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This is a multicenter study that will be conducted at approximately 20 centers and up to 30 centers, if the sample size will be increased following interim assessment.
The Q Therapeutic System (BQ 3.0) is a wearable medical device that produces and delivers non-invasive, extremely-low-intensity and low-frequency, frequency-tuned electromagnetic fields in order to stimulate neuronal networks with the aim of reducing disability and promoting neurorecovery.
The Q Therapeutic System (BQ 3.0) is indicated for adjunctive use in a clinical facility or home setting, in addition to standard-of-care therapies.
Each session will last approximately 60 minutes, with stimulation activated for up to 40 minutes, in conjunction with a home-based exercise program. Treatments may be administered in the hospital, in the clinic or in a home setting.
The study will enroll 100-122 adult subjects who will be randomly assigned (1:1 allocation ratio) to either active or sham study intervention using the BQ 3.0 system.
The study intervention will be initiated 4-21 days after the index stroke event and will consist of 5 treatments per week until the primary endpoint follow-up visit, at day 90 (±15) after the onset of the index stroke. A minimum of 45 treatment sessions should be completed during this stage, with a potential of a maximum of 72 treatment sessions, depending on the start date of the first treatment and the timing of the 90-day follow-up visit. Though, participants and sites will be guided to conduct the 90 days follow-up visit as soon as possible after the 45th treatment session and within up to 7 days from the 45th treatment and after the window opening.
Each treatment session will last approximately 60 minutes and include 40 minutes of active or sham stimulation. Subjects in both groups will be asked to perform a home-based exercise program for the upper and the lower limb, concurrent with the study intervention.
Screening phase:
Prospective subjects, who are 3 to 21 days post-stroke, may be offered informed consent to participate in the study at either:
a participating inpatient or outpatient center, non-participating inpatient or outpatient center, in accordance with both the participating and the non-participating centers' policy, or home Consented subjects, who are 4 to 21 days post-stroke, will be screened for eligibility to participate in the treatment phase of the study.
Eligible subjects will be randomly assigned, at a 1:1 allocation ratio, to either the active or sham study intervention groups.
Stimulation with the Q Therapeutic System (BQ 3.0) does not produce any noticeable sound, light, or tactile sensation which could disclose the treatment arm assignment, making this device ideal for testing in a sham-controlled design. During sham treatment sessions, for purposes of maintaining the blind, the device will function as if it is delivering the therapy (i.e., the device will turn on and all indicators will function), but the frequency and intensity parameters, which are not visible to the subject or site study members (or any blinded personnel), will be set to zero so that no stimulation is delivered.
Stage 1 (day 4 to day 90 (±15) post-stroke) - double-blind sham-controlled:
Efforts should be made to initiate the 1st treatment as early as possible within the window of recruitment, and target to complete a first treatment within 6 days from admission to a participating IRF (where applicable). The study intervention will be initiated 4-21 days after the index stroke event and will consist of 5 treatments per week until the primary endpoint follow-up visit, at day 90 (±15) after the onset of the index stroke. Each treatment session will last approximately 60 minutes and include 40 minutes of active or sham stimulation. Subjects in both groups will be asked to perform a home- based exercise program for the upper and the lower limb, concurrent with the study intervention. The program will be standardized, pre-defined, home-based, and aligned with standard-of-care1.
The participant and their caregiver will be trained on the use of the device and exercise program. Treatment sessions will be completed by the subject with the assistance of a trained caregiver, as needed. Periodic supervision will be provided by the study team (combined audio and video remote conferencing or audio only, if video is not available). A sponsor's representative may provide in-person or remote technical support to the participant and their caregiver, as well as device training, as needed.
Subjects will undergo a detailed interim outcome assessment on the 45th (±4) day after the onset of the index stroke, and a detailed primary endpoint outcome assessment on the 90th (±15) day after the onset of the index stroke. In addition, a focused, long-term outcome assessment on the 180th (±15) day after the onset of the index stroke will be performed.
Stage 2 (day 90 (±15) to day 180 (±15) post-stroke) - open-label:
Subjects in both the active and the sham groups (active /sham), who were adherent to the treatment in Stage 1 (defined as at least 35 completed treatment sessions in Stage 1) will be allowed to continue to receive active EMFstimulation treatments (i.e., with the electromagnetic therapy turned on).
Up to 5 active treatments per week will be completed, starting following the primary endpoint assessment follow-up visit at 90 (±15) days after the onset of the index stroke and continuing until the follow-up visit at 180 (±15) days after the onset of the index. Technically, a maximum of 86 treatment sessions can be completed during stage 2, depending on the timing of the 90-day and 180-day follow-up visits.
