Clinical Trial Details
— Status: Terminated
Administrative data
NCT number |
NCT02951377 |
Other study ID # |
RES0032934 |
Secondary ID |
|
Status |
Terminated |
Phase |
Phase 1
|
First received |
|
Last updated |
|
Start date |
October 1, 2017 |
Est. completion date |
January 31, 2020 |
Study information
Verified date |
March 2020 |
Source |
University of Alberta |
Contact |
n/a |
Is FDA regulated |
No |
Health authority |
|
Study type |
Interventional
|
Clinical Trial Summary
Aim 1: The primary aim of this study is to test the feasibility of Mechanical Diagnosis and
Treatment (MDT) +/- transforaminal epidural steroid injections (TESI) on pain and disability
in patients awaiting physiatry consult for lumbar radiculopathy secondary to lumbar disc
herniation, compared to usual care within the current healthcare system in Calgary, Alberta,
Canada.
Hypothesis: the investigators hypothesise that centralisers treated with MDT and
non-centralisers receiving TESIs + MDT will have demonstrate reductions in self-reported pain
and disability, compared to usual care controls.
Aim 2: the investigators will also describe the potential impact on healthcare resources by
tracking surgical rates and self-reported healthcare utilisation during the study period.
Hypothesis: based on predicted reductions in pain and disability, the investigators
hypothesise that there will be a trend toward overall less healthcare utilisation (including
surgery) in the MDT guided group compared to the surgical wait list group.
Description:
Study Purpose and Specific Objectives: This pilot study aims to determine the feasibility of
conducting a definitive clinical trial of MDT +/- TESI in patients awaiting physiatry consult
for lumbar radiculopathy secondary to lumbar disc herniation compared to usual care.
Research Design and Methodology:
Design and participants: Randomised clinical trial pilot study. Eligible candidates will be
identified by Physiatrists at a Physiatry clinic in Calgary. The investigators will recruit
30 patients (15 per group). Fifteen - twenty subjects per group provide reasonable
bias-corrected estimates for medium effects. Inclusion criteria: Leg dominant pain secondary
to lumbar disc protrusion confirmed on MRI with duration > 3 months, at least one
neurological sign and able to speak English and provide written informed consent. Exclusion
criteria: pregnancy and specific causes of low back pain (LBP) not directly related to
herniated discs, progressive neurological signs and/or cauda equine syndrome, or
contraindication for the use of corticosteroids or fluoroscopy. Consecutive patients will
randomised into either the intervention described below to enable an estimation of the
magnitude of the treatment effect or the usual care will be followed to estimate the
magnitude of effect for the control group.
Interventions: Group 1- Control group: Outcome assessments will be conducted on patients on
the wait list for physiatry consultation at baseline, 6 weeks, and 3 months. Group 2 -
Intervention group (MDT group): Consistent with the MDT approach, patients will be initially
assessed for centralisation over 2 visits by a Credentialed MDT therapist and further
classified into centraliser (group 2a) and non-centralising pain responses (group 2b). A
centralising pain response is defined as those whose most distal pain is reduced and retreats
toward mid-line (e.g., pain now above knee) in response to certain postures and repeated
end-range movement testing. Group 2a, Centralisers: Patients with a centralising pain
response will continue with treatment based on MDT principles and will complete an exercise
diary to indicate the frequency in which the exercises were performed daily. Group 2b,
Non-centralisers: Patients with a non-centralising pain response will be offered TESIs
followed by MDT. TESIs of 20mg dexamethasone and 0.5cc lidocaine 2%, under fluoroscopic
guidance with contrast medium (Omni Pac 240) as described by the Spine Intervention Society
(SIS) guidelines will be provided. Segment level will be determined based on MRI findings in
combination with the clinical examination findings.
Two weeks after completion of the MDT or TESI intervention, patients will be reassessed and
treated in a manner consistent with their presenting pain response classification: 1)
resolved: advice on remaining active; 2) centralising: treated according to MDT principles
with direction specific exercises and postural advise; 3) non-centralising but significant
less pain: advice to remain active, with respect for worsening leg pain; and 4) persisting
high levels of pain and/or disability: advise to remain active as tolerated and consult
family physicians. Those who continue to perform MDT exercises will complete an exercise
diary to indicate the frequency in which the exercises were performed daily
Outcome assessments: Assessing and treating therapists are credentialed in MDT and will be
blinded to outcomes. The following outcomes will be assessed in all groups at baseline, 6
weeks, and 3 months. The primary outcome measures will be the Roland-Morris Disability
Questionnaire (RMDQ) adapted and validated for sciatica, leg pain intensity, and global
perceived effect (GPE). Average leg pain intensity will be measured using a numeric rating
scale ranging from 0 (no pain) to 10 (worst imaginable pain) over the past 24 hours. GPE will
be measured using a 7 point Likert scale, with lower scores suggesting recovery and higher
scores suggesting worsening. Secondary outcome measures will include fear avoidance (FABQ),
general health (SF-12), and medication use. Demographics will also be collected. In addition,
participants who are prescribed exercises will complete a diary indicating the frequency at
which the exercises were performed.
Data analysis: Leg pain intensity at 3 months, measured using a 10 point numeric rating scale
(NRS) will be the primary outcome for which the larger more definitive study will be planned.
An independent t-test will be used to estimate the effect sizes of the intervention group
compared to the control group. Independent t-tests will also be applied to the other outcome
measures for exploratory purposes. Statistical significance will be set at α=0.05.
Descriptive statistics will be calculated.