Cervical RadiculopathyNCT04320836
Non-organic Signs to Predict Outcomes for Neck Pain
An observational study of Cervical Radiculopathy and Cervical Radicular Pain, run by Johns Hopkins University at 3 sites in 2 countries.
Trial summary
Neck pain is the 4th leading cause of disability in the world, with approximately 50% being neuropathic in nature. Epidural steroid injections (ESI) are one of the most commonly used treatments for cervical radiculopathy. Read more about this study
- Who is it for?
- Ages 18 to 90 years
- Conditions the study is for
- Cervical Radiculopathy, Cervical Radicular Pain
- What is being tested?
- Cervical epidural steroid injection
- Type of treatment
- Injection or infusion, Surgery or procedure
- How many people
- 78 participants
- Where
- 3 sitesin 2 countries
- Study dates
- 15 Jun 2020to 30 Mar 2022
- Phase
- Observational
- 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 18 to 90 years
- All sexes
- Adult, Older adult
Study population: Adult patients with clinical and MRI evidence of cervical radicular pain who are scheduled to undergo cervical epidural steroid injection
Who may be able to join
- Age > 18
- Cervical radicular pain based on history and physical exam (e.g. pain radiating into one or both extremities, sensory loss, muscle weakness, Spurling's test etc.)
- Pain duration > 6 weeks
- Average NRS arm pain score > 4
- MRI evidence of disc pathology consistent with symptoms
Who cannot join
- Untreated coagulopathy
- Previous spine surgery
- No MRI study
- Epidural steroid injection within past 3 years
- Radiculopathy resulting from tumor or herpes zoster
- Signs or symptoms or myelopathy or spinal cord compression
Show all 10Show fewer
- Allergic reactions to contrast allergy including macrocyclic gadolinium or depo-methylprednisolone
- Referrals from surgery for diagnostic injections for surgical evaluation
- Serious medical (e.g. congestive heart failure) condition that might preclude optimal outcome
- Pregnancy
Trial locations and contacts
3 sites in 2 countries.
3 sites in 2 countries
United States2 sites
Johns Hopkins
Baltimore, Maryland, 21205
DC VA Medical Center
Washington D.C., District of Columbia, 20422
About this study
Official title: Prospective Study to Determine Evaluate the Validity and Predictive Ability of Physical Exam Signs for Cervical Radiculopathy to Predict Epidural Steroid Injection (ESI) Treatment Outcomes.
Neck pain is the 4th leading cause of disability in the world, with approximately 50% being neuropathic in nature. Epidural steroid injections (ESI) are one of the most commonly used treatments for cervical radiculopathy. Physical exam signs, including non-organic signs, have been shown to predict outcomes for low back pain treatments, but have yet to be adequately studied for neck pain.
In this prospective, observational study, 72 patients with cervical radiculopathy undergoing an initial ESI for this pain episode will undergo a comprehensive history and physical examination that includes the presence of Spurling test, midline and paraspinal tenderness, 9 non-organic tests in 5 categories, and 3 questionnaires to assess depression, anxiety, sleep, and somatization. The investigators will also evaluate patients' MRI results to determine patients' precise pathology. Patients will then receive interlaminar cervical ESI. The primary outcome measure will be the difference in the proportion of people with a positive categorical outcome, defined as a >/= 2-point decrease in arm pain 4 weeks post-procedure coupled with a score >/= 5 on a 7-point patient global impression of change (PGIC) scale 4 weeks post-treatment, indicating subjective improvement.
Read more
The main objectives of this study are to:
- Determine the ability of physical exam, including non-organic signs, to predict ESI outcomes in individuals with cervical radicular pain.
- Determine the prevalence of different non-organic signs, and the association with other factors that may be associated with non-organic illness such as psychopathology and multiple unrelated pain conditions.
Read the detailed description
Seventy-two patients with cervical radiculopathy undergoing an initial ESI for this pain episode will undergo a comprehensive history and physical examination that includes the presence of Spurling test, midline and paraspinal tenderness, 9 non-organic tests in 5 categories, and 3 questionnaires to assess depression, anxiety, sleep, and somatization.