The blind, with respect to the group allocation in Stage 1, would be maintained for all parties (participants, investigators, assessors and Sponsor) until the trial completion and database lock.
Each session will last approximately 60 minutes and include 40 minutes of active stimulation. Subjects will be asked to perform a home-based exercise program, concurrent with the study intervention.
Treatment sessions will be completed by the subject with the assistance of a trained caregiver, as needed. Periodic supervision will be provided by the study team (combined audio and video remote conferencing or audio only, if video is not available). A sponsor's representative willmay provide in-person or remote technical support to the participant and their caregiver, as well as device training, as needed.
All subjects, including those who decided not to continue to receive treatments in Stage 2, will undergo a detailed follow-up assessment on the 180th (±15) day after the onset of the index stroke.
Stage 3 (day 180 (±15) to day 270 (±15) post-stroke):
At this Stage, no treatments sessions will take place. All subjects, including those who decided not to continue to receive treatments in Stage 2, will undergo In addition, aa focused, long-term outcome assessment on the 180th 270th (±15) day after the onset of the index stroke will be performed.
Any adverse events and device deficiencies occurring during the period of subject's participation in the trial will be recorded.
Participation in the study will not replace any of the usual care patient should receive.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| BQ 3.0 Sham Stimulation Group | Sham Comparator | Q Therapeutic System (BQ 3.0) sham stimulation group: Device used: Q Therapeutic System (BQ 3.0) In Stage 1: 45 sessions over a period of 9 weeks (5 treatments per week) of sham study intervention with BQ 3.0 (frequency and intensity parameters will be set to zero so that no stimulation is delivered) including a standardized, pre-defined and evidence-based physical and occupational therapy regimen concurrent with the study intervention. |
|
| BQ 3.0 Active Stimulation Group | Active Comparator | Q Therapeutic System (BQ 3.0) active stimulation group: Device used: Q Therapeutic System (BQ 3.0) In Stage 1: 45 sessions over a period of 9 weeks (5 treatments per week) of active study intervention with the BQ 3.0 (frequency and intensity parameters will be set to 1-100 Hz.; 0.1-1.0 G), including a standardized, pre-defined and evidence-based physical and occupational therapy regimen concurrent with the study intervention. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Q Therapeutic System (BQ 3.0) - Sham | Device | The BQ 3.0 is a medical device that produces and delivers non-invasive, extremely low intensity and frequency (1-100 Hz.; 0.1-1.0 G), frequency tuned electromagnetic fields in order to stimulate neuronal networks with the aim of reducing disability and promoting neurorecovery. Frequency and intensity parameters will be set to zero so that no stimulation is delivered. |
| Measure | Description | Time Frame |
|---|---|---|
| Change from Baseline in Modified Rankin Scale | Proportion of subjects achieving an excellent outcome defined as a Modified Rankin Scale (mRS) score of 0-1 at the 90-day post-stroke assessment, reflecting freedom from disability. | 4 to 21 days following an ischemic stroke to 90-day post-stroke |
| Measure | Description | Time Frame |
|---|---|---|
| Ordinal shift analysis of the mRS (trichotomized at 0-1, 2, 3-6) (Key Secondary Effectiveness Endpoint) | baseline to the 90-day post-stroke assessment | |
| Change from Baseline in Modified Rankin Scale (Key Secondary Effectiveness Endpoint) | To show that the BQ therapy is effective in reducing disability levels |
| Measure | Description | Time Frame |
|---|---|---|
| Serious procedure or device related adverse events & device deficiencies | To characterize the safety profile of the BQ therapy and to show that the BQ 3.0 performs reliably. | Through study completion, an average of 90 ± 15 days post-stroke |
| Change in Montreal Cognitive Assessment (global cognitive function) |
Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Assaf Lifshitz | Contact | 9720544586787 | assaf@brainqtech.com | |
| Iren Basanov | Contact | 972526936695 | iren.basanov@brainqtech.com |
| Name | Affiliation | Role |
|---|---|---|
| Jeffrey L. Saver, MD | Coordinating PI | Study Chair |
| Joel Stein, MD | Coordinating PI | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Rancho Research Institute | Recruiting | Downey | California | 90242 | United States |
will be shared following site level approval
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subjects will be assigned (1:1 allocation ratio) to either active or sham study intervention using the BQ3. system
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This is a double-blind study, Sponsor, subjects and Investigators will be blinded to the device setting (Active/Sham). The study site team members receiving, storing, dispensing, preparing, and administering the study interventions will be blinded (except the unblinded randomizer). Subjects' caregivers will also be blinded. There are no differences in the active and sham device appearance. Due to the non-invasive nature of the treatment, as well as the physical characteristic of the EMF, there is no noticeable difference between sessions conducted using an active or a sham device, facilitating full blinding of both subjects and Investigators.
