Back to resultsIontophoresis With Dexamethasone and Physical Therapy to Treat Apophysitis of the Knee in Pediatrics
Primary Purpose
Apophysitis; Juvenile
Status
Completed
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
Dexamethasone Sodium Phosphate
Iontophoresis
Physical Therapy
Sponsored by
About this trial
This is an interventional treatment trial for Apophysitis; Juvenile
Eligibility Criteria
Inclusion Criteria:
- Written approval from the referring physician for potential subject to be considered for enrollment into this study
- Provision of signed and dated informed consent form
- Stated willingness to comply with all study procedures and availability for the duration of the study
- In good general health as evidenced by written approval from referring physician for potential inclusion in study.
- Has the ability to effectively identify pain/burns and communicate with the investigators or their parents that they are experiencing pain or burning during treatment
- Referred to CHKD Sports Medicine PT by CHKD Primary Care Sports Medicine physicians or CHKD Orthopedics physicians with a diagnosis of apophysitis of the knee and with a prescription for standard PT treatment with iontophoresis
- Able and willing to complete iontophoresis treatments within eight (8) weeks of first treatment
- Must be ambulatory
- Males 7 to 14 years of age who have not reached skeletal maturity (skeletal maturity based on referring physician's clinical judgement or as demonstrated via radiograph images taken within 90 days of enrollment)
Females 7 to 14 years of age who have not reached skeletal maturity (skeletal maturity based on referring physician's clinical judgement or as demonstrated via radiograph images taken within 90 days of enrollment) and who meet one of the following criteria:
- Pre-menarcheal
- Within two (2) year post onset of menses
- Males or females over the age of 14 only with radiographic evidence of skeletal immaturity, with images taken within 90 days of enrollment
- Index knee symptomatic for pain with activities of daily living or while playing sports.
Exclusion Criteria:
- Index knee symptomatic for pain only with palpation and not with activities of daily living or while playing sport
- Diagnosis of bilateral apophysitis of the knee where both knees meet all of the inclusion criteria
- Systemic fungal infections
- Has an implanted electronic device
- Has a known sensitivity to DSP
- Presence of damaged skin, denuded skin, or other recent scar tissue on index knee
- Presence of active dermatologic conditions in the affected area (e.g., eczema, psoriasis)
- Presence of an abnormal neurological exam that indicates the subject would have a reduced ability to perceive pain (e.g. peripheral neuropathy)
- Has a known sensitivity to electrical current
- Is currently taking systemic steroids
- Has had iontophoresis with DSP treatment within the past 30 days
- Previously enrolled in this study
- Currently enrolled in another treatment research study
Sites / Locations
- CHKD Sports Medicine Physical Therapy - Oakbrooke
- CHKD Sports Medicine Physical Therapy - Tech Center
- CHKD Sports Medicine Physicial Therapy - Ghent
- CHKD Sports Medicine Physical Therapy - Loehmann's Plaza
- CHKD Sports Medicine Physical Therapy - Landstown
Arms of the Study
Arm 1
Arm 2
Arm 3
Arm Type
Experimental
Placebo Comparator
Active Comparator
Arm Label
Iontophoresis with Dexamethasone
Iontophoresis with Sodium Chloride
Physical Therapy alone
Arm Description
Iontophoresis is a non-invasive delivery mechanism for transmitting a medication to a local area of the body. The I-Bresis™ System and I-Bresis™ Patch will be the delivery system used for this study. The I-Bresis™ Patch is an adhesive patch. 1.5 ml of the dexamethasone sodium phosphate (4ml/1mL) will be placed on one side and 1.5 ml of 0.9% sodium chloride (saline) solution will be placed on the other. Duration of exposure: 123 minutes. Frequency of exposure: twice per week for a total of 12 sessions over a maximum of 8 weeks or until Return to Sport Criteria are met, whichever is sooner. Participants will also receive the standard PT protocol for apophysitis of the knee. This will involve up to 20 visits.
Iontophoresis is a non-invasive delivery mechanism for transmitting a medication to a local area of the body. The I-Bresis™ System and I-Bresis™ Patch will be the delivery system used for this study. The I-Bresis™ Patch is an adhesive patch. 1.5 ml of 0.9% sodium chloride (saline) solution will be placed on one side and 1.5 ml of 0.9% saline solution will be placed on the other. Duration of exposure: 123 minutes. Frequency of exposure: twice per week for a total of 12 sessions over a maximum of 8 weeks or until Return to Sport Criteria are met, whichever is sooner. Participants will also receive the standard PT protocol for apophysitis of the knee. This will involve up to 20 visits.