Non-organic signs that the investigators will evaluate are:
- Tenderness
- Superficial
- Non-anatomical (e.g. cervical radicular pain causing tenderness in the arm or mid-back)
- Sham stimulation
- Downward pressure on head elicits neck pain
- With hands clasped behind neck, passive rotation of shoulders elicits neck pain
- Distraction
- Inability to rotate head > 45 degrees during overt range-of-motion testing, but significantly greater range of motion when patient is lying prone and asked to turn head to respond to physician request (e.g. sign paper, count fingers, answer question).
- Regional disturbances
- Sensory disturbances that deviate from normal neuroanatomy or pathology (e.g. single herniated disc causing pain throughout entire arm or radiating into lower back)
- Motor disturbances that deviate from normal neuroanatomy or pathology (e.g. dramatic non-neurological weakness, give-away weakness)
- Overreaction
- Verbal (e.g. crying, screaming)
- Non-verbal (e.g. exaggerated grimacing, clutching affected area, abnormally slow or rigid movements)
The investigators will evaluate MRI results to determine the precise pathology. Patients will then receive interlaminar cervical ESI. In accordance with standard practice, a Tuohy needle will be directed towards the side of the radicular pain, with correct needle position in the epidural space being confirmed with real-time contrast injection. Once the physician is satisfied with the spread, a 3 mL solution consisting of depo-methylprednisolone 40 mg + 2 mL normal saline will be injected. At Seoul National University, due to Korean healthcare regulations, the mixture will be a 3 mL solution containing 10 mg of dexamethasone and 2 mL saline. The primary outcome measure will be the difference in the proportion of people with a positive categorical outcome, defined as a >/= 2-point decrease in average arm pain 4 weeks post-procedure coupled with a score >/= 5 on a 7-point patient global impression of change (PGIC) scale 4 weeks post-treatment, indicating subjective improvement. Secondary outcome measures will include mean reductions in average and worst 0-10 numerical rating scale (NRS) arm pain scores over the past 7 days, mean reduction in average and worst neck pain scores, neck disability index (NDI) score, medication usage, patient global impression of change (PGIC), Hospital Anxiety and Depression Scale (HADS), Athens Insomnia Scale (AIS), Somatic Symptom Scale-8 (SSS-8), and side effects. Individuals who experience a positive categorical outcome at 4 weeks will continue to be evaluated at 12 weeks, while those with a negative outcome will exit the study.
- Conditions
- Cervical Radiculopathy, Cervical Radicular Pain
- Being tested
- Cervical epidural steroid injection
- Keywords
- Cervicalgia, Neck pain, Cervical radiculopathy, Cervical radicular pain, Epidural steroid injection, Non-organic sign
- Medical subject headings
- Radiculopathy, Neck Pain
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Cervical epidural steroid injectionProcedure or surgery
Interlaminar cervical epidural steroid injection with steroid and normal saline at C6-7 and C7-T1 (standard of care).
| Study group | Role | What they receive |
|---|---|---|
| Cervical epidural steroid injection | This group will receive an interlaminar cervical ESI at C6-7 or C7-T1 with 1 mL steroid (depo-methylprednisolone 40 mg at Johns Hopkins and the DC VA Hospital or dexamethasone 10 mg at Seoul National University) and 2 mL normal saline. Receives: Procedure: Cervical epidural steroid injection |
What is being measured
The primary outcome is the main question the study is designed to answer.
Categorical response
Positive response is defined as a >/= 2-point reduction in average arm pain coupled with >/= 5/7 score on patient global impression of change. Anything else is a negative response.
Measured: 4 weeks
Secondary outcomes (19)
Average arm pain
Average arm pain on 0-10 numerical rating scale.
Measured: 4 weeks
Worst arm pain
Worst arm pain on 0-10 numerical rating scale.
Measured: 4 weeks
Average neck pain
Average neck pain on 0-10 numerical rating scale.
Measured: 4 weeks
Worst neck pain
Worst neck pain on 0-10 numerical rating scale.
