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Infantile ColicCHICNCT02138656

CHiropractic for Infantile Colic Study

A study testing Chiropractic in people with Infantile Colic, run by University of Southampton at 1 site in United Kingdom.

Terminated

Stopped early. The study ended before it was planned to and will not resume.

Official record
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Trial 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: 1. Do parents of colicky infants randomised to the groups receiving a course of McTimoney chiropractic treatment: report a significantly greater… Read more about this study

Who is it for?
Ages 1 day to 12 weeks
Conditions the study is for
Infantile Colic
What is being tested?
Chiropractic
Could I receive a placebo?
Yes, some participants may receive a placebo
How many people
1 participants
Where
1 siteUnited Kingdom
Study dates
Mar 2014to Dec 2014
Phase
Interventional
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 1 day to 12 weeks
  • All sexes
  • No healthy volunteers
  • Child

Who may be able to join

  • 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

Who cannot join

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

Trial locations and contacts

1 site in 1 country.

United Kingdom1 site
  • University of Southampton

    Southampton, Hampshire

Other trials in United Kingdom

About this study

Official title: The Effectiveness of Chiropractic in the Treatment of Infantile Colic

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:

  1. Do parents of colicky infants randomised to the groups receiving a course of McTimoney chiropractic treatment:
Read more
  • 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?
  1. 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:

  1. 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
  2. Any particular characteristics of the treatment (e.g. specific adjustments) that are associated with good or poor outcomes.
Read the 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.

Conditions
Infantile Colic
Being tested
Chiropractic, Best Standard Care
Keywords
Crying, Chiropractic, Infant, pediatric, Infantile colic, Clinical Trial
Medical subject headings
Colic, Crying

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • ChiropracticOther

    Chiropractic treatment delivered in accordance with clinical protocols developed and agreed with the participant clinicians

  • Best Standard CareOther

    Counselling and advice delivered in accordance with the Map of Medicine care pathway for Infantile colic

Study groups in NCT02138656
Study groupRoleWhat they receive
Best standard care only - not blindActive comparatorBest Standard Care (as defined by Map of Medicine care pathway) - counseling and advice. Parents aware that infant is not receiving chiropractic treatment
Receives: Other: Best Standard Care
Best Standard Care and Sham - BlindSham comparatorBest 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.
Receives: Other: Best Standard Care
BSC & Chiropractic - Not blindExperimentalBest 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.
Receives: Other: Chiropractic; Other: Best Standard Care
BSC & Chiropractic - BlindExperimentalBest 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.
Receives: Other: Chiropractic; Other: Best Standard Care

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Changes to the duration of crying per day

    Measured: Baseline to day after first clinic visit (~day 2), mid point (~day 8) and final clinic visit (~day 15)

  2. Proportion of infants achieving clinically-relevant reduction in crying time

    Defined as 60 minutes (median) based on survey

    Measured: Baseline to day after first clinic visit (~day 2), mid point (~day 8) and final clinic visit (~day 15)

  3. Proportion of infants reported with absence of 'colic'

    Taken from the Parental Global Impression of Severity scale

    Measured: Follow-up telephone call after first, mid point and final clinic visit (approx days 2, 8 and 15)

  4. Number of adverse events

    Measured: at any time during an infant's engagement in the study, circa 28 days

Secondary outcomes (9)
  1. Changes to the duration of crying per day

    Measured: baseline to day 21 and day 28

  2. Changes to parental anxiety and depression scores

    Measured: first visit (day 1) to each of the 5 follow-up questionnaires (~day 2, 8, 15, 21 & 28)

  3. Proportion of infants achieving clinically-relevant reduction in crying time

    Measured: From baseline to day 21 and day 28 follow ups

  4. Proportion of infants reported with absence of 'colic'

    Measured: At day 21 and day 28 (final 2 follow-ups)

  5. Parental Global Impressions of Change in symptoms

    Measured: At each of the follow-up questionanaires (~day 2, 8, 15, 21 and 28)

  6. 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.

    Measured: Reported 'during the preceding week' at each telephone questionnaire (~day 2, 8, 15, 21 and 28)

  7. 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

    Measured: Baseline to day after first, mid point and final clinic visits (~days 2, 8, 15) then to day 21 and day 28

  8. Change to Parental Global Impressions of Severity

    Measured: Baseline to follow-ups after first second and final clinic visits (~days 2, 8, 15) then to day 21 and day 28 follow ups

  9. Effectiveness of Blinding

    Proportion of correct, incorrect and 'don't know' guesses, reported using James' and Bangs' blinding indices

    Measured: 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)

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted14 May 2014 (estimated)
  2. Study startMar 2014
  3. Primary completionDec 2014
  4. Study completionDec 2014

Why it stopped: Review of recruitment methods

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Factorial
Masking
Double blind
Who is masked
Participant, Outcomes assessor
Enrolment
1 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT02138656
Sponsor's protocol ID
ERGO 4866
Acronym
CHIC
Status last verified
Apr 2021
First submitted
28 Apr 2014
Last updated
26 Apr 2021
Results posted
No
Data monitoring committee
Yes

Questions about this trial

What is this clinical trial studying?

A study testing Chiropractic in people with Infantile Colic, run by University of Southampton at 1 site in United Kingdom.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 4 inclusion and 1 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: stopped early, as of the sponsor's last update on 26 Apr 2021. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in United Kingdom. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. Some participants in this study may receive a placebo. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

The study was stopped early (reason given: Review of recruitment methods). Results are not available in the source record.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

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)). The study lists 4 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 26 Apr 2021.

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