An independent unblinded statistician (not the study statistician) will perform the assessments described. Only the unblinded statistician and members of the DSMB will be exposed to the interim report.
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|
| Q Therapeutic System (BQ 3.0) - Active | Device | The BQ 3.0 is a medical device that produces and delivers non-invasive, extremely low intensity and frequency (1-100 Hz.; 0.1-1.0 G), frequency tuned electromagnetic fields in order to stimulate neuronal networks with the aim of reducing disability and promoting neurorecovery |
|
|
| baseline (4-21 days post-stroke) to 90 days post-stroke |
| Proportion of subjects achieving functional independence (mRS score of 0-2) (Key Secondary Effectiveness Endpoint) | To show that the BQ therapy is effective in achieving functional independence. | at the 90-day post-stroke assessment |
| Stroke Impact Scale Hand Domain (Lead Secondary Endpoint) | Patient reported hand function - To show that the BQ therapy is effective in improving upper limb impairment and function | baseline (4 to 21 days following an ischemic stroke) to 90-day post-stroke |
| Stroke Impact Scale 16 | Patient-reported physical function - To show that the BQ therapy is effective in improving physical function | baseline (4 to 21 days following an ischemic stroke) to 90-day post-stroke |
| 10-meter Walk Test | The Functional Ambulation Categories (FAC) will be collected concurrent to the 10MWT to assess the level of independent ambulation. | change from baseline to 90 days post-stroke |
| Box and Block Test | Arm motor function - To show that the BQ therapy is effective in improving Arm motor function | baseline (4 to 21 days following an ischemic stroke) to 90-day post-stroke |
| Evaluation of 5-level EQ-5D | Health-related quality of life - To show that the BQ therapy is effective in achieving health-related quality of life (HRQoL) | At 90-days post-stroke |
| Fugl-Meyer Assessment for Upper Extremity (FMA-UE) | upper limb impairment - To show that the BQ therapy is effective in achieving reducing upper limb impairment, and improving upper limb function | baseline (4 to 21 days following an ischemic stroke) to 90-day post-stroke |
| Nine-Hole Peg Test | finger dexterity - To show that the BQ therapy is effective in achieving reducing upper limb impairment, and improving upper limb function | change from baseline to 90-days post-stroke |
| The proportion of subjects within those in the active group who continued to receive treatments in Stage 2, achieving an excellent outcome (defined as a mRS of 0-1) at the 180-day post-stroke assessment. | To show, within those in the active group who continued to receive treatments in Stage 2, that the BQ therapy is effective in attaining freedom from disability, as well as reducing global disability, at 6 months post-stroke in disabled patients when initiated 4 to 21 days following an ischemic stroke. | at the 180-day post-stroke assessment |
| The proportion of patients within those in the active group who continued to receive treatments in Stage 2, who achieved an excellent outcome defined as a mRS score of 0-1 at the 90-day post-stroke assessment and had an mRS >1 at 180-day post-stroke | To show, within those in the active group who continued to receive treatments in Stage 2, that the BQ therapy is effective in attaining freedom from disability, as well as reducing global disability, at 6 months post-stroke in disabled patients when initiated 4 to 21 days following an ischemic stroke | at 180 days post-stroke |
| The proportion of patients within those in the active group who continued to receive treatments in Stage 2, who achieved an excellent outcome defined as mRS score of 0-1 at the 180-day post-stroke assessment and had an mRS >1 at 270 days post-stroke. | To show, within those in the active group who continued to receive treatments in Stage 2, that the effect attained in obtaining freedom from disability, as well as reducing global disability, is maintained at 6- and 9- months post-stroke in disabled patients with upper limb motor impairment when initiated 4 to 21 days following an ischemic stroke. | at 270 days post-stroke |
| Ordinal shift analysis of the mRS (4 levels at 0, 1, 2, 3-6) from the 90-day post-stroke assessment to 180-day post-stroke assessment, within those in the active group who continued to receive treatments in Stage 2 | from the 90-day post-stroke assessment to 180-day post-stroke assessment |
| The proportion of patients who improved by at least 1 level on the mRS from the 90-day post-stroke assessment to 180-day post-stroke assessment, within those in the active group who continued to receive treatments in Stage 2. | To show, within those in the active group who continued to receive treatments in Stage 2, that the BQ therapy is effective in attaining freedom from disability, as well as reducing global disability, at 6 months post-stroke in disabled patients when initiated 4 to 21 days following an ischemic stroke | from the 90-day post-stroke assessment to 180-day post-stroke assessment |