Participants will only receive the standard PT protocol for apophysitis of the knee. This will involve up to 20 visits.
Outcomes
Primary Outcome Measures
Functional outcome as measured in length of time to meet Return To Sport criteria (measured in days)
The Return To Sport Criteria is met when all items on the Return To Sport Checklist can be successfully achieved. There are no units of measure for any of the criteria listed as they are either achieved/passed or not achieved/failed based on the criteria listed. Once all criteria can be passed, this date is noted. The number of days from Visit 1 to the date when all criteria are achieved is calculated. This outcome is measured in days.
Secondary Outcome Measures
Patient reported outcome - percent difficulty with activities as measured by the Lower Extremity Function Scale (LEFS)
Subjects will be asked to attend 2 Study Treatments per week for a maximum of 12 treatments over a maximum of 8 weeks or until Return To Sport Criteria are met, whichever is sooner. The LEFS is a patient reported questionnaire that measures difficult of completing 20 activities. The maximum possible score of the LEFS is 80 points, indicating very high function. The minimum possible score is 0 points, indicating very low function.
Patient reported outcome - activity level as measured by the Godin Leisure-Time Activity Questionnaire
The Godin Leisure-Time Activity Questionnaire measures physical activity. Scores of 24 and above indicate the individual is "Active", scores of 14-23 indicate the individual is "Moderately Active", and scores of 14 and below indicate the individual is insufficiently active/sedentary.
Patient reported outcome - pain as measured by the Wong-Baker FACES Pain Rating Scale
This scale was created for children to help them communicate their pain. The scale shows a series of faces ranging from a happy face at 0, "No hurt" to a crying face at 10 "Hurts worst".
Safety as measured by the number and intensity of iontophoresis or DSP-related adverse events
All adverse events that occur during participation in this research study, whether or not considered intervention-related, will be collected.
Full Information
NCT ID
NCT03606980
First Posted
June 29, 2018
Last Updated
August 29, 2023
Sponsor
Children's Health System, Inc.
1. Study Identification
Unique Protocol Identification Number
NCT03606980
Brief Title
Iontophoresis With Dexamethasone and Physical Therapy to Treat Apophysitis of the Knee in Pediatrics
Official Title
Iontophoresis With Dexamethasone in Combination With Physical Therapy for the Treatment of Pediatric Patients Diagnosed With Apophysitis of the Knee: A Randomized, Double-Blind, Placebo-Controlled Trial
Study Type
Interventional
2. Study Status
Record Verification Date
August 2023
Overall Recruitment Status
Completed
Study Start Date
November 5, 2018 (Actual)
Primary Completion Date
December 22, 2021 (Actual)
Study Completion Date
March 1, 2023 (Actual)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Children's Health System, Inc.
4. Oversight
Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No
Product Manufactured in and Exported from the U.S.
Yes
Data Monitoring Committee
No
5. Study Description
Brief Summary
The goal of this clinical research study is to determine if there is a difference in time to meet return to sport criteria for Pediatric patients with apophysitis of the knee who receive iontophoresis with Dexamethasone Sodium Phosphate (DSP) and Physical Therapy (PT) as those who receive iontophoresis with placebo and PT or PT alone.
Approximately 147 patients will be enrolled in this study.
Detailed Description
Iontophoresis is a treatment that allows medication to be delivered across your skin to the painful area without having to have an injection into your muscle or soft tissue, through a vein in your arm, or taking a pill. Instead, liquid medication is placed on a patch (like a large Band-Aid) and then placed on your knee over the location where it hurts. A plastic device, like a battery, is then attached to the patch for three minutes. During this time, this device begins to deliver the medication through your skin and into the area that hurts, and also charges the patch so it can continue to deliver the medication for two hours once the device is removed. The medication is delivered by a mild electrical current. The most common drug used with iontophoresis for pain caused by such things as apophysitis of the knee is dexamethasone sodium phosphate (dexamethasone).
