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CHiropractic for Infantile Colic Study (CHIC)

Primary Purpose

Infantile Colic

Status
Terminated
Phase
Not Applicable
Locations
United Kingdom
Study Type
Interventional
Intervention
Chiropractic
Best Standard Care
Sponsored by
University of Southampton
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Infantile Colic focused on measuring Crying, Chiropractic, Infant, pediatric, Infantile colic, Clinical Trial

Eligibility Criteria

1 Day - 12 Weeks (Child)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Parentally-reported crying of more than three hours per day for three or more days in the preceding week (reported at initial contact to determine preliminary diagnosis of colic)
  • Confirmation at first clinic visit that the infant has cried for more than three hours per day for at least one day in the base-lining period.
  • Otherwise normal infants, born at term, with normal growth and development, and no indication of other underlying pathology
  • Parents fluent in English, providing informed written consent

Exclusion Criteria:

  • Infants who have received previous chiropractic, osteopathic or other manipulative treatment

Sites / Locations

  • University of Southampton

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm 4

Arm Type

Active Comparator

Sham Comparator

Experimental

Experimental

Arm Label

Best standard care only - not blind

Best Standard Care and Sham - Blind

BSC & Chiropractic - Not blind

BSC & Chiropractic - Blind

Arm Description

Best Standard Care (as defined by Map of Medicine care pathway) - counseling and advice. Parents aware that infant is not receiving chiropractic treatment

Best Standard Care (as defined by Map of Medicine care pathway) - counseling and advice plus sham chiropractic treatment. Parents unaware of whether infant is receiving real treatment or sham.

Best Standard Care (as defined by Map of Medicine care pathway) - counseling and advice plus real chiropractic treatment. Parents aware that infant is receiving chiropractic treatment.

Best Standard Care (as defined by Map of Medicine care pathway) - counseling and advice plus real chiropractic treatment. Parents not aware that infant is receiving chiropractic treatment.

Outcomes

Primary Outcome Measures

Changes to the duration of crying per day
Proportion of infants achieving clinically-relevant reduction in crying time
Defined as 60 minutes (median) based on survey
Proportion of infants reported with absence of 'colic'
Taken from the Parental Global Impression of Severity scale
Number of adverse events

Secondary Outcome Measures

Changes to the duration of crying per day
Changes to parental anxiety and depression scores
Proportion of infants achieving clinically-relevant reduction in crying time
Proportion of infants reported with absence of 'colic'
Parental Global Impressions of Change in symptoms
Cost of NHS resources used
Costs calculated based on reported interactions and standard costs published annually by the Personal Social Services Research Unit (PSSRU) in the UK.
Change to Severity of colic-related specific symptoms
Based on 5-point likert scale 'not at all' to 'a very great deal' for crying with high pitched sound, crying with pain cry, pulling faces (apparently in pain), having a flushed face, holding breath, clenching fists, bending elbows/holding arms rigid, punching fists, wind milling arms, kicking legs, drawing legs up, arching back, tense/distended abdomen, borborygmus, flatulence, vomiting/regurgitating
Change to Parental Global Impressions of Severity
Effectiveness of Blinding
Proportion of correct, incorrect and 'don't know' guesses, reported using James' and Bangs' blinding indices

Full Information

First Posted
April 28, 2014
Last Updated
April 23, 2021
Sponsor
University of Southampton
Collaborators
McTimoney College of Chiropractic
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1. Study Identification

Unique Protocol Identification Number
NCT02138656
Brief Title
CHiropractic for Infantile Colic Study
Acronym
CHIC
Official Title
The Effectiveness of Chiropractic in the Treatment of Infantile Colic
Study Type
Interventional

2. Study Status

Record Verification Date
April 2021
Overall Recruitment Status
Terminated
Why Stopped
Review of recruitment methods
Study Start Date
March 2014 (Actual)
Primary Completion Date
December 2014 (Actual)
Study Completion Date
December 2014 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
University of Southampton
Collaborators
McTimoney College of Chiropractic

