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Pilot Study of PEMF Therapy in Treatment of Post-operative Pain Following Total Knee Arthroplasty

Primary Purpose

Post-Operative Pain Following Total Knee Arthroplasty

Status
Completed
Phase
Not Applicable
Locations
United States
Study Type
Interventional
Intervention
Pulsed Electromagnetic Field Device (Provant)
Sham Pulsed Electromagnetic Field Device
Sponsored by
Regenesis Biomedical, Inc.
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Post-Operative Pain Following Total Knee Arthroplasty focused on measuring Pulsed Electromagnetic Energy Fields, Total Knee Arthroplasty, Pain Intensity

Eligibility Criteria

18 Years - undefined (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  1. Subject age is greater or equal to 18 years.
  2. Subject has undergone a total knee replacement for the treatment of osteoarthritis, and has persistent post-operative pain in the index knee for > 3 months and < 36 months following surgery.
  3. Subject has been receiving medication for persistent post-operative knee pain, including opioid or non-opioid analgesic medication that is administered on an "as needed" (prn) basis, and is on a stable analgesic dosing regimen (i.e. the same medications and dosages) for > 30 days prior to the screening visit.
  4. Mean Pain Intensity (calculated as the mean of the daily average pain intensity scores) is ≥3 and < 9 as measured on Numeric Pain Rating Scale (NPRS) during the run-in phase.
  5. Subject has completed a minimum of 80% (8 of 10 possible) of the pain intensity assessments during the run-in phase.
  6. Subject is willing and able to wear an activity meter from the screening visit through Day 75.
  7. Subject is able to access an internet browser in the home environment.
  8. Subject is willing and able to give written informed consent and to comply with all parts of the study protocol.
  9. Female Subjects must be post menopausal, surgically sterile, abstinent, or practicing (or agree to practice) an effective method of birth control if they are sexually active for the duration of the study. (Effective methods of birth control include prescription hormonal contraceptives, intrauterine devices, double-barrier methods, and/or male partner sterilization).

Exclusion Criteria:

  1. Subject has undergone simultaneous bilateral knee arthroplasty or revision arthroplasty on the index knee.
  2. Subject requires revision surgery prior to Day 75.
  3. Subject has undergone manipulation under anesthesia of the index knee or any local injection into the index knee within 30 days prior to the Screening Visit, or within 6 weeks prior to the Screening Visit for long acting lidocaine injection products.
  4. Subject has received any investigational drug or device within 30 days prior to the Screening Visit or is enrolled in another clinical trial.
  5. Subjects consuming an average of > 100 mg oral Morphine Sulfate equivalents per day during the run-in phase.
  6. Subject has evidence on physical or radiological exam of joint instability or infection involving the index knee.
  7. Passive range of motion demonstrates maximal flexion of the index knee < 90 degrees or maximal extension of the index knee < -10 degrees.
  8. Body Mass Index (BMI) < 19 kg/m2, or > 38 kg/m2.
  9. Subject has a history of any uncontrolled medical illness that in the investigator's judgment places the subject at unacceptable risk for receipt of Provant therapy.
  10. Subject has an ongoing painful condition that in the opinion of the Investigator might have a confounding influence on the safety or effectiveness analysis for this study.
  11. Use of systemic corticosteroids within 2 months of the Screening visit.
  12. Subject anticipates the need for surgery of any type through the Day 75 visit.
  13. Subjects whom, in the judgment of the Investigator, have serious psychosocial co-morbidities.
  14. History of drug or alcohol abuse within one year prior to screening.
  15. Subject has a history of malignancy within the past five years other than successfully treated non-metastatic basal cell or squamous cell carcinomas of the skin in the treatment area and/or localized carcinoma in situ of the cervix.
  16. Subject has an implanted pacemaker, defibrillator, neurostimulator, spinal cord stimulator, bone stimulator, cochlear implant, or other implanted device with an implanted metal lead(s).
  17. Existing or planned pregnancy.
  18. Subject has been previously treated with study device.
  19. Subject is in current litigation related to the index knee or is receiving Worker's Compensation for an injury related to the index knee.
  20. Subject is unwilling or unable to follow study instructions, comply with the treatment regimen, study visits, and ePRO assessments.
  21. Standard deviation around the mean of the average pain intensity scores during the run-in period is >2.0.