Measured: 4 weeks
Neck disability index (NDI) score
NDI Score on 0-10 numerical rating scale.
Measured: 4 weeks
Somatic Symptom Scale (SS-8) score
8-question survey, out of 32 points measuring somatization.
Measured: 4 weeks
Athens Insomnia Scale (AIS) score
8-question survey, out of 24 points measuring sleep quality.
Measured: 4 weeks
Hospital Anxiety and Depression Scale (HADS)
14-question survey measuring anxiety and depression (each out of 21 points).
Measured: 4 weeks
Patient Global Impression of Change (PGIC) scale
7-point Likert scale measuring patient-reported improvement.
Measured: 4 weeks
Patient Global Impression of Change (PGIC) scale
7-point Likert scale measuring patient-reported improvement.
Measured: 12 weeks
Hospital Anxiety and Depression Scale (HADS)
14-question survey measuring anxiety and depression (each out of 21 points).
Measured: 12 weeks
Athens Insomnia Scale (AIS) score
8-question survey, out of 24 points measuring sleep quality.
Measured: 12 weeks
Somatic Symptom Scale (SS-8) score
8-question survey, out of 32 points measuring somatization.
Measured: 12 weeks
Average arm pain
Average arm pain on 0-10 numerical rating scale.
Measured: 12 weeks
Worst arm pain
Worst arm pain on 0-10 numerical rating scale.
Measured: 12 weeks
Average neck pain
Average neck pain on 0-10 numerical rating scale.
Measured: 12 weeks
Worst neck pain
Worst neck pain on 0-10 numerical rating scale.
Measured: 12 weeks
Neck disability index (NDI) score
NDI Score on 0-10 numerical rating scale.
Measured: 12 weeks
Categorical response
Positive response is a >/= 2-point reduction in average arm pain coupled with >/= 5/7 score on patient. Anything else is a negative response.
Measured: 12 weeks
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted25 Mar 2020
- Study start15 Jun 2020
- Primary completion30 Mar 2022
- Study completion30 Mar 2022
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (4)Papers the sponsor has linked to this study.
- Other trials for Cervical RadiculopathyStudies of the same condition, open and under way.
- More trials run by Johns Hopkins UniversityThe sponsor's other registered studies.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Observational
- Observational model
- Cohort
- Time perspective
- Prospective
- Enrolment
- 78 participants (actual)
Sponsor and investigators
- Lead sponsor
- Johns Hopkins University
- Sponsor type
- University, hospital or other
- Collaborators
- Washington DC VA Medical Center, Seoul National University
- Responsible party
- Sponsor
- Investigators
- Steven P Cohen, MD, Principal investigator, Johns Hopkins University
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT04320836
- Sponsor's protocol ID
- IRB00243203
- Status last verified
- Jun 2022
- First submitted
- 23 Mar 2020
- Last updated
- 10 Jun 2022
- Results posted
- No
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- Yes: Upon request
Publications
Fishbain DA, Cole B, Cutler RB, Lewis J, Rosomoff HL, Rosomoff RS. A structured evidence-based review on the meaning of nonorganic physical signs: Waddell signs. Pain Med. 2003 Jun;4(2):141-81. doi: 10.1046/j.1526-4637.2003.03015.x.
PubMed 12911018Waddell G, McCulloch JA, Kummel E, Venner RM. Nonorganic physical signs in low-back pain. Spine (Phila Pa 1976). 1980 Mar-Apr;5(2):117-25. doi: 10.1097/00007632-198003000-00005.
PubMed 6446157Jorritsma W, Dijkstra PU, De Vries GE, Geertzen JH, Reneman MF. Physical dysfunction and nonorganic signs in patients with chronic neck pain: exploratory study into interobserver reliability and construct validity. J Orthop Sports Phys Ther. 2014 May;44(5):366-76. doi: 10.2519/jospt.2014.4715. Epub 2014 Apr 14.