This is an investigational study. Dexamethasone is a steroid medication that has been approved by the U.S Food and Drug Administration (FDA) to treat many types of problems (such as joint problems, skin and allergy problems, eye, stomach, and lung problems), but has not been approved to treat apophysitis of the knee using iontophoresis. In this study, it is an experimental drug.
Participants will be randomized to one of three treatment groups:
Physical therapy with iontophoresis using Dexamethasone
Physical therapy with iontophoresis using an inactive drug called a placebo
Physical therapy alone
Participants will be asked to attend study visits twice/week for up to 8 weeks or until they are able to pass the Return To Sport Checklist, whichever is sooner. Participants will the receive a 30-Day Follow Up phone call and complete a survey at the 90-Day mark, making each participant's study duration approximately five (5) months.
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Apophysitis; Juvenile
7. Study Design
Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Masking
ParticipantCare ProviderInvestigator
Allocation
Randomized
Enrollment
46 (Actual)
8. Arms, Groups, and Interventions
Arm Title
Iontophoresis with Dexamethasone
Arm Type
Experimental
Arm Description
Iontophoresis is a non-invasive delivery mechanism for transmitting a medication to a local area of the body. The I-Bresis™ System and I-Bresis™ Patch will be the delivery system used for this study. The I-Bresis™ Patch is an adhesive patch. 1.5 ml of the dexamethasone sodium phosphate (4ml/1mL) will be placed on one side and 1.5 ml of 0.9% sodium chloride (saline) solution will be placed on the other. Duration of exposure: 123 minutes. Frequency of exposure: twice per week for a total of 12 sessions over a maximum of 8 weeks or until Return to Sport Criteria are met, whichever is sooner. Participants will also receive the standard PT protocol for apophysitis of the knee. This will involve up to 20 visits.
Arm Title
Iontophoresis with Sodium Chloride
Arm Type
Placebo Comparator
Arm Description
Iontophoresis is a non-invasive delivery mechanism for transmitting a medication to a local area of the body. The I-Bresis™ System and I-Bresis™ Patch will be the delivery system used for this study. The I-Bresis™ Patch is an adhesive patch. 1.5 ml of 0.9% sodium chloride (saline) solution will be placed on one side and 1.5 ml of 0.9% saline solution will be placed on the other. Duration of exposure: 123 minutes. Frequency of exposure: twice per week for a total of 12 sessions over a maximum of 8 weeks or until Return to Sport Criteria are met, whichever is sooner. Participants will also receive the standard PT protocol for apophysitis of the knee. This will involve up to 20 visits.
Arm Title
Physical Therapy alone
Arm Type
Active Comparator
Arm Description
Participants will only receive the standard PT protocol for apophysitis of the knee. This will involve up to 20 visits.
Intervention Type
Drug
Intervention Name(s)
Dexamethasone Sodium Phosphate
Intervention Description
Dexamethasone sodium phosphate administered via iontophoresis
Intervention Type
Procedure
Intervention Name(s)
Iontophoresis
Intervention Description
Iontophoresis on affected knee
Intervention Type
Procedure
Intervention Name(s)
Physical Therapy
Intervention Description
Physical therapy of affected knee
Primary Outcome Measure Information:
Title
Functional outcome as measured in length of time to meet Return To Sport criteria (measured in days)
Description
The Return To Sport Criteria is met when all items on the Return To Sport Checklist can be successfully achieved. There are no units of measure for any of the criteria listed as they are either achieved/passed or not achieved/failed based on the criteria listed. Once all criteria can be passed, this date is noted. The number of days from Visit 1 to the date when all criteria are achieved is calculated. This outcome is measured in days.
Time Frame
Measured at each Study Treatment Visit for a maximum of 12 Study Treatment Visits over a maximum of 8 weeks or until Return to Sport Criteria are met, whichever is sooner
Secondary Outcome Measure Information:
Title
Patient reported outcome - percent difficulty with activities as measured by the Lower Extremity Function Scale (LEFS)
Description
Subjects will be asked to attend 2 Study Treatments per week for a maximum of 12 treatments over a maximum of 8 weeks or until Return To Sport Criteria are met, whichever is sooner. The LEFS is a patient reported questionnaire that measures difficult of completing 20 activities. The maximum possible score of the LEFS is 80 points, indicating very high function. The minimum possible score is 0 points, indicating very low function.