Sites / Locations

Arms of the Study

Arm 1

Arm 2

Arm Type

Active Comparator

Sham Comparator

Arm Label

Pulsed Electromagnetic Field Device

Sham Pulsed Electromagnetic Field Device

Arm Description

Pulsed Electromagnetic Field therapy device; self-administered at home twice daily for 30 minutes.

Inactive Pulsed Electromagnetic Field Therapy device; self-administered at home twice daily for 30 minutes.

Outcomes

Primary Outcome Measures

Change in Pain Intensity
Percent change from Baseline in Pain Intensity (PI): a validated 11-point Numeric Pain Rating Scale (NPRS) with scores (0-10) collected as patient-reported outcomes on an electronic diary (ePRO). A score of 0 represents 'No Pain' while a score of 10 represents "Worst Pain Imaginable".

Secondary Outcome Measures

Mean Change From Baseline in Knee Injury and Osteoarthritis Outcome Score (KOOS)
Knee Injury and Osteoarthritis Outcome Score (KOOS): a validated knee-specific instrument that measures the short-term and long-term symptoms and function associated with knee injury. KOOS consists of 5 categories: pain, other symptoms, function in daily living, function in sport and recreation, and knee related quality of life. Patients are asked to answer questions relating to these categories and respond with Never/None/Not at all, Rarely/Monthly/Mild, Sometimes/Moderate/Weekly, Often/Severe/Daily or Always/Extreme/Totally/Constantly. Each response gets a score from 0 to 4. A normalized score (100 indicating no symptoms and 0 indicating extreme symptoms) is calculated for each subscale. The mean change in score from baseline to Day 75 is displayed below.
Beck Depression Inventory (BDI)
Responders: Defined as subjects with a 5-point decrease in Beck Depression Inventory (BDI) score. BDI is a validated self-reported assessment of current symptoms of depressive disorders, with total scores ranging from 0 to 63. The BDI scale consists of 21 groups of statements with each score/response ranging from 0 to 3. Higher scores represent greater depression. The BDI was conducted at baseline prior to study device treatments and again at Day 61.
Patient Global Impression of Change (PGIC)
Responder Analysis at Day 75 (patents stating they are "Improved" to "Much Improved") using the Patient Global Impression of Change (PGIC). PGIC is a 7-point validated categorical scale of overall change in status since initiation of treatment with the study device. PGIC allows subjects to integrate into one overall evaluation the different aspects of their response to treatment, including pain reduction, improvement in functioning and side effects. Subjects select one of the following response at the end of treatment: Very Much Worse, Much Worse, Minimally Worse, No Change, Minimally Improved, Improved, or Much Improved.
Analgesic Consumption
Consumption of opioid analgesics in the preceding 24 hours will be self-reported by the subject in the ePRO diary on a daily basis during the 10-day run-in period, treatment period and through Day 75. The results below display the difference in opioid analgesic consumption from baseline to Day 56-60. Subject recorded the number of tablets consumed.
Change From Baseline in Range of Motion (ROM)
The degree of passive (movement of the knee with the aid of study personnel) and active (subject moving the knee) knee flexion and extension tolerated by the subject will be recorded. ROM will be assessed in the sitting position using a goniometer.
Change From Baseline in Peripheral Edema - Maximal Circumference of Calf (cm)
The maximal circumference of the calf and circumference of the thigh at 10 cm and 15 cm cranial to the superior pole of the patella of the index knee will be measured using a tape measure.
Change in Pain Intensity - Average Pain Intensity
Pain Intensity (PI): a validated 11-point Numeric Pain Rating Scale (NPRS) with scores (0-10) collected as patient-reported outcomes on an electronic diary (ePRO).