PubMed 24730436Cohen SP, Doshi TL, Dolomisiewicz E, Reece DE, Zhao Z, Anderson-White M, Kasuke A, Wang EJ, Hsu A, Davis SA, Yoo Y, Pasquina PF, Moon JY. Nonorganic (Behavioral) Signs and Their Association With Epidural Corticosteroid Injection Treatment Outcomes and Psychiatric Comorbidity in Cervical Radiculopathy: A Multicenter Study. Mayo Clin Proc. 2023 Jun;98(6):868-882. doi: 10.1016/j.mayocp.2022.11.022. Epub 2023 Feb 15.
PubMed 36803892
Study at a glance
From the registry record, last updated by the sponsor on 10 Jun 2022. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Prospective Study to Determine Evaluate the Validity and Predictive Ability of Physical Exam Signs for Cervical Radiculopathy to Predict Epidural Steroid Injection (ESI) Treatment Outcomes.
- ClinicalTrials.gov ID
- NCT04320836
- Acronym / sponsor ID
- IRB00243203
- Conditions
- Cervical Radiculopathy, Cervical Radicular Pain
- Keywords
- Cervicalgia, Neck pain, Cervical radiculopathy, Cervical radicular pain, Epidural steroid injection, Non-organic sign
- Study type
- Observational
- Recruitment status
- Completed
- Enrolment
- 78 participants (actual)
- Lead sponsor
- Johns Hopkins UniversityUniversity, hospital or other
- Collaborators
- Washington DC VA Medical Center, Seoul National University
- Study start
- 15 Jun 2020 (actual)
- Primary completion
- 30 Mar 2022 (actual)
- Study completion
- 30 Mar 2022 (actual)
- First posted
- 25 Mar 2020 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
Neck pain is the 4th leading cause of disability in the world, with approximately 50% being neuropathic in nature. Epidural steroid injections (ESI) are one of the most commonly used treatments for cervical radiculopathy. Physical exam signs, including non-organic signs, have been shown to predict outcomes for low back pain treatments, but have yet to be adequately studied for neck pain.
In this prospective, observational study, 72 patients with cervical radiculopathy undergoing an initial ESI for this pain episode will undergo a comprehensive history and physical examination that includes the presence of Spurling test, midline and paraspinal tenderness, 9 non-organic tests in 5 categories, and 3 questionnaires to assess depression, anxiety, sleep, and somatization. The investigators will also evaluate patients' MRI results to determine patients' precise pathology. Patients will then receive interlaminar cervical ESI. The primary outcome measure will be the difference in the proportion of people with a positive categorical outcome, defined as a >/= 2-point decrease in arm pain 4 weeks post-procedure coupled with a score >/= 5 on a 7-point patient global impression of change (PGIC) scale 4 weeks post-treatment, indicating subjective improvement.
The main objectives of this study are to:
- Determine the ability of physical exam, including non-organic signs, to predict ESI outcomes in individuals with cervical radicular pain.
- Determine the prevalence of different non-organic signs, and the association with other factors that may be associated with non-organic illness such as psychopathology and multiple unrelated pain conditions.
Detailed description
Seventy-two patients with cervical radiculopathy undergoing an initial ESI for this pain episode will undergo a comprehensive history and physical examination that includes the presence of Spurling test, midline and paraspinal tenderness, 9 non-organic tests in 5 categories, and 3 questionnaires to assess depression, anxiety, sleep, and somatization.
Non-organic signs that the investigators will evaluate are:
- Tenderness
- Superficial
- Non-anatomical (e.g. cervical radicular pain causing tenderness in the arm or mid-back)
- Sham stimulation
- Downward pressure on head elicits neck pain
- With hands clasped behind neck, passive rotation of shoulders elicits neck pain
- Distraction
- Inability to rotate head > 45 degrees during overt range-of-motion testing, but significantly greater range of motion when patient is lying prone and asked to turn head to respond to physician request (e.g. sign paper, count fingers, answer question).
