Study of PEMF to Evaluate VPT and Thermal Sensory in Subjects With Diabetic Peripheral Neuropathy
Primary Purpose
Diabetic Peripheral Neuropathy
Status
Completed
Phase
Not Applicable
Locations
United States
Study Type
Interventional
Intervention
Active Provant Therapy System
Inactive (sham) Provant Therapy System
Sponsored by
About this trial
This is an interventional treatment trial for Diabetic Peripheral Neuropathy
Eligibility Criteria
Inclusion Criteria:
- Subject age is greater than or equal to 22 years and less than 80 years of age.
- Subject has documented Type 1 or Type 2 diabetes mellitus (receiving insulin, diet controlled, or taking parenteral hypoglycemic agents)
- Subject is on a stable antidiabetic regimen (medication and/or diet) to control their diabetes for at least 30 days prior to Screening.
- Subject has an HbA1c <10% at Screening or within 2 months of Screening.
- Subject has daily pain attributed to bilateral symmetrical Diabetic Peripheral Neuropathy with numbness, tingling, and/or burning based on clinical judgement for at least 6 months prior to screening.
- Subject's pain or discomfort from DPN is identifiable.
- Subject is in pain Phase 2, 3, or 4 as per the Phasing of Neuropathy Scale.
- Subjects average pain over the last 24 hours is ≥3 based on the 11-point Numeric Pain Rating Scale (NPRS) at the Screening Visit.
- Subject has adequate lower extremity pulse in both feet and no intermittent claudication.
- Subject is able to ambulate independently without assistive devices.
- 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 agrees 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 is in pain Phase 1 or 5 as per the Phasing of Neuropathy Scale.
- Subject has an active, open ulcer on the lower extremities.
- Subject has peripheral vascular disease defined as absence of more than one foot pulse per foot and/or ABI <0.8 and >1.4 and/or history of angioplasty or peripheral bypass surgery within 6 months of the Screening Visit.
- Subject has venous insufficiency as classified by the Venous Insufficiency Classification System of grade C6.
- Subject has undergone nerve decompression surgery on the lower extremities.
- Subject has a history of previous kidney, pancreas, cardiac transplantation, or severe renal disease.
- Subject has been diagnosed with non-diabetic chronic inflammatory neuropathic disease (e.g. end stage renal disease, hepatitis C, chemotherapy induced neuropathy, known connective tissue disease, systemic lupus).
- Subject has peripheral vascular disease requiring revascularization of lower limb or amputation or evidence of ulcer amputation.
- Subject has clinically significant cardiovascular disease within 6 months prior to screening (unstable or poorly controlled hypertension, transient ischemic attack, MI, unstable angina, arrhythmia, any heart surgery, stent placement, heart disease).
- Subject has a history of any uncontrolled medical illness that in the Investigators judgment places the subject at unacceptable risk for receipt of PEMF therapy.
- Subject requires or anticipates the need for surgery of any type or travel during the treatment period.
- Subject has a total foot depth (most inferior aspect of the medial malleolus to the plantar aspect of the foot when residing on a treatment pad) of >8 cm.
- Subject has received any investigational drug or device 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 used systemic corticosteroids within 3 months of the Screening Visit.
- Subject has a history of malignancy within the past 5 years other than successfully treated non-metastatic basal cell or squamous cell carcinomas of the skin in the treatment area and/or localized in situ carcinoma of the cervix.
- Subject has a serious psychosocial co-morbidity.
- Subject has a history of drug or alcohol abuse, as confirmed by urine drug screen, within one year prior to the Screening Visit.
- Subject has an implanted pacemaker, defibrillator, neurostimulator, spinal cord stimulator, bone stimulator, cochlear implant, or other implanted device with an implanted metal lead(s).
- Subject is currently pregnant or planning on becoming pregnant prior to Day 121.
- Subject has previously treated with PROVANT® Therapy System within 60 days on the lower extremity.
- Subject is unwilling or unable to follow study instructions or comply with the treatment regimen, diary documentation, and study visits.
- Subject has pain from any other source that can confuse the assessment of the pain associated with DPN.
- Subject has a clinically significant foot deformity (Charcot's syndrome or club foot).
- Subject has received nerve blocks for neuropathic pain within 4 weeks of the Screening Visit.
- Subject has been diagnosed with mononeuropathy.