| The proportion of subjects within those in the sham group who continued to receive treatments in Stage 2, achieving an excellent outcome (defined as a mRS of 0-1) at the 180-day post-stroke assessment, and had an mRS >1 at 90 days post-stroke. | To show, within those in the sham group who continued to receive treatments in Stage 2 that the BQ therapy is effective in attaining freedom from disability, as well as reducing global disability, at 6 months post-stroke in disabled patients when initiated 90 days following an ischemic stroke | from the 90-day assessment to the 180-day assessment |
To show that the BQ therapy is effective in reducing cognitive impairment, at 3 months post-stroke, when initiated 4 to 21 days following an ischemic stroke. |
| at 90-day post-stroke |
| Change in Patient Health Questionnaire-8 (depression) | To show that the BQ therapy is effective in reducing depression, at 3 months post-stroke, when initiated 4 to 21 days following an ischemic stroke. | at 90-day post stroke |
| Academic Medical Center Linear Disability Scale (granular level of disability) | To show that the BQ therapy is effective in reducing fine-grained level of disability at 3 months post-stroke | At 90 days post stroke |
| Proportion of subjects achieving functional independence (modified Rankin Scale score of 0-1) | To show that the BQ therapy is effective in increasing functional independence at 1.5 months post-stroke | at 45 days post-stroke |
| Zarit Burden Interview | To formally evaluate the cost-effectiveness of the BQ therapy via caregiver burden. | at midterm, 90 days post-stroke, 180 days post-stroke, and 270 days post-stroke. |
| Formal cost-effectiveness analysis over a lifetime horizon from the perspective of the United States healthcare system. | To formally evaluate the cost-effectiveness of the BQ therapy over a lifetime horizon from the perspective of the United States healthcare system | will be assessed at MidTerm (45 Day ± 4 days post- stroke) , Day-90 and D-180 post stroke |
| Relationship between adherence to treatment as measured by the Qompass and the clinical outcomes. | To explore the relationship between adherence to treatment as measured by the Qompass and clinical outcomes. | Will be assessed upon data base lock |
| The proportion of patients within those in the sham group who continued to receive treatments in Stage 2 who improved from the 90-day assessment to 180-day and the improvement was maintained at 270 days post-stroke | To show, within those in the sham group who continued to receive treatments in Stage 2 that the BQ therapy is effective in improving functional independence at 6 months post-stroke, when initiated 90 days following an ischemic stroke. | At 180 days post stroke and 270 days post-stroke |
| MedStar National Rehabililtaion Hospital, | Recruiting | Washington D.C. | District of Columbia | 20010 | United States |
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| Brooks Rehabilitation Hospital | Not yet recruiting | Jacksonville | Florida | 32216 | United States |
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| Emory University School of Medicine | Not yet recruiting | Altanta | Georgia | 30322 | United States |
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| Shirley Ryan AbilityLab | Not yet recruiting | Chicago | Illinois | 60611 | United States |
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| KUMC- KU Medical Center | Recruiting | Kansas City | Kansas | 66160 | United States |
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| Hackensack Meridian JFK Johnson Rehabilitation Institute | Recruiting | Edison | New Jersey | 08818 | United States |
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| Kessler Foundation for Rehabilitation | Recruiting | West Orange | New Jersey | 07052 | United States |
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| New York-Presbyterian Brooklyn Methodist Hospital Inpatient Rehabilitation Unit | Not yet recruiting | Brooklyn | New York | 11215 | United States |
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| Burke Rehabilitation Hospital | Recruiting | White Plains | New York | 10605 | United States |
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| Atrium Health Carolinas Rehabilitation | Recruiting | Charlotte | North Carolina | 28203 | United States |
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| Moss Rehabilitation Research Institute | Not yet recruiting | Elkins Park | Pennsylvania | 19027 | United States |
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| UTHealth Houston | Not yet recruiting | Houston | Texas | 77030 | United States |
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| Froedtert & Medical College of Wisconsin | Not yet recruiting | Milwaukee | Wisconsin | 53226 | United States |
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| ID | Term |
|---|---|
| D000083242 | Ischemic Stroke |
| ID | Term |
|---|---|
| D020521 | Stroke |
| D002561 | Cerebrovascular Disorders |
| D001927 | Brain Diseases |
| D002493 | Central Nervous System Diseases |
| D009422 | Nervous System Diseases |
| D014652 | Vascular Diseases |
| D002318 | Cardiovascular Diseases |
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