Time Frame
Study Treatment Visit 1, 5 and 12 (or after 8 Weeks of treatment or when Return To Sport Criteria are met, whichever is sooner) and again 30-Days after meeting Return To Sport Criteria.
Title
Patient reported outcome - activity level as measured by the Godin Leisure-Time Activity Questionnaire
Description
The Godin Leisure-Time Activity Questionnaire measures physical activity. Scores of 24 and above indicate the individual is "Active", scores of 14-23 indicate the individual is "Moderately Active", and scores of 14 and below indicate the individual is insufficiently active/sedentary.
Time Frame
Measured at Study Treatment Visit 1 and 30-Days after Return To Sport Criteria are met and 90-Days after Return To Sport Criteria are met.
Title
Patient reported outcome - pain as measured by the Wong-Baker FACES Pain Rating Scale
Description
This scale was created for children to help them communicate their pain. The scale shows a series of faces ranging from a happy face at 0, "No hurt" to a crying face at 10 "Hurts worst".
Time Frame
Measured at each Study Treatment Visit up to 12 Study Treatment Visits over a maximum of 8 weeks or until Return to Sport Criteria are met, whichever is sooner, and again 2-3 days after meeting Return To Sport Criteria.
Title
Safety as measured by the number and intensity of iontophoresis or DSP-related adverse events
Description
All adverse events that occur during participation in this research study, whether or not considered intervention-related, will be collected.
Time Frame
Measured at each Study Treatment Visit (up to 12 Study Treatment Visits over a maximum of 8 weeks or until Return to Sport Criteria are met, whichever is sooner), then again 2 - 3 days, 30 days, and 90 days after Return To Sport Criteria are met.
10. Eligibility
Sex
All
Minimum Age & Unit of Time
7 Years
Maximum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria:
Written approval from the referring physician for potential subject to be considered for enrollment into this study
Provision of signed and dated informed consent form
Stated willingness to comply with all study procedures and availability for the duration of the study
In good general health as evidenced by written approval from referring physician for potential inclusion in study.
Has the ability to effectively identify pain/burns and communicate with the investigators or their parents that they are experiencing pain or burning during treatment
Referred to CHKD Sports Medicine PT by CHKD Primary Care Sports Medicine physicians or CHKD Orthopedics physicians with a diagnosis of apophysitis of the knee and with a prescription for standard PT treatment with iontophoresis
Able and willing to complete iontophoresis treatments within eight (8) weeks of first treatment
Must be ambulatory
Males 7 to 14 years of age who have not reached skeletal maturity (skeletal maturity based on referring physician's clinical judgement or as demonstrated via radiograph images taken within 90 days of enrollment)
Females 7 to 14 years of age who have not reached skeletal maturity (skeletal maturity based on referring physician's clinical judgement or as demonstrated via radiograph images taken within 90 days of enrollment) and who meet one of the following criteria:
Pre-menarcheal
Within two (2) year post onset of menses
Males or females over the age of 14 only with radiographic evidence of skeletal immaturity, with images taken within 90 days of enrollment
Index knee symptomatic for pain with activities of daily living or while playing sports.
Exclusion Criteria:
Index knee symptomatic for pain only with palpation and not with activities of daily living or while playing sport
Diagnosis of bilateral apophysitis of the knee where both knees meet all of the inclusion criteria
Systemic fungal infections
Has an implanted electronic device
Has a known sensitivity to DSP
Presence of damaged skin, denuded skin, or other recent scar tissue on index knee
Presence of active dermatologic conditions in the affected area (e.g., eczema, psoriasis)
Presence of an abnormal neurological exam that indicates the subject would have a reduced ability to perceive pain (e.g. peripheral neuropathy)
Has a known sensitivity to electrical current
Is currently taking systemic steroids
Has had iontophoresis with DSP treatment within the past 30 days
Previously enrolled in this study
Currently enrolled in another treatment research study
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Dana Reesman, PT, DPT
Organizational Affiliation
Children's Hospital of the Kings Daughters
Official's Role
Principal Investigator
Facility Information:
Facility Name
CHKD Sports Medicine Physical Therapy - Oakbrooke
City
Chesapeake
State/Province
Virginia
ZIP/Postal Code
23320
Country
United States
Facility Name
CHKD Sports Medicine Physical Therapy - Tech Center
City
Newport News
State/Province
Virginia
ZIP/Postal Code
23602
Country
United States
Facility Name
CHKD Sports Medicine Physicial Therapy - Ghent
City
Norfolk
State/Province
Virginia
ZIP/Postal Code
23507
Country
United States
Facility Name
CHKD Sports Medicine Physical Therapy - Loehmann's Plaza
City
Virginia Beach
State/Province
Virginia
ZIP/Postal Code
23452
Country
United States
Facility Name
CHKD Sports Medicine Physical Therapy - Landstown
City
Virginia Beach
State/Province
Virginia
ZIP/Postal Code
23456
Country
United States
12. IPD Sharing Statement
Plan to Share IPD
No
Citations:
PubMed Identifier
17224661
Citation
Gholve PA, Scher DM, Khakharia S, Widmann RF, Green DW. Osgood Schlatter syndrome. Curr Opin Pediatr. 2007 Feb;19(1):44-50. doi: 10.1097/MOP.0b013e328013dbea.
