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Evaluation of NMES for Reducing Pain and Improving Functional Outcomes in Knee OA Patients (NMES)

Primary Purpose

Knee Osteoarthritis, Knee Pain Chronic, Knee Arthritis

Status
Completed
Phase
Not Applicable
Locations
United States
Study Type
Interventional
Intervention
Active NMES
Sponsored by
CyMedica Orthopedics, Inc
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Knee Osteoarthritis focused on measuring NMES, arthritis, knee pain, osteoarthritis, electrical stimulation therapy

Eligibility Criteria

18 Years - 85 Years (Adult, Older Adult)All SexesAccepts Healthy Volunteers

Inclusion Criteria:

  1. Patients with symptomatic Kellgren-Lawrence (KL) Grade 2, 3, or 4 OA by radiograph (AP tunnel view) within 30 days prior to day 0 visit, where the K-L grades are defined as:

    • Grade 0: no radiographic features of OA are present
    • Grade 1: doubtful joint space narrowing (JSN) and possible osteophytic lipping
    • Grade 2: definite osteophytes and possible JSN on anteroposterior weight-bearing radiograph
    • Grade 3: multiple osteophytes, definite JSN, sclerosis, possible bony deformity
    • Grade 4: large osteophytes, marked JSN, severe sclerosis and definite bony deformity
  2. Patients who are between the ages of 18 - 85 years
  3. Patient has signed informed consent
  4. Patient has access to a smartphone or tablet (Android or iOS)
  5. Subject must be ambulatory.
  6. Subject must be willing to stop taking any pain medications 24 hours prior any scheduled study visit.
  7. Subjects must be proficient in English.
  8. Subject must be willing and able to sign an informed consent document.
  9. Subjects must be willing and able to comply with all study procedures for the duration of the clinical study.

Exclusion Criteria:

  1. Subjects who have a body mass index > 40 at the time of consent. Exclusion of a patient with BMI>40 is up to the discretion of the PI.
  2. Subjects with a diagnosis of inflammatory arthritis (rheumatoid arthritis, gout, joint infection, Lyme disease, SLE, etc.).
  3. Subjects who have had an injury or an acute traumatic injury to the index knee within 6 months of screening will be excluded.
  4. Subject must NOT have had arthroscopy within 8 weeks of randomization.
  5. Subjects who have had treatment of the target knee with intra-articular injections of steroids within 8 weeks of screening.
  6. Subjects who have had intra-articular injections of hyaluronic acid within 12 weeks of screening.
  7. Subjects who have had a scheduled surgery on the target knee within the study period.

    (Note- Patients who are scheduled to go under surgery within the next 6 months will be excluded. Patients that are contemplating the surgery can be included.)

  8. Subjects who have used electrotherapy or acupuncture for OA of the target knee within 4 weeks of screening
  9. Subjects with significant and clinically evident mal-alignment of the target knee (> 10 degrees varus or valgus in the target knee).
  10. Subjects with surgical metallic hardware in the target knee.
  11. Subjects who have contraindications to MRI and X-rays, for example, implanted electrical devices (cardiac pacemakers, deep brain stimulators).
  12. Subjects with a current malignancy or who have received treatment for malignancy with the last 5 years, with the exception of resected basal cell carcinoma and squamous cell carcinoma of the skin.
  13. Subjects who have an active substance abuse problem (drugs or alcohol) or a history of chronic substance abuse (> 5 years).
  14. Subjects with skin breakdown or infection in the area where the study device will be placed.
  15. Subjects with any chronic conditions (e.g., diabetes, hypertension, congestive heart failure, etc.) that have not been well-controlled for at least 3 months prior to screening.
  16. Subjects who have any ongoing litigation for worker's compensation.
  17. Subjects with any condition, in the opinion of the Investigator that might interfere with the evaluation of the study objectives.
  18. Subjects who are pregnant.
  19. Subject must not have participated in a clinical study within the past 12 weeks that required the use of an investigational device, drug or biologic

Sites / Locations

  • Lenox Hill Hospital

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Sham Comparator

Arm Label

Active NMES

Inactive NMES

Arm Description

Treatment arm receives an active NMES therapy including a conductive garment with NMES therapy, electrodes, and mobile app.

Control arm receives inactive NMES therapy including a conductive garment (no NMES and no electrodes), and mobile app.

