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Low back pain is a common musculoskeletal problem. It is the main cause of activity limitation and work absence and carries a huge medical burden and economic cost. Low back pain is considered "chronic" when it persists for more than 3 months. Chronic low back pain affects daily activities and constitutes a psychological burden, which could lead to anxiety and/or depression. Prevention of low back pain is recognized as a pivotal challenge in high-risk populations to help tackle high healthcare costs related to therapy and rehabilitation. Current pharmacological drugs, namely anti-inflammatory and narcotics medications, have limited efficacy and numerous side effects. In addition, most available treatment options only address single, targeted causes; however, given the complexity of low back pain, a multi-modal interdisciplinary approach is highly needed. Transcutaneous electrical nerve stimulation (TENS) is a safe alternative to current treatments. Many studies have shown its efficacy and benefit in reducing pain. However, it only targets a limited number of muscles. For this reason, transcutaneous stimulation using the EXOPULSE Mollii suit might help reduce pain and related outcomes in this context since it simultaneously targets several muscle groups.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Experimental Condition | Active Comparator | Active sessions will last 1 hour each. The following parameters will be used for electric stimulation: low frequency (20 Hz), low current intensity (2 mA), with a small pulse width of 25-170 microseconds. These parameters were previously found to be safe in human studies. Based on the clinical exam of each patient, the spastic muscles will be targeted. |
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| Control Condition | Sham Comparator | The control arm will be a sham intervention. The patients will receive a sham stimulation, for which the same EXOPULSE Mollii suit will be used but the suit control unit will be programmed to start stimulating for 1 minute then it will shut off which could enable cutaneous sensations that mimic the active condition, aiming to achieve an effective blinding integrity. There is no risk related to the sham intervention since it consists of applying the same parameters used for the active session (low frequency: 20 Hz; current intensity: 2 mA; pulse width ranging from 25 to 175 µs) but for a shorter duration of time (1 minute). |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| EXOPULSE MOLLII SUIT (active) | Device | Exopulse Mollii suit is a new assistive device that has been developed by Exoneural Network (initially Inerventions AB), a Swedish med-tech company. Exopulse Mollii suit is a full-body garment with integrated 58 electrodes that can transcutaneously stimulate several groups of muscles. The device is CE labelled and is intended to use for reducing spasticity and improving blood circulation. The outfit is very easy to put on, it can be used for one hour every day and the analgesic effects last 24 hours or more. EXOPULSE Mollii suit consists of transcutaneous stimulation of several muscles by means of a feeble electric current (i.e., low frequency ~20 Hz, low-intensity 2mA), aiming to reduce pain. This treatment method theoretical background primarily refers to the theory of gate control. Based on this theory, the stimulation of large proprioceptive fibers would inhibit the nociceptive information transmitted by small fibers. |
| Measure | Description | Time Frame |
|---|---|---|
| Pain-related disability reduction will be assessed using the QBPDS (Quebec Back Pain Disability Scale) before and after active and sham stimulation | The QBPDS (Quebec Back Pain Disability Scale) is a 20-item scale that is widely used in back pain research. Items evaluate the ability to perform the mentioned activity and are rated using 5 possibilities ranging from "not difficult at all" to "unable to do". Lower scores reflect lower disability. The French version has good psychometric properties (internal consistency, content validity, and acceptability). | This will be assessed through study completion, an average of 3 months at Visit 1(Day 0) , Visit 2 (Day 15), Visit 3 (Day 30), Visit 4 (Day45), Visit 5 (Day 60) and Visit 6 (Day 90) |
| Measure | Description | Time Frame |
|---|---|---|
| Assessment of pain-related disability reduction using the ODQ (Owestry Disability scale) | The ODQ (Owestry Disability scale) consists of 10 items questionnaire (pain intensity, personal care, lifting, walking, sitting, standing, sleeping, social life, driving/riding a car, changing degree of pain) rated using 6 possibilities as well as a visual item assessing pain quality from absence to extreme. ). Lower scores reflect lower disability. |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Samar S AYACHE, MD, PhD | Contact | +33 149814662 | samarayache@gmail.com | |
| Moussa A CHALAH, MD, PhD | Contact | moussachalah@gmail.com |
| Name | Affiliation | Role |
|---|---|---|
| Samar S Ayache, MD, PhD, HDR | Hopital Henri Mondor, Assistance Publique - Hôpitaux de Paris, Créteil, France | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Clinical Neurophysiology department, Henri Mondor Hospital, Créteil, France | Recruiting | Créteil | VAL DE Marne | 94000 | France |
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| ID | Term |
|---|---|
| D017116 | Low Back Pain |
| ID | Term |
|---|---|
| D001416 | Back Pain |
| D010146 | Pain |
| D009461 | Neurologic Manifestations |
| D012816 | Signs and Symptoms |
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We designed a randomized, sham-controlled, double-blind trial to demonstrate the improvement of pain, pain-related disability, quality of life, fatigue and mood in adult patients with chronic low back pain following a 2-week intervention of "active" versus "sham" EXOPULSE Mollii suit. A 2-week washout period should be enough to prevent a potential carry-over effect. After this phase (phase 1), a second open-label phase (phase 2) will be proposed for patients to understand the effects of the EXOPULSE Mollii suit employed for 4 weeks (7 sessions per week) on the studied outcomes.