Full Information

First Posted
August 1, 2014
Last Updated
September 27, 2017
Sponsor
Regenesis Biomedical, Inc.
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1. Study Identification

Unique Protocol Identification Number
NCT02211534
Brief Title
Pilot Study of PEMF Therapy in Treatment of Post-operative Pain Following Total Knee Arthroplasty
Official Title
A Randomized, Sham-Controlled Pilot Study of Pulsed Electromagnetic Field Therapy in the Treatment of Persistent Post-Operative Pain Following Total Knee Arthroplasty
Study Type
Interventional

2. Study Status

Record Verification Date
September 2017
Overall Recruitment Status
Completed
Study Start Date
September 2014 (undefined)
Primary Completion Date
March 2016 (Actual)
Study Completion Date
March 2016 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Regenesis Biomedical, Inc.

4. Oversight

Data Monitoring Committee
No

5. Study Description

Brief Summary
The purpose of this study is to investigate whether pulsed electromagnetic energy field (PEMF) therapy is effective in the treatment of persistent pain following total knee arthroplasty (TKA)
Detailed Description
This is a multi-site randomized, double-blinded, parallel-group prospective pilot study of the analgesic effectiveness of twice-daily PEMF therapy in the treatment of persistent post-operative pain following Total Knee Arthroplasty (TKA). Following a run-in period of 10 days to collect their baseline pain intensity scores, activity levels and opioid consumption, eligible subjects will be randomized in a 2:1 ratio to receive therapy with an active PEMF device or an identical inactive Sham device. Subjects will self-treat twice daily for 60 days while at home. Subjects will collect electronic patient-reported outcome (ePRO) data each morning through Day 75. Subjects will be evaluated at the research center for Interim Visits at Day 21, Day 41, Day 61 and Day 75 for assessment of safety, concomitant medications, range of motion, weight, peripheral edema, and quality of life outcomes. At Day 90, Day 150, and Day 240 assessment of pain intensity, opioid consumption, safety, review of concomitant medications and interval history will be performed, with data collected via telephone contact.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Post-Operative Pain Following Total Knee Arthroplasty
Keywords
Pulsed Electromagnetic Energy Fields, Total Knee Arthroplasty, Pain Intensity