- Subject has a skin condition that could alter their sensation.
- Subject has had a previous surgery to the spine or lower extremity with residual symptoms of pain or difficulty with movement.
- Subject has moderate or severe arthropathy (RA, OA, Gout) that causes discomfort during casual walking or stair climbing.
Sites / Locations
- Associated Foot & Ankle Specialists, LLC
Arms of the Study
Arm 1
Arm 2
Arm Type
Experimental
Sham Comparator
Arm Label
Active Group
Sham Group
Arm Description
Treatment with active Provant Therapy System
Treatment with Inactive (sham) Provant Therapy System
Outcomes
Primary Outcome Measures
Vibration Perception Threshold (VPT)
A non-invasive test used in quantifying sensation/sensitivity to vibration in evaluating sensory dysfunction associated with diabetic neuropathy
Quantitative Sensory Testing (QST)
QST is a noninvasive test used in peripheral nervous system disorders for thermal sensory testing.
Secondary Outcome Measures
Nerve Conduction Velocity (NCV) - Velocity
NC-stat® DPNCheck® will be used to record NCV at Baseline and Day 121. Outcome Measure Data table displays change in NCV from Baseline to Day 121.
Skin Perfusion Pressures (SPP)
The Vasamed Sensilase PAD-IQ will be used to record SPP. This machine measures pressure (in mm Hg) of microcirculation using a laser Doppler sensor. Outcome Measure Data Table below displays change from Baseline to Day 121.
Pain Intensity (PI)
Mean change from Baseline to Day 121, using a validated 11-point Numeric Pain Rating Scale (NPRS) with scores 0-10, where 0 = no pain and 10 = worst possible pain.
Brief Pain Inventory (BPI); Question on Pain Right Now.
The BPI long form will be administered at the Enrollment Visit, Day 30, 61, 91, and end of study visit (Day 121). Results for question #15 on Pain Right Now displayed below. Subject were asked to rate pain right now on a scale from 0 (no pain) to 10 (pain as bad as you can imagine).
Brief Fatigue Inventory (BFI)
A 4-question assessment that assesses the level of fatigue and the impact of the fatigue on daily function over the last 24 hours. BFI is patient reported and collected at the Enrollment Visit, Days 30, 61, 91, and end of study visit (Day 121). A global fatigue score was calculated by averaging all of the values on the questionnaire and results for the change from Baseline to Day 121 are displayed below. The scale ranged from 0 (no fatigue/does not interfere) to 10 (as bad as you can imagine/completely interferes).
Patient Global Impression of Change (PGIC)
A 7-choice validated categorical scale of overall change in status since initiation of treatment with the study device.PGIC was collected every 7 days in the paper diary, immediately following the morning treatment. Subjects were asked: Since the start of the study, my overall status is? Choices on the scale included: Very much worse, much worse, minimally worse, no change, minimally improved, much improved and very much improved.
Hospital Anxiety and Depression Scale (HADS)
A patient reported 14 question assessment that detects the status of depression and anxiety. Subjects completed the assessment at the Enrollment Visit, Days 30, 61, 91, and end of study visit (Day 121). The total score for anxiety and the total score for depression was calculated at Day 121. Low scores represent normal (0-7) while high scores represent abnormal (11-21).
Neuro-QoL
A validated set of health-related quality of life measures that are domain specific.Subjects will completed 6 domains: (1) Pain, (2) Lost/Reduced Feeling, (3) Diffuse Sensory Motor Symptoms, (4) Restrictions in Activities of Daily Living, (5) Disruptions in Social Relationships, and (6) Emotional Distress.The short forms were completed by the subject at the Enrollment Visit and end of study visit (Day 121). Each question in the domain was rated on a symptom scale from 1 (never) to 5 (all the time) and a bothersome scale from 1 (none) to 3 (very much).
The total score for the domain was calculated by multiplying the symptom score by the bothersome score. The scale range is from 1 to 15 where the minimum (best/least symptomatic) score is 1 and the maximum (worst/most symptomatic) score is 15.
Nerve Conduction Velocity (NCV) - Amplitude
NC-stat® DPNCheck® will be used to record NCV at Baseline and Day 121. Outcome Measure Data table displays change in NCV from Baseline to Day 121.
