion against gravity and expected from an unimpaired person.Upper extremity muscle strength will also be measured using a handheld dynamometer (HHD). | Baseline (T0), 6 weeks after T0 (T1), end of inpatient rehab (T2)* (average 3 months after T0), end of outpatient rehab (T4) (average 3 months after T2) , 3 months after end of outpatient rehab (T6) |
| Cardiometabolic risk factors - Waist circumference (cm) | Measured in a standing position across the belly button during the exhale. | Baseline (T0) , 3 months after end of outpatient rehab (T6) |
| Cardiometabolic risk factors - Skinfold thickness | Measured by a skinfold calliper and will be performed according to the American College of Sports Medicine standard description of skinfold measurements. | Baseline (T0) , 3 months after end of outpatient rehab (T6) |
| Cardiometabolic risk factors - Blood pressure | Descriptive outcome measure in mmHg | Baseline (T0), 6 weeks after T0 (T1), end of inpatient rehab (T2)* (average 3 months after T0), end of outpatient rehab (T4) (average 3 months after T2) , 3 months after end of outpatient rehab (T6) |
| Cardiometabolic risk factors - Heart rate | Descriptive outcome measure in beats per minute | Baseline (T0), 6 weeks after T0 (T1), end of inpatient rehab (T2)* (average 3 months after T0), end of outpatient rehab (T4) (average 3 months after T2) , 3 months after end of outpatient rehab (T6) |
| Cardiometabolic risk factors - Low Density Lipoprotein Cholesterol (LDL-C) | Measured by a venous blood sample when participants have been sober for 4 hours | Baseline (T0) , 3 months after end of outpatient rehab (T6) |
| Cardiometabolic risk factors - High Density Lipoprotein Cholesterol (HDL-C) | Measured by a venous blood sample when participants have been sober for 4 hours | Baseline (T0) , 3 months after end of outpatient rehab (T6) |
| Cardiometabolic risk factors - Total Cholesterol (TC) | Measured by a venous blood sample when participants have been sober for 4 hours | Baseline (T0) , 3 months after end of outpatient rehab (T6) |
| Cardiometabolic risk factors - Fasted insulin | Measured by a venous blood sample when participants have been sober for 4 hours | Baseline (T0) , 3 months after end of outpatient rehab (T6) |
| Cardiometabolic risk factors - Fasted glucose | Measured by a venous blood sample when participants have been sober for 4 hours | Baseline (T0) , 3 months after end of outpatient rehab (T6) |
| Secondary complications - Urinary and bowel dysfunction | Descriptive outcome measure | Baseline (T0), 6 weeks after T0 (T1), end of inpatient rehab (T2)* (average 3 months after T0), end of outpatient rehab (T4) (average 3 months after T2) , 3 months after end of outpatient rehab (T6) |
| Secondary complications - Level of pain experienced during the last week | Measured by the visual analog scale (VAS). The VAS is an unidimensional measure, containing a straight horizontal line of 100 mm. Furthermore, pain will be classified according to the type of pain (neuropathic or nociceptive (musculoskeletal / visceral / other). | Baseline (T0), 6 weeks after T0 (T1), end of inpatient rehab (T2)* (average 3 months after T0), end of outpatient rehab (T4) (average 3 months after T2) , 3 months after end of outpatient rehab (T6) |
| Secondary complications - Shoulder pain | Measured by the pain subscale of the Shoulder Pain and Disability Index (SPADI) questionnaire. The subscale consists of five items on the numerical rating scale from 0 to 10, with a higher value indicating more disability. | Baseline (T0), 6 weeks after T0 (T1) |
| Secondary complications - Level of fatigue experienced during the last week | Measured by the visual analog scale (VAS). The VAS is an unidimensional measure, containing a straight horizontal line of 100 mm. | Baseline (T0), 6 weeks after T0 (T1), end of inpatient rehab (T2)* (average 3 months after T0), end of outpatient rehab (T4) (average 3 months after T2) , 3 months after end of outpatient rehab (T6) |
| Secondary complications - Pressure sores | Descriptive outcome measure including location, severity and duration | Baseline (T0), 6 weeks after T0 (T1), end of inpatient rehab (T2)* (average 3 months after T0), end of outpatient rehab (T4) (average 3 months after T2) , 3 months after end of outpatient rehab (T6) |