7. Study Design

Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Parallel Assignment
Masking
ParticipantCare ProviderInvestigator
Allocation
Randomized
Enrollment
35 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Pulsed Electromagnetic Field Device
Arm Type
Active Comparator
Arm Description
Pulsed Electromagnetic Field therapy device; self-administered at home twice daily for 30 minutes.
Arm Title
Sham Pulsed Electromagnetic Field Device
Arm Type
Sham Comparator
Arm Description
Inactive Pulsed Electromagnetic Field Therapy device; self-administered at home twice daily for 30 minutes.
Intervention Type
Device
Intervention Name(s)
Pulsed Electromagnetic Field Device (Provant)
Other Intervention Name(s)
Provant Therapy System
Intervention Description
The PEMF device delivers non-thermal, non-ionizing pulsed electromagnetic energy to the target tissue, using 27.12 megahertz pulses lasting 42 microseconds and delivered 1000 times per second. The system generates an electromagnetic field that is continuously monitored and regulated to ensure consistent dosing. The therapeutic electromagnetic field is delivered by means of an applicator pad that is placed against the treatment site. The active and sham devices will be identical in appearance and all other physical characteristics in order to maintain the masking of the treatment.
Intervention Type
Device
Intervention Name(s)
Sham Pulsed Electromagnetic Field Device
Other Intervention Name(s)
Sham Provant Therapy System
Intervention Description
The Sham device will be identical in appearance, physical characteristics and operation to the Active device.
Primary Outcome Measure Information:
Title
Change in Pain Intensity
Description
Percent change from Baseline in Pain Intensity (PI): a validated 11-point Numeric Pain Rating Scale (NPRS) with scores (0-10) collected as patient-reported outcomes on an electronic diary (ePRO). A score of 0 represents 'No Pain' while a score of 10 represents "Worst Pain Imaginable".
Time Frame
Assessed at Day 60 as compared to Baseline
Secondary Outcome Measure Information:
Title
Mean Change From Baseline in Knee Injury and Osteoarthritis Outcome Score (KOOS)
Description
Knee Injury and Osteoarthritis Outcome Score (KOOS): a validated knee-specific instrument that measures the short-term and long-term symptoms and function associated with knee injury. KOOS consists of 5 categories: pain, other symptoms, function in daily living, function in sport and recreation, and knee related quality of life. Patients are asked to answer questions relating to these categories and respond with Never/None/Not at all, Rarely/Monthly/Mild, Sometimes/Moderate/Weekly, Often/Severe/Daily or Always/Extreme/Totally/Constantly. Each response gets a score from 0 to 4. A normalized score (100 indicating no symptoms and 0 indicating extreme symptoms) is calculated for each subscale. The mean change in score from baseline to Day 75 is displayed below.
Time Frame
Mean change from Day 0 to Day 75
Title
Beck Depression Inventory (BDI)
Description
Responders: Defined as subjects with a 5-point decrease in Beck Depression Inventory (BDI) score. BDI is a validated self-reported assessment of current symptoms of depressive disorders, with total scores ranging from 0 to 63. The BDI scale consists of 21 groups of statements with each score/response ranging from 0 to 3. Higher scores represent greater depression. The BDI was conducted at baseline prior to study device treatments and again at Day 61.
Time Frame
Responders at Day 75 (compared to baseline)
Title
Patient Global Impression of Change (PGIC)
Description
Responder Analysis at Day 75 (patents stating they are "Improved" to "Much Improved") using the Patient Global Impression of Change (PGIC). PGIC is a 7-point validated categorical scale of overall change in status since initiation of treatment with the study device. PGIC allows subjects to integrate into one overall evaluation the different aspects of their response to treatment, including pain reduction, improvement in functioning and side effects. Subjects select one of the following response at the end of treatment: Very Much Worse, Much Worse, Minimally Worse, No Change, Minimally Improved, Improved, or Much Improved.
Time Frame
Day 75
Title
Analgesic Consumption
Description
Consumption of opioid analgesics in the preceding 24 hours will be self-reported by the subject in the ePRO diary on a daily basis during the 10-day run-in period, treatment period and through Day 75. The results below display the difference in opioid analgesic consumption from baseline to Day 56-60. Subject recorded the number of tablets consumed.
Time Frame
Day 56 to Day 60 (compared to baseline)
Title
Change From Baseline in Range of Motion (ROM)
Description
The degree of passive (movement of the knee with the aid of study personnel) and active (subject moving the knee) knee flexion and extension tolerated by the subject will be recorded. ROM will be assessed in the sitting position using a goniometer.
Time Frame
Days 0 (Baseline) and Day 75
Title
Change From Baseline in Peripheral Edema - Maximal Circumference of Calf (cm)
Description
The maximal circumference of the calf and circumference of the thigh at 10 cm and 15 cm cranial to the superior pole of the patella of the index knee will be measured using a tape measure.
Time Frame
Day 75
Title
Change in Pain Intensity - Average Pain Intensity
Description
Pain Intensity (PI): a validated 11-point Numeric Pain Rating Scale (NPRS) with scores (0-10) collected as patient-reported outcomes on an electronic diary (ePRO).
Time Frame
At Days 75, 90, 150 and 240, as compared to Baseline