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
The purpose of this study is to investigate whether a course of chiropractic treatment has a significant impact on the natural course of infantile colic, specifically: Do parents of colicky infants randomised to the groups receiving a course of McTimoney chiropractic treatment: report a significantly greater improvement in hours of crying than those in the control group? report a significantly greater improvement their own quality of life (anxiety and depression)? report "resolution" of colic following treatment than the control group? What effect does parental blinding have on parentally-reported symptoms of infantile colic and parental quality of life? The study will also include exploratory investigations to determine whether there are: Any particular groupings of patient characteristics (for example; 'other' presenting symptoms, position in the natural course of colic, age of onset, spinal dysfunction, perinatal factors) that are associated with good or poor outcomes Any particular characteristics of the treatment (e.g. specific adjustments) that are associated with good or poor outcomes.
Detailed Description
Overall Design The study will be a two-by-two factorial design combining groups of chiropractic treatment or 'Best Standard Care' with blinded or unblinded parents. The two treatment groups will be 'Best Standard Care only' (BSC) and 'Best Standard Care plus chiropractic' (Chiro). Best standard care will be based on the recommendations from United Kingdom (UK) National Health Service (NHS), using the Map of Medicine care map. Chiropractic treatment will be delivered according to the protocol defined by the participating chiropractors. There will be two blinded and two unblinded groups. The blinded BSC group will receive the 'sham' treatment in addition to the BSC counselling. The unblinded BSC group will not require this. In addition, to allow the effects of the n-shaped curve inherent in the natural course of colic to be evaluated, all groups will be stratified by age at entry (below 4 weeks (expected increasing crying over the 2 weeks of the main intervention), between 4 and 6 weeks (expected plateau), and over 6 weeks (decreasing crying)). The study has a longitudinal design over a ~4 1/2 week period. For the primary outcomes which take data from the crying diaries, the main data points are defined as: Baseline: the 24 hour period of the day before the first treatment First treatment: the 24 hour period of the day after the first treatment Mid-point treatment: the 24 hour period of the day after the second treatment Final treatment: the 24 hour period of the day after the third treatment Secondary outcomes will include data from the following points: Follow-up 1: the 24 hour period of the day 7 days after the third treatment Follow-up 2: the 24 hour period of the day 14 days after the third treatment Other data will be sourced from: The initial visit questionnaires Follow-up questionnaires approximately 2 days after first treatment, 2 days after 2nd treatment, 2 days after final treatment, around day 21 and day 28. Instruments Data collection will be done through 8 main data collection instruments, drafts of which have now been developed: First contact questionnaire Crying Diary (including severity of other symptoms) Initial Visit Questionnaire - Part 1 (demographics and history) Initial Visit Questionnaire - Part 2 (success of blinding) Credibility and Expectancy Questionnaire (CEQ) Hospital Anxiety and Depression Scale Adjustments record Weekly telephone questionnaire Power The sample size is 160, calculated achieve 80% power, 5% significance level, and using an estimated standard deviation of around 2 (based on results from similar studies) for a 1 hour between-groups difference (identified as a 'clinically relevant reduction in crying time' from a parental survey) and allowing for a 25% attrition rate in the latter 2 weeks (based on experiences in similar studies). Analysis: Primary Outcomes For the primary