| Secondary complications - Spasticity | Measured by the Modified Ashworth Scale (MAS). The MAS is a scale of perceived resistance (tone) against passive movement of the limb and is the most widely used scale in the clinical setting. MAS assigns a grade of spasticity from a 0-4 ordinal scale, where lower scores represent normal muscle tone and higher scores represent spasticity. | Baseline (T0), 6 weeks after T0 (T1), end of inpatient rehab (T2)* (average 3 months after T0), end of outpatient rehab (T4) (average 3 months after T2) , 3 months after end of outpatient rehab (T6) |
| Secondary complications - Number of respiratory and cardiovascular complications | Descriptive outcome measure | Baseline (T0), 6 weeks after T0 (T1), end of inpatient rehab (T2)* (average 3 months after T0), end of outpatient rehab (T4) (average 3 months after T2) , 3 months after end of outpatient rehab (T6) |
| Secondary complications - Number of rehospitalizations | Descriptive outcome measure | Baseline (T0), 6 weeks after T0 (T1), end of inpatient rehab (T2)* (average 3 months after T0), end of outpatient rehab (T4) (average 3 months after T2) , 3 months after end of outpatient rehab (T6) |
| Quality of Life (QoL) | Measured by the Quality of Life Basic Data Set Version 2.0 (QoL-BDS V2.0). This questionnaire includes four items on the individual's satisfaction with their life as a whole, their physical health, mental health, and social life. All items use a 0-10 numerical rating scale with higher scores indicating better QoL. | Baseline (T0), 6 weeks after T0 (T1), end of inpatient rehab (T2)* (average 3 months after T0), 2 weeks after T2 (T3), end of outpatient rehab (T4) (average 3 months after T2) , 2 weeks after T4 (T5), 3 months after end of outpatient rehab (T6) |
| Functional independence | Measured by the Spinal Cord Independence Measure III (SCIM III). This questionnaire includes three specific areas of function: selfcare, respiration and sphincter management and a patient's mobility abilities. Each subscale score is evaluated within the 100-point scale, where a score of 0 defines total dependence and a score of 100 is indicative of complete independence. | Baseline (T0), 6 weeks after T0 (T1), end of inpatient rehab (T2)* (average 3 months after T0), 2 weeks after T2 (T3), end of outpatient rehab (T4) (average 3 months after T2) , 2 weeks after T4 (T5), 3 months after end of outpatient rehab (T6) |
| Exercise self-efficacy | Measured by the exercise self-efficacy scale (ESES). The ESES consists of 10 items about level of self-confidence with regard to performing regular physical activities and exercise. | Baseline (T0), 6 weeks after T0 (T1), end of inpatient rehab (T2)* (average 3 months after T0), 2 weeks after T2 (T3), end of outpatient rehab (T4) (average 3 months after T2) , 2 weeks after T4 (T5), 3 months after end of outpatient rehab (T6) |
| Height (cm) | Descriptive outcome measure | Baseline (T0) |
| Weight (kg) | Descriptive outcome measure | Baseline (T0) |
| Body Mass Index (kg/m^2) | Descriptive outcome measure | Baseline (T0) |
| Nationality | Descriptive outcome measure | Baseline (T0) |
| Medical history | Descriptive outcome measure | Baseline (T0) |
| Time since spinal cord injury (days) | Descriptive outcome measure | Baseline (T0) |
| Cause of spinal cord injury (traumatic / non-traumatic) | Descriptive outcome measure | Baseline (T0) |
| Level of spinal cord injury | The level of injury for a person with SCI is the lowest point on the spinal cord below which sensory feeling and motor movement diminish or disappear. The level is denoted by the letter-and-number name of the vertebra at the injury site (such as C3, T2, or L4). | Baseline (T0) |
| Medication use | Medication that could influence outcome measures (e.g. beta-blockers, antihypertensives, statins). | Baseline (T0), 6 weeks after T0 (T1), end of inpatient rehab (T2)* (average 3 months after T0), end of outpatient rehab (T4) (average 3 months after T2) , 3 months after end of outpatient rehab (T6) |
| Smoking history | Descriptive outcome measure | Baseline (T0) |
| D011154 | Population Characteristics |
| D010906 | Pituitary Hormone-Releasing Hormones |
| D007028 | Hypothalamic Hormones |
| D036361 | Peptide Hormones |
| D006728 | Hormones |
| D006730 | Hormones, Hormone Substitutes, and Hormone Antagonists |
| D009479 | Neuropeptides |
| D010455 | Peptides |
| D000602 | Amino Acids, Peptides, and Proteins |
| D009419 | Nerve Tissue Proteins |
| D011506 | Proteins |