Full Information
NCT ID
NCT03077893
First Posted
February 28, 2017
Last Updated
July 11, 2019
Sponsor
Regenesis Biomedical, Inc.
1. Study Identification
Unique Protocol Identification Number
NCT03077893
Brief Title
Study of PEMF to Evaluate VPT and Thermal Sensory in Subjects With Diabetic Peripheral Neuropathy
Official Title
A Multi-Center, Sham-Controlled, Double-Blind Randomized Withdrawal Study of PEMF Therapy to Evaluate Vibration Perception Threshold and Thermal Sensory in Subjects With Diabetic Peripheral Neuropathy in the Lower Extremity
Study Type
Interventional
2. Study Status
Record Verification Date
May 2019
Overall Recruitment Status
Completed
Study Start Date
March 9, 2017 (Actual)
Primary Completion Date
December 26, 2017 (Actual)
Study Completion Date
December 26, 2017 (Actual)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Regenesis Biomedical, 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
No
5. Study Description
Brief Summary
A study to demonstrate the effectiveness of PEMF treatment compared to sham treatment in changing Vibration Perception Threshold (VPT) and Thermal Sensory (QST) in patients with diabetic peripheral neuropathy (DPN) when treatment is administered twice daily through 120-day period.
Detailed Description
Multi-center, sham-controlled, double-blind, enriched enrollment, randomized withdrawal clinical trial conducted on subjects with bilateral symmetrical diabetic peripheral neuropathy. Eligible subjects will include those between 22 and 80 years of age with Type 1 or Type 2 diabetes having persistent pain, numbness, tingling, or burning in both feet despite treatment. Eligible subjects will receive two active treatment devices (one for each foot, to allow simultaneous treatment) and treat at home, twice daily for 60 days after which they will return to the clinic at Day 61 for a response assessment. Subjects that are determined to be responders at Day 61 (subjects that achieve a 1-point decrease in the average pain score over the last 24 hours using the Numeric Pain Rating Scale (NPRS)) will be randomized 1:1 to either active treatment or inactive sham devices and will continue treating through Day 120. Subjects that are determined to be non-responders at Day 61 will continue treating with the active devices given at enrollment and will return to the clinic at Day 75 and Day 91 for a response assessment. If a subject is determined to be a responder at Day 75, they will be randomized 1:1 to receive either active treatment or inactive sham and will continue treating through Day 120. If a subject is determined to be a responder at Day 91, they will be randomized 1:1 to receive either active treatment or sham and will continue to treat through Day 120. If a subject continues to be a non-responder at Day 91 they will be terminated from the study.
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Diabetic Peripheral Neuropathy
7. Study Design
Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Parallel Assignment
Model Description
Subjects deemed "responders" after active treatment will be randomized in a 1:1 ratio to either active treatment or a sham device.
Masking
ParticipantCare ProviderInvestigatorOutcomes Assessor
Masking Description
Sham devices will look identical to active devices. This is a double-blind study.
Allocation
Randomized
Enrollment
44 (Actual)
8. Arms, Groups, and Interventions
Arm Title
Active Group
Arm Type
Experimental
Arm Description
Treatment with active Provant Therapy System
Arm Title
Sham Group
Arm Type
Sham Comparator
Arm Description
Treatment with Inactive (sham) Provant Therapy System
Intervention Type
Device
Intervention Name(s)
Active Provant Therapy System
Intervention Description
Treatment with active Provant Therapy System
Intervention Type
Device
Intervention Name(s)
Inactive (sham) Provant Therapy System
Intervention Description
Treatment with Inactive (sham) Provant Therapy System
Primary Outcome Measure Information:
Title
Vibration Perception Threshold (VPT)
Description
A non-invasive test used in quantifying sensation/sensitivity to vibration in evaluating sensory dysfunction associated with diabetic neuropathy
Time Frame
Baseline to End of Treatment (Day 121)
Title
Quantitative Sensory Testing (QST)
Description
QST is a noninvasive test used in peripheral nervous system disorders for thermal sensory testing.
Time Frame
Baseline to End of Treatment (Day 121)
Secondary Outcome Measure Information:
Title
Nerve Conduction Velocity (NCV) - Velocity
Description
NC-stat® DPNCheck® will be used to record NCV at Baseline and Day 121. Outcome Measure Data table displays change in NCV from Baseline to Day 121.