analyses comparisons will be carried out using all the data in one analysis which will assess the significance of the treatments, the blindness and the age groups in an ANCOVA. This will include interaction terms to assess whether the treatment effects are different for the different levels of blindness and for the different age groups and all baseline variables will be included as covariates. A logistic regression analysis will be used to produce odds ratios for the comparison of treatment, blindness and age groups. The between-groups differences in proportion (risk ratio) of patients reporting 'complete resolution' of colic symptoms (PGIS) after first, mid-point and final treatments (primary outcome) and at follow ups (secondary outcomes) Adverse events will be reported with no analysis. Extraction of primary data from crying diaries will be performed by observers blinded to group allocation. The primary analysis will be performed by a statistician blinded to group allocation. Secondary Outcomes The primary analysis of primary outcomes will be extended to days 21 and 28, as above. The ANCOVA will be extended to evaluate the between-group differences in Cost of NHS resource usage Duration that the infant is fussy It is anticipated that parent compliance in completing the diary is likely to deteriorate during once the clinic visits have ceased. However, regular telephone calls will attempt to encourage continued completion. The primary study outcomes will be based on the first 15 days of the diary and it is anticipated that there will be greater compliance during this time. Investigative Analysis The exploratory investigations seek to establish any associations between the outcome measures (daily hours crying, presence of other symptoms, Parental Global Impressions of Severity (PGIS), Parental Global Impressions of Change (PGIC), and 'resolution' of colic) after first, mid-point and final treatments, and at follow-ups and any other predictor variables as gathered in the initial visit (Part 1). For example, : baseline daily hours crying initial symptom trajectory; worsening, plateau, improving baseline 'other symptoms' not at all, low, medium and high severity age at onset perinatal factors (Miller, 2007) treatment characteristics Intention to treat v per protocol Since this is a clinical study, the primary analysis will be done on an intention-to-treat basis, including any patients who fail to comply with the protocol for their group (e.g. dropping out of the treatment groups). For some of the analyses, accurate data is required (e.g. actual adjustments performed) which cannot be imputed. In these cases, the analysis will be done on a per protocol basis. Missing data Previous studies have reported that the majority of dropouts occur in the no-treatment groups due to worsening symptoms and in the treatment groups due to resolution of symptoms, so data imputed at last value carried forward will represent a conservative approach. For the primary crying time outcome data, where there is a record for Day 8, this will be carried forward to Day 15. Where reasons for withdrawal on the basis of worsening symptoms are given, this will be included as data points within the PGIS & PGIC analysis, so no imputation will be required. Attempts will be made to contact any drop-outs to ascertain their reasons for choosing not to continue in the study and these will be reported separately. For the other analyses, a longitudinal analysis of variance will assess changes over time for the treatment, blindness and age groups together with any interactions and covariates. Although there may be some loss of data in the later time periods, a repeated measures analysis should be able to cope with this without imputation of missing data. Numbers of subjects responding to the study and progressing to each stage will be recorded on a CONSORT-style flow diagram.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Infantile Colic
Keywords
Crying, Chiropractic, Infant, pediatric, Infantile colic, Clinical Trial