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Subject age is greater or equal to 18 years. Subject has undergone a total knee replacement for the treatment of osteoarthritis, and has persistent post-operative pain in the index knee for > 3 months and < 36 months following surgery. Subject has been receiving medication for persistent post-operative knee pain, including opioid or non-opioid analgesic medication that is administered on an "as needed" (prn) basis, and is on a stable analgesic dosing regimen (i.e. the same medications and dosages) for > 30 days prior to the screening visit. Mean Pain Intensity (calculated as the mean of the daily average pain intensity scores) is ≥3 and < 9 as measured on Numeric Pain Rating Scale (NPRS) during the run-in phase. Subject has completed a minimum of 80% (8 of 10 possible) of the pain intensity assessments during the run-in phase. Subject is willing and able to wear an activity meter from the screening visit through Day 75. Subject is able to access an internet browser in the home environment. Subject is willing and able to give written informed consent and to comply with all parts of the study protocol. Female Subjects must be post menopausal, surgically sterile, abstinent, or practicing (or agree to practice) an effective method of birth control if they are sexually active for the duration of the study. (Effective methods of birth control include prescription hormonal contraceptives, intrauterine devices, double-barrier methods, and/or male partner sterilization). Exclusion Criteria: Subject has undergone simultaneous bilateral knee arthroplasty or revision arthroplasty on the index knee. Subject requires revision surgery prior to Day 75. Subject has undergone manipulation under anesthesia of the index knee or any local injection into the index knee within 30 days prior to the Screening Visit, or within 6 weeks prior to the Screening Visit for long acting lidocaine injection products. Subject has received any investigational drug or device within 30 days prior to the Screening Visit or is enrolled in another clinical trial. Subjects consuming an average of > 100 mg oral Morphine Sulfate equivalents per day during the run-in phase. Subject has evidence on physical or radiological exam of joint instability or infection involving the index knee. Passive range of motion demonstrates maximal flexion of the index knee < 90 degrees or maximal extension of the index knee < -10 degrees. Body Mass Index (BMI) < 19 kg/m2, or > 38 kg/m2. Subject has a history of any uncontrolled medical illness that in the investigator's judgment places the subject at unacceptable risk for receipt of Provant therapy. Subject has an ongoing painful condition that in the opinion of the Investigator might have a confounding influence on the safety or effectiveness analysis for this study. Use of systemic corticosteroids within 2 months of the Screening visit. Subject anticipates the need for surgery of any type through the Day 75 visit. Subjects whom, in the judgment of the Investigator, have serious psychosocial co-morbidities. History of drug or alcohol abuse within one year prior to screening. Subject has a history of malignancy within the past five years other than successfully treated non-metastatic basal cell or squamous cell carcinomas of the skin in the treatment area and/or localized carcinoma in situ of the cervix. Subject has an implanted pacemaker, defibrillator, neurostimulator, spinal cord stimulator, bone stimulator, cochlear implant, or other implanted device with an implanted metal lead(s). Existing or planned pregnancy. Subject has been previously treated with study device. Subject is in current litigation related to the index knee or is receiving Worker's Compensation for an injury related to the index knee. Subject is unwilling or unable to follow study instructions, comply with the treatment regimen, study visits, and ePRO assessments. Standard deviation around the mean of the average pain intensity scores during the run-in period is >2.0.
Facility Information:
City
Birmingham
State/Province
Alabama
Country
United States
City
Phoenix
State/Province
Arizona
ZIP/Postal Code
85018
Country
United States
City
Phoenix
State/Province
Arizona
ZIP/Postal Code
85023
Country
United States
City
El Cajon
State/Province
California
ZIP/Postal Code
92020
Country
United States
City
Lone Tree
State/Province
Colorado
ZIP/Postal Code
80124
Country
United States
City
Bradenton
State/Province
Florida
Country
United States
City
Fort Lauderdale
State/Province
Florida
Country
United States
City
Las Vegas
State/Province
Nevada
ZIP/Postal Code
89128
Country
United States
City
New York
State/Province
New York
ZIP/Postal Code
10022
Country
United States
City
Raleigh
State/Province
North Carolina
Country
United States
City
Spartanburg
State/Province
South Carolina
ZIP/Postal Code
29303
Country
United States
City
Saint George
State/Province
Utah
ZIP/Postal Code
84790
Country
United States
City
Danville
State/Province
Virginia
Country
United States
City
Spokane
State/Province
Washington
ZIP/Postal Code
99218
Country
United States

12. IPD Sharing Statement

Learn more about this trial

Pilot Study of PEMF Therapy in Treatment of Post-operative Pain Following Total Knee Arthroplasty

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