Time Frame
The sural nerve conduction velocity will be recorded at the Enrollment Visit and end of study visit (Day 121).
Title
Skin Perfusion Pressures (SPP)
Description
The Vasamed Sensilase PAD-IQ will be used to record SPP. This machine measures pressure (in mm Hg) of microcirculation using a laser Doppler sensor. Outcome Measure Data Table below displays change from Baseline to Day 121.
Time Frame
SPP will be conducted at the Enrollment Visit, Day 61, and end of study visit (Day 121).
Title
Pain Intensity (PI)
Description
Mean change from Baseline to Day 121, using a validated 11-point Numeric Pain Rating Scale (NPRS) with scores 0-10, where 0 = no pain and 10 = worst possible pain.
Time Frame
Collected as patient-reported outcomes on a paper diary and at the Enrollment visit to obtain a baseline value and on Days 61, 75, and 91
Title
Brief Pain Inventory (BPI); Question on Pain Right Now.
Description
The BPI long form will be administered at the Enrollment Visit, Day 30, 61, 91, and end of study visit (Day 121). Results for question #15 on Pain Right Now displayed below. Subject were asked to rate pain right now on a scale from 0 (no pain) to 10 (pain as bad as you can imagine).
Time Frame
Change in BPI, pain right now question, from Baseline to Day 121.
Title
Brief Fatigue Inventory (BFI)
Description
A 4-question assessment that assesses the level of fatigue and the impact of the fatigue on daily function over the last 24 hours. BFI is patient reported and collected at the Enrollment Visit, Days 30, 61, 91, and end of study visit (Day 121). A global fatigue score was calculated by averaging all of the values on the questionnaire and results for the change from Baseline to Day 121 are displayed below. The scale ranged from 0 (no fatigue/does not interfere) to 10 (as bad as you can imagine/completely interferes).
Time Frame
Change from Baseline to Day 121 in BFI.
Title
Patient Global Impression of Change (PGIC)
Description
A 7-choice validated categorical scale of overall change in status since initiation of treatment with the study device.PGIC was collected every 7 days in the paper diary, immediately following the morning treatment. Subjects were asked: Since the start of the study, my overall status is? Choices on the scale included: Very much worse, much worse, minimally worse, no change, minimally improved, much improved and very much improved.
Time Frame
PGIC results at Day 121 displayed below.
Title
Hospital Anxiety and Depression Scale (HADS)
Description
A patient reported 14 question assessment that detects the status of depression and anxiety. Subjects completed the assessment at the Enrollment Visit, Days 30, 61, 91, and end of study visit (Day 121). The total score for anxiety and the total score for depression was calculated at Day 121. Low scores represent normal (0-7) while high scores represent abnormal (11-21).
Time Frame
Change in Depression and Anxiety from Baseline to Day 121.
Title
Neuro-QoL
Description
A validated set of health-related quality of life measures that are domain specific.Subjects will completed 6 domains: (1) Pain, (2) Lost/Reduced Feeling, (3) Diffuse Sensory Motor Symptoms, (4) Restrictions in Activities of Daily Living, (5) Disruptions in Social Relationships, and (6) Emotional Distress.The short forms were completed by the subject at the Enrollment Visit and end of study visit (Day 121). Each question in the domain was rated on a symptom scale from 1 (never) to 5 (all the time) and a bothersome scale from 1 (none) to 3 (very much).
The total score for the domain was calculated by multiplying the symptom score by the bothersome score. The scale range is from 1 to 15 where the minimum (best/least symptomatic) score is 1 and the maximum (worst/most symptomatic) score is 15.
Time Frame
Change in each domain from Baseline to Day 121 is displayed below.
Title
Nerve Conduction Velocity (NCV) - Amplitude
Description
NC-stat® DPNCheck® will be used to record NCV at Baseline and Day 121. Outcome Measure Data table displays change in NCV from Baseline to Day 121.
Time Frame
The sural nerve conduction amplitude will be recorded at the Enrollment Visit and end of study visit (Day 121).
10. Eligibility
Sex
All
Minimum Age & Unit of Time
22 Years
Maximum Age & Unit of Time
80 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria:
Subject age is greater than or equal to 22 years and less than 80 years of age.