7. Study Design

Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Factorial Assignment
Masking
ParticipantOutcomes Assessor
Allocation
Randomized
Enrollment
1 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Best standard care only - not blind
Arm Type
Active Comparator
Arm Description
Best Standard Care (as defined by Map of Medicine care pathway) - counseling and advice. Parents aware that infant is not receiving chiropractic treatment
Arm Title
Best Standard Care and Sham - Blind
Arm Type
Sham Comparator
Arm Description
Best Standard Care (as defined by Map of Medicine care pathway) - counseling and advice plus sham chiropractic treatment. Parents unaware of whether infant is receiving real treatment or sham.
Arm Title
BSC & Chiropractic - Not blind
Arm Type
Experimental
Arm Description
Best Standard Care (as defined by Map of Medicine care pathway) - counseling and advice plus real chiropractic treatment. Parents aware that infant is receiving chiropractic treatment.
Arm Title
BSC & Chiropractic - Blind
Arm Type
Experimental
Arm Description
Best Standard Care (as defined by Map of Medicine care pathway) - counseling and advice plus real chiropractic treatment. Parents not aware that infant is receiving chiropractic treatment.
Intervention Type
Other
Intervention Name(s)
Chiropractic
Intervention Description
Chiropractic treatment delivered in accordance with clinical protocols developed and agreed with the participant clinicians
Intervention Type
Other
Intervention Name(s)
Best Standard Care
Intervention Description
Counselling and advice delivered in accordance with the Map of Medicine care pathway for Infantile colic
Primary Outcome Measure Information:
Title
Changes to the duration of crying per day
Time Frame
Baseline to day after first clinic visit (~day 2), mid point (~day 8) and final clinic visit (~day 15)
Title
Proportion of infants achieving clinically-relevant reduction in crying time
Description
Defined as 60 minutes (median) based on survey
Time Frame
Baseline to day after first clinic visit (~day 2), mid point (~day 8) and final clinic visit (~day 15)
Title
Proportion of infants reported with absence of 'colic'
Description
Taken from the Parental Global Impression of Severity scale
Time Frame
Follow-up telephone call after first, mid point and final clinic visit (approx days 2, 8 and 15)
Title
Number of adverse events
Time Frame
at any time during an infant's engagement in the study, circa 28 days
Secondary Outcome Measure Information:
Title
Changes to the duration of crying per day
Time Frame
baseline to day 21 and day 28
Title
Changes to parental anxiety and depression scores
Time Frame
first visit (day 1) to each of the 5 follow-up questionnaires (~day 2, 8, 15, 21 & 28)
Title
Proportion of infants achieving clinically-relevant reduction in crying time
Time Frame
From baseline to day 21 and day 28 follow ups
Title
Proportion of infants reported with absence of 'colic'
Time Frame
At day 21 and day 28 (final 2 follow-ups)
Title
Parental Global Impressions of Change in symptoms
Time Frame
At each of the follow-up questionanaires (~day 2, 8, 15, 21 and 28)
Title
Cost of NHS resources used
Description
Costs calculated based on reported interactions and standard costs published annually by the Personal Social Services Research Unit (PSSRU) in the UK.
Time Frame
Reported 'during the preceding week' at each telephone questionnaire (~day 2, 8, 15, 21 and 28)
Title
Change to Severity of colic-related specific symptoms
Description
Based on 5-point likert scale 'not at all' to 'a very great deal' for crying with high pitched sound, crying with pain cry, pulling faces (apparently in pain), having a flushed face, holding breath, clenching fists, bending elbows/holding arms rigid, punching fists, wind milling arms, kicking legs, drawing legs up, arching back, tense/distended abdomen, borborygmus, flatulence, vomiting/regurgitating
Time Frame
Baseline to day after first, mid point and final clinic visits (~days 2, 8, 15) then to day 21 and day 28
Title
Change to Parental Global Impressions of Severity
Time Frame
Baseline to follow-ups after first second and final clinic visits (~days 2, 8, 15) then to day 21 and day 28 follow ups
Title
Effectiveness of Blinding
Description
Proportion of correct, incorrect and 'don't know' guesses, reported using James' and Bangs' blinding indices
Time Frame
immediately after first "treatment" (day 1) and at follow-up telephone questionnaires after first, mid point and final clinic visits (~day 2, 8 and 15)

10. Eligibility

Sex
All
Minimum Age & Unit of Time
1 Day
Maximum Age & Unit of Time
12 Weeks
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Parentally-reported crying of more than three hours per day for three or more days in the preceding week (reported at initial contact to determine preliminary diagnosis of colic) Confirmation at first clinic visit that the infant has cried for more than three hours per day for at least one day in the base-lining period. Otherwise normal infants, born at term, with normal growth and development, and no indication of other underlying pathology Parents fluent in English, providing informed written consent Exclusion Criteria: Infants who have received previous chiropractic, osteopathic or other manipulative treatment
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
George Lewith
Organizational Affiliation
University of Southampton
Official's Role
Principal Investigator
Facility Information:
Facility Name
University of Southampton
City
Southampton
State/Province
Hampshire
Country
United Kingdom

12. IPD Sharing Statement

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CHiropractic for Infantile Colic Study

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