Outcomes

Primary Outcome Measures

Visual Analogue Scale (VAS) pain level
Pain for a nominated activity causing the worst knee pain
Visual Analogue Scale (VAS) pain level
Worst pain at rest
Visual Analogue Scale (VAS) pain level
Worst pain walking

Secondary Outcome Measures

Quadriceps strength
Isometric quadriceps strength or torque
TUG
Timed Up and Go test
Repeated chair rise
Repeated chair rise test
Stair climb
Stair climb
6 min walk test
6 min walk test
Activity
Average number of daily steps
Pain related medication
NSAIDS, Narcotics
Knee injections
HA and CS injections
Physical therapy
Utilization of physical therapy
Ambulation assist devices
Utilization of ambulation assist devices
Plan for TKA surgery
Plan for TKA surgery

Full Information

First Posted
June 7, 2019
Last Updated
May 20, 2021
Sponsor
CyMedica Orthopedics, Inc
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1. Study Identification

Unique Protocol Identification Number
NCT03980964
Brief Title
Evaluation of NMES for Reducing Pain and Improving Functional Outcomes in Knee OA Patients
Acronym
NMES
Official Title
Prospective Evaluation of Neuromuscular Electrical Stimulation (NMES) for Reducing Pain and Improving Functional Outcomes in Knee Osteoarthritis (OA) Patients
Study Type
Interventional

2. Study Status

Record Verification Date
May 2021
Overall Recruitment Status
Completed
Study Start Date
June 7, 2019 (Actual)
Primary Completion Date
May 22, 2020 (Actual)
Study Completion Date
April 16, 2021 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
CyMedica Orthopedics, Inc

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
Yes
Product Manufactured in and Exported from the U.S.
No
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
The present prospective trial is designed to evaluate the efficacy of CyMedica Orthopedics e-vive™ system, a multifunctional electrotherapy device providing neuromuscular electrical stimulation (NMES) for reducing pain and accelerating functional recovery in patients with knee osteoarthritis. This post-market trial will involve patients who have been diagnosed with knee osteoarthritis, Kelgren-Lawrence Grades II, III, and IV. It is hypothesized that the use of the CyMedica e-vive NMES can reduce pain, improve knee function, and improve quality of life.
Detailed Description
The study will be conducted at Lenox Hill Hospital, Northwell Health, located in New York, New York, and involve a total of 120 patients. All study patients will be evenly divided into two groups: (a) conductive garment and mobile app with NMES therapy; (b) conductive garment and mobile app without NMES therapy (sham). Eligible patients will be evaluated according to the time and events schedule. Clinical outcomes will be assessed from 1 to 10 days before day of intervention and followed up after intervention over a 24 weeks ± 1 week study period. These two groups will be analyzed using several outcome measures including validated patient-reported outcome measures including Visual Analogue Scale (VAS) pain level, the Knee Injury and Osteoarthritis Outcome Score (KOOS) JR., KOOS ADL, and WOMAC survey. Functional measures include isometric quadriceps strength, Time Up and Go (TUG), 6 minute walk test, repeated chair rise test, stair climb test, and number of steps recorded by an Apple Watch Series 3 or a Samsung watch. Reduction of use of anti-inflammatory medications (NSAIDS) and narcotics, use of ambulation assist devices, plan for TKA procedure survey, device compliance use, and patient satisfaction survey will be tracked The primary endpoint for the study is Visual Analogue Scale (VAS) pain The proprietary app for this product will be used to track device usage (intensity, duration of session, frequency of use), VAS, WOMAC, and KOOS JR.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Knee Osteoarthritis, Knee Pain Chronic, Knee Arthritis
Keywords
NMES, arthritis, knee pain, osteoarthritis, electrical stimulation therapy

7. Study Design

Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Crossover Assignment
Model Description
One-way crossover- Patients from the control cohort are allowed to crossover to the treatment cohort after 12 weeks of study enrollment, if a subject would request receiving knee intra-articular injections of hyaluronic acid (HA) or corticosteroids (CS) or opioids. Patients are also allowed to crossover to the treatment arm if they decide to drop out of the study due to the potential lack of clinical benefits from the sham treatment.
Masking
None (Open Label)
Allocation
Randomized
Enrollment
40 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Active NMES
Arm Type
Experimental
Arm Description
Treatment arm receives an active NMES therapy including a conductive garment with NMES therapy, electrodes, and mobile app.
Arm Title
Inactive NMES
Arm Type
Sham Comparator
Arm Description
Control arm receives inactive NMES therapy including a conductive garment (no NMES and no electrodes), and mobile app.
Intervention Type
Device
Intervention Name(s)
Active NMES
Intervention Description
Daily home-based, mobile-app controlled, neuromuscular electrical stimulation (NMES) therapy
Primary Outcome Measure Information:
Title
Visual Analogue Scale (VAS) pain level
Description
Pain for a nominated activity causing the worst knee pain
Time Frame
12 weeks post intervention
Title
Visual Analogue Scale (VAS) pain level
Description
Worst pain at rest
Time Frame
12 weeks post intervention
Title
Visual Analogue Scale (VAS) pain level
Description
Worst pain walking
Time Frame
12 weeks post intervention
Secondary Outcome Measure Information:
Title
Quadriceps strength
Description
Isometric quadriceps strength or torque
Time Frame
12 weeks post intervention
Title
TUG
Description
Timed Up and Go test
Time Frame
12 weeks post intervention
Title
Repeated chair rise
Description
Repeated chair rise test
Time Frame
12 weeks post intervention
Title
Stair climb
Description
Stair climb
Time Frame
12 weeks post intervention
Title
6 min walk test
Description
6 min walk test
Time Frame
12 weeks post intervention
Title
Activity
Description
Average number of daily steps
Time Frame
12 weeks post intervention
Title
Pain related medication
Description
NSAIDS, Narcotics
Time Frame
12 weeks post intervention
Title
Knee injections
Description
HA and CS injections
Time Frame
12 weeks post intervention
Title
Physical therapy
Description
Utilization of physical therapy
Time Frame
12 weeks post intervention
Title
Ambulation assist devices
Description
Utilization of ambulation assist devices
Time Frame
12 weeks post intervention
Title
Plan for TKA surgery
Description
Plan for TKA surgery
Time Frame
12 weeks post intervention