Subject has documented Type 1 or Type 2 diabetes mellitus (receiving insulin, diet controlled, or taking parenteral hypoglycemic agents)
Subject is on a stable antidiabetic regimen (medication and/or diet) to control their diabetes for at least 30 days prior to Screening.
Subject has an HbA1c <10% at Screening or within 2 months of Screening.
Subject has daily pain attributed to bilateral symmetrical Diabetic Peripheral Neuropathy with numbness, tingling, and/or burning based on clinical judgement for at least 6 months prior to screening.
Subject's pain or discomfort from DPN is identifiable.
Subject is in pain Phase 2, 3, or 4 as per the Phasing of Neuropathy Scale.
Subjects average pain over the last 24 hours is ≥3 based on the 11-point Numeric Pain Rating Scale (NPRS) at the Screening Visit.
Subject has adequate lower extremity pulse in both feet and no intermittent claudication.
Subject is able to ambulate independently without assistive devices.
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 agrees 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 is in pain Phase 1 or 5 as per the Phasing of Neuropathy Scale.
Subject has an active, open ulcer on the lower extremities.
Subject has peripheral vascular disease defined as absence of more than one foot pulse per foot and/or ABI <0.8 and >1.4 and/or history of angioplasty or peripheral bypass surgery within 6 months of the Screening Visit.
Subject has venous insufficiency as classified by the Venous Insufficiency Classification System of grade C6.
Subject has undergone nerve decompression surgery on the lower extremities.
Subject has a history of previous kidney, pancreas, cardiac transplantation, or severe renal disease.
Subject has been diagnosed with non-diabetic chronic inflammatory neuropathic disease (e.g. end stage renal disease, hepatitis C, chemotherapy induced neuropathy, known connective tissue disease, systemic lupus).
Subject has peripheral vascular disease requiring revascularization of lower limb or amputation or evidence of ulcer amputation.
Subject has clinically significant cardiovascular disease within 6 months prior to screening (unstable or poorly controlled hypertension, transient ischemic attack, MI, unstable angina, arrhythmia, any heart surgery, stent placement, heart disease).
Subject has a history of any uncontrolled medical illness that in the Investigators judgment places the subject at unacceptable risk for receipt of PEMF therapy.
Subject requires or anticipates the need for surgery of any type or travel during the treatment period.
Subject has a total foot depth (most inferior aspect of the medial malleolus to the plantar aspect of the foot when residing on a treatment pad) of >8 cm.
Subject has received any investigational drug or device 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 used systemic corticosteroids within 3 months of the Screening Visit.
Subject has a history of malignancy within the past 5 years other than successfully treated non-metastatic basal cell or squamous cell carcinomas of the skin in the treatment area and/or localized in situ carcinoma of the cervix.
Subject has a serious psychosocial co-morbidity.
Subject has a history of drug or alcohol abuse, as confirmed by urine drug screen, within one year prior to the Screening Visit.
Subject has an implanted pacemaker, defibrillator, neurostimulator, spinal cord stimulator, bone stimulator, cochlear implant, or other implanted device with an implanted metal lead(s).
Subject is currently pregnant or planning on becoming pregnant prior to Day 121.
Subject has previously treated with PROVANT® Therapy System within 60 days on the lower extremity.
Subject is unwilling or unable to follow study instructions or comply with the treatment regimen, diary documentation, and study visits.
Subject has pain from any other source that can confuse the assessment of the pain associated with DPN.
Subject has a clinically significant foot deformity (Charcot's syndrome or club foot).
Subject has received nerve blocks for neuropathic pain within 4 weeks of the Screening Visit.
Subject has been diagnosed with mononeuropathy.
Subject has a skin condition that could alter their sensation.
Subject has had a previous surgery to the spine or lower extremity with residual symptoms of pain or difficulty with movement.
Subject has moderate or severe arthropathy (RA, OA, Gout) that causes discomfort during casual walking or stair climbing.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Arthur Tallas, DPM
Organizational Affiliation
Associated Foot & Ankle Specialists, LLC
Official's Role
Principal Investigator
Facility Information:
Facility Name
Associated Foot & Ankle Specialists, LLC
City
Phoenix
State/Province
Arizona
ZIP/Postal Code
85015
Country
United States
12. IPD Sharing Statement
Plan to Share IPD
No
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Study of PEMF to Evaluate VPT and Thermal Sensory in Subjects With Diabetic Peripheral Neuropathy
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