Results Reference
background
PubMed Identifier
20631461
Citation
Maffulli N, Longo UG, Spiezia F, Denaro V. Sports injuries in young athletes: long-term outcome and prevention strategies. Phys Sportsmed. 2010 Jun;38(2):29-34. doi: 10.3810/psm.2010.06.1780.
Results Reference
background
PubMed Identifier
28593576
Citation
Circi E, Atalay Y, Beyzadeoglu T. Treatment of Osgood-Schlatter disease: review of the literature. Musculoskelet Surg. 2017 Dec;101(3):195-200. doi: 10.1007/s12306-017-0479-7. Epub 2017 Jun 7.
Results Reference
background
PubMed Identifier
4025675
Citation
Kujala UM, Kvist M, Heinonen O. Osgood-Schlatter's disease in adolescent athletes. Retrospective study of incidence and duration. Am J Sports Med. 1985 Jul-Aug;13(4):236-41. doi: 10.1177/036354658501300404.
Results Reference
background
PubMed Identifier
24338751
Citation
Joshi A, Stagni G, Cleary A, Patel K, Weiss DS, Hagins M. Iontophoresis successfully delivers dexamethasone sodium phosphate to dermis as measured by microdialysis. J Pharm Sci. 2014 Jan;103(1):191-6. doi: 10.1002/jps.23771. Epub 2013 Nov 6.
Results Reference
background
PubMed Identifier
12642251
Citation
Nirschl RP, Rodin DM, Ochiai DH, Maartmann-Moe C; DEX-AHE-01-99 Study Group. Iontophoretic administration of dexamethasone sodium phosphate for acute epicondylitis. A randomized, double-blinded, placebo-controlled study. Am J Sports Med. 2003 Mar-Apr;31(2):189-95. doi: 10.1177/03635465030310020601.
Results Reference
background
PubMed Identifier
12135445
Citation
Runeson L, Haker E. Iontophoresis with cortisone in the treatment of lateral epicondylalgia (tennis elbow)--a double-blind study. Scand J Med Sci Sports. 2002 Jun;12(3):136-42. doi: 10.1034/j.1600-0838.2002.02142.x.
Results Reference
background
PubMed Identifier
19347928
Citation
Amirjani N, Ashworth NL, Watt MJ, Gordon T, Chan KM. Corticosteroid iontophoresis to treat carpal tunnel syndrome: a double-blind randomized controlled trial. Muscle Nerve. 2009 May;39(5):627-33. doi: 10.1002/mus.21300.
Results Reference
background
PubMed Identifier
14617059
Citation
Neeter C, Thomee R, Silbernagel KG, Thomee P, Karlsson J. Iontophoresis with or without dexamethazone in the treatment of acute Achilles tendon pain. Scand J Med Sci Sports. 2003 Dec;13(6):376-82. doi: 10.1046/j.1600-0838.2003.00305.x.
Results Reference
background
Citation
Marovino T, Graves C. Iontophoresis in Pain Management. Practical Pain Management . 2011; 8(2): 1-2. Available from: https://www.practicalpainmanagement.com/treatments/interventional/iontophoresis-pain-management, Accessed May 17, 2018
Results Reference
background
Citation
Dexamethasone sodium phosphate. In: Micromedex Solutions DRUGDEX® System. IBM Watson Health. Ann Arbor, MI. [cited April 22, 2018]. Available from: http://micromedexsolutions.com
Results Reference
background
PubMed Identifier
22396901
Citation
Dhote V, Bhatnagar P, Mishra PK, Mahajan SC, Mishra DK. Iontophoresis: a potential emergence of a transdermal drug delivery system. Sci Pharm. 2012 Jan-Mar;80(1):1-28. doi: 10.3797/scipharm.1108-20. Epub 2011 Dec 13.