Summary:
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| EXOPULSE MOLLII SUIT (sham) | Device | It consists of applying the same parameters used for the active session (low frequency: 20 Hz; current intensity: 2 mA; pulse width ranging from 25 to 175 µs) but for a shorter duration of time (1 minute). |
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| This will be assessed through study completion, an average of 3 months (at Visits 1, 2, 3, 4, 5 and 6) |
| Analgesic effects based on the VAS (Visual Analogue Scale) | The visual analogue scale of pain (VASpain) consists of rating the symptom on a 10 cm horizontal line going from "no pain" to "worst pain imaginable" . | This will be assessed through study completion, an average of 3 months (at Visits 1, 2, 3, 4, 5 and 6) |
| Analgesic effects based on the Brief Pain Inventory (BPI) | The validated French version of the Brief Pain Inventory (BPI) will be used to assess pain severity (4 items) and pain interference (7 items). BPI items are rated on a 10-point scale running from 0 (no pain/does not interfere) to 10 (pain as bad as you can feel/interferes completely). A total pain severity score can be found by averaging these items. Higher scores indicate greater severity and more interference. | This will be assessed through study completion, an average of 3 months (at Visits 1, 2, 3, 4, 5 and 6) |
| Analgesic effects based on the Pain Catastrophizing Scale (PCS) | The Pain Catastrophizing Scale (PCS) is a valid and reliable scale that includes 13 items assessing the presence and severity of feelings or thoughts that emerge when experiencing pain. Each item is rated on a 5-point Likert scale ranging from 0 (not at all) to 4 (all the time). Along with three subscale scores evaluating rumination, magnification, and helplessness, the overall score has a range of 0-52. Higher scores indicate a greater degree of pain catastrophizing. A total score of >30 represents a clinically significant level of pain catastrophization. | This will be assessed through study completion, an average of 3 months (at Visits 1, 2, 3, 4, 5 and 6) |
| Assessment of anti-fatigue effects according to VAS (visual analogue scale) | The visual analogue fatigue scale (EVA fatigue) is a 10 mm straight hozontal line, with one end corresponding to no fatigue and the other to extreme fatigue. | This will be assessed through study completion, an average of 3 months (at Visits 1, 2, 3, 4, 5 and 6) |
| Mood symptoms will be evaluated using the Hospital Anxiety and Depression Scale (HADS) | It is a 14-item generic scale with good psychometric properties. It consists of seven items assessing anxiety and seven others assessing depression. Scores can range from 0 to 21 on each subscale, with higher scores indicating worse symptomatology . | This will be assessed through study completion, an average of 3 months (at Visits 1, 2, 3, 4, 5 and 6) |
| Improvement of the quality of life using the Short Form 36 Health Survey (SF-36) | It is a generic survey that contains 36 items that assess the quality of life and yield eight dimensions: physical functioning, physical role, emotional role, bodily pain, general health, vitality, social functioning, and mental health. The score of each dimension ranges from 0 to 100, with higher scales implying better health status. The French version has excellent convergent and discriminant validity (100% and 97.9%, respectively) and good internal consistency. | This will be assessed through study completion, an average of 3 months (at Visits 1, 2, 3, 4, 5 and 6) |
| Evaluation of overall improvement using the CGI (Clinical Global Impression) | It consists of 7-point scale ranging from "very much improved since the initiation of treatment" to "very much worse since the initiation of treatment" (from 1 to 7) | This will be assessed at Visit2 (Day 15) , Visit4 (Day 45) and Visit6 (Day 90) since CGI is designed to be applied after interventions |
| Evaluation of patient's blinding to the type of stimulation in the crossover trial | This blind evaluation will be done in phase 1 using a dedicated questionnaire (only for each condition since all patients will receive the same active treatment in the open-label phase 2). | This will only be assessed at Visit2 (Day 15) and Visit4 (Day 45) of Phase 1. |
| D013568 |
| Pathological Conditions, Signs and Symptoms |