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
85 Years
Accepts Healthy Volunteers
Accepts Healthy Volunteers
Eligibility Criteria
Inclusion Criteria: Patients with symptomatic Kellgren-Lawrence (KL) Grade 2, 3, or 4 OA by radiograph (AP tunnel view) within 30 days prior to day 0 visit, where the K-L grades are defined as: Grade 0: no radiographic features of OA are present Grade 1: doubtful joint space narrowing (JSN) and possible osteophytic lipping Grade 2: definite osteophytes and possible JSN on anteroposterior weight-bearing radiograph Grade 3: multiple osteophytes, definite JSN, sclerosis, possible bony deformity Grade 4: large osteophytes, marked JSN, severe sclerosis and definite bony deformity Patients who are between the ages of 18 - 85 years Patient has signed informed consent Patient has access to a smartphone or tablet (Android or iOS) Subject must be ambulatory. Subject must be willing to stop taking any pain medications 24 hours prior any scheduled study visit. Subjects must be proficient in English. Subject must be willing and able to sign an informed consent document. Subjects must be willing and able to comply with all study procedures for the duration of the clinical study. Exclusion Criteria: Subjects who have a body mass index > 40 at the time of consent. Exclusion of a patient with BMI>40 is up to the discretion of the PI. Subjects with a diagnosis of inflammatory arthritis (rheumatoid arthritis, gout, joint infection, Lyme disease, SLE, etc.). Subjects who have had an injury or an acute traumatic injury to the index knee within 6 months of screening will be excluded. Subject must NOT have had arthroscopy within 8 weeks of randomization. Subjects who have had treatment of the target knee with intra-articular injections of steroids within 8 weeks of screening. Subjects who have had intra-articular injections of hyaluronic acid within 12 weeks of screening. Subjects who have had a scheduled surgery on the target knee within the study period. (Note- Patients who are scheduled to go under surgery within the next 6 months will be excluded. Patients that are contemplating the surgery can be included.) Subjects who have used electrotherapy or acupuncture for OA of the target knee within 4 weeks of screening Subjects with significant and clinically evident mal-alignment of the target knee (> 10 degrees varus or valgus in the target knee). Subjects with surgical metallic hardware in the target knee. Subjects who have contraindications to MRI and X-rays, for example, implanted electrical devices (cardiac pacemakers, deep brain stimulators). Subjects with a current malignancy or who have received treatment for malignancy with the last 5 years, with the exception of resected basal cell carcinoma and squamous cell carcinoma of the skin. Subjects who have an active substance abuse problem (drugs or alcohol) or a history of chronic substance abuse (> 5 years). Subjects with skin breakdown or infection in the area where the study device will be placed. Subjects with any chronic conditions (e.g., diabetes, hypertension, congestive heart failure, etc.) that have not been well-controlled for at least 3 months prior to screening. Subjects who have any ongoing litigation for worker's compensation. Subjects with any condition, in the opinion of the Investigator that might interfere with the evaluation of the study objectives. Subjects who are pregnant. Subject must not have participated in a clinical study within the past 12 weeks that required the use of an investigational device, drug or biologic
Facility Information:
Facility Name
Lenox Hill Hospital
City
New York
State/Province
New York
ZIP/Postal Code
10075
Country
United States

12. IPD Sharing Statement

Plan to Share IPD
No

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Evaluation of NMES for Reducing Pain and Improving Functional Outcomes in Knee OA Patients

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