Results Reference
background
Citation
Kaur J, Malik M, Sharma P, Sangwan P, Rani M. Effect of iontophoresis with dexamethasone in pain. Indian Journal of Physiotherapy and Occupational Therapy. 2017; 11(3).
Results Reference
background
Citation
Clijsen R, Taeymans J, Baeyens JP, Barl AO, Clarys P. The effects of iontophoresis in the treatment of musculoskeletal disorders - a systematic review and meta-analysis. Drug Delivery Letters. 2012: 2(3).
Results Reference
background
Citation
Goyal M, Kumar A, Mahajan N, Moitra M. Treatment of plantar fasciitis by taping vs. iontophoresis: a randomized clinical trial. Journal of Exercise Science and Physiotherapy. 2013: 9(1):34-39
Results Reference
background
PubMed Identifier
22034112
Citation
Mina R, Melson P, Powell S, Rao M, Hinze C, Passo M, Graham TB, Brunner HI. Effectiveness of dexamethasone iontophoresis for temporomandibular joint involvement in juvenile idiopathic arthritis. Arthritis Care Res (Hoboken). 2011 Nov;63(11):1511-6. doi: 10.1002/acr.20600.
Results Reference
background
PubMed Identifier
22196293
Citation
Stefanou A, Marshall N, Holdan W, Siddiqui A. A randomized study comparing corticosteroid injection to corticosteroid iontophoresis for lateral epicondylitis. J Hand Surg Am. 2012 Jan;37(1):104-9. doi: 10.1016/j.jhsa.2011.10.005.
Results Reference
background
PubMed Identifier
27752406
Citation
Vaishya R, Azizi AT, Agarwal AK, Vijay V. Apophysitis of the Tibial Tuberosity (Osgood-Schlatter Disease): A Review. Cureus. 2016 Sep 13;8(9):e780. doi: 10.7759/cureus.780.
Results Reference
background
Citation
WHO Physical activity and young people [Internet]. World Health Organization; c2018 [cited 2018 June 20]. Available from: http://www.who.int/dietphysicalactivity/factsheet_young_people/en/
Results Reference
background
Citation
WHO Physical activity [Internet]. World Health Organization; c2018 [cited 2018 June 20]. Available from: http://www.who.int/dietphysicalactivity/pa/en/
Results Reference
background
Citation
I-Bresis™ Charging Station (1360) - Instructions For Use [Internet]. Rev. B 2017 [cited 2018 May 17]. Available from: http://www.djoglobal.com/sites/default/files/Charging%20Station%20IFU.pdf
Results Reference
background
Citation
I-Bresis™ Controller (1361) - Instructions For Use, [Internet]. Rev. B 2017 [cited 2018 May 17]. Available from: http://www.djoglobal.com/sites/default/files/Controller%20IFU.pdf
Results Reference
background
Citation
I-Bresis™ Patch (5000060) - Instructions For Use, [Internet]. Rev. B 2017 [cited 2018 May 17]. Available from: http://www.djoglobal.com/sites/default/files/Electrode%20IFU.pdf
Results Reference
background
Citation
Sodium Chloride Injection, USP [package insert]. Deerfield, IL: Baxter Corporation; 2018 [cited 2018 April 25]. Available from http://baxterpi.com/pi-pdf/Sodium_Chloride_Injection_Viaflex_PI.pdf
Results Reference
background
Citation
2007 Standard Operating Procedures of the Eastern Virginia Medical School Institutional Review Board [Internet]. July 2007 [cited 2018 May 17]. Available from: https://www.evms.edu/media/evms_public/departments/research_administration/research_subjects_protections/2007_EVMS_IRB_SOPs.pdf
Results Reference
background
Learn more about this trial
Iontophoresis With Dexamethasone and Physical Therapy to Treat Apophysitis of the Knee in Pediatrics
We'll reach out to this number within 24 hrs