- Regional disturbances
- Sensory disturbances that deviate from normal neuroanatomy or pathology (e.g. single herniated disc causing pain throughout entire arm or radiating into lower back)
- Motor disturbances that deviate from normal neuroanatomy or pathology (e.g. dramatic non-neurological weakness, give-away weakness)
- Overreaction
- Verbal (e.g. crying, screaming)
- Non-verbal (e.g. exaggerated grimacing, clutching affected area, abnormally slow or rigid movements)
The investigators will evaluate MRI results to determine the precise pathology. Patients will then receive interlaminar cervical ESI. In accordance with standard practice, a Tuohy needle will be directed towards the side of the radicular pain, with correct needle position in the epidural space being confirmed with real-time contrast injection. Once the physician is satisfied with the spread, a 3 mL solution consisting of depo-methylprednisolone 40 mg + 2 mL normal saline will be injected. At Seoul National University, due to Korean healthcare regulations, the mixture will be a 3 mL solution containing 10 mg of dexamethasone and 2 mL saline. The primary outcome measure will be the difference in the proportion of people with a positive categorical outcome, defined as a >/= 2-point decrease in average arm pain 4 weeks post-procedure coupled with a score >/= 5 on a 7-point patient global impression of change (PGIC) scale 4 weeks post-treatment, indicating subjective improvement. Secondary outcome measures will include mean reductions in average and worst 0-10 numerical rating scale (NRS) arm pain scores over the past 7 days, mean reduction in average and worst neck pain scores, neck disability index (NDI) score, medication usage, patient global impression of change (PGIC), Hospital Anxiety and Depression Scale (HADS), Athens Insomnia Scale (AIS), Somatic Symptom Scale-8 (SSS-8), and side effects. Individuals who experience a positive categorical outcome at 4 weeks will continue to be evaluated at 12 weeks, while those with a negative outcome will exit the study.
Study design
- Observational model
- Cohort
- Time perspective
- Prospective
- Number of arms
- 1
| Arm | Type | Receives |
|---|---|---|
| Cervical epidural steroid injection | – | Procedure: Cervical epidural steroid injectionThis group will receive an interlaminar cervical ESI at C6-7 or C7-T1 with 1 mL steroid (depo-methylprednisolone 40 mg at Johns Hopkins and the DC VA Hospital or dexamethasone 10 mg at Seoul National University) and 2 mL normal saline. |
Who may qualify
- Ages
- 18 to 90 years
- Sex
- All
- Age groups
- Adult, Older adult
- Study population
- Adult patients with clinical and MRI evidence of cervical radicular pain who are scheduled to undergo cervical epidural steroid injection
Key inclusion criteria (5 listed)
- Age > 18
- Cervical radicular pain based on history and physical exam (e.g. pain radiating into one or both extremities, sensory loss, muscle weakness, Spurling's test etc.)
- Pain duration > 6 weeks
- Average NRS arm pain score > 4
- MRI evidence of disc pathology consistent with symptoms
Key exclusion criteria (10 listed)
- Untreated coagulopathy
- Previous spine surgery
- No MRI study
- Epidural steroid injection within past 3 years
- Radiculopathy resulting from tumor or herpes zoster
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Cervical epidural steroid injectionInterlaminar cervical epidural steroid injection with steroid and normal saline at C6-7 and C7-T1 (standard of care). | Procedure or surgery | Cervical epidural steroid injection |
Primary outcome
Categorical response
Time frame: 4 weeks
Positive response is defined as a >/= 2-point reduction in average arm pain coupled with >/= 5/7 score on patient global impression of change. Anything else is a negative response.
19 secondary outcomes
Average arm pain
Time frame: 4 weeks
Worst arm pain
Time frame: 4 weeks
Average neck pain
Time frame: 4 weeks
Worst neck pain
Time frame: 4 weeks
Neck disability index (NDI) score
Time frame: 4 weeks
Somatic Symptom Scale (SS-8) score
Time frame: 4 weeks
Athens Insomnia Scale (AIS) score
Time frame: 4 weeks
Hospital Anxiety and Depression Scale (HADS)
Time frame: 4 weeks
Patient Global Impression of Change (PGIC) scale
Time frame: 4 weeks
Patient Global Impression of Change (PGIC) scale
Time frame: 12 weeks
Hospital Anxiety and Depression Scale (HADS)
Time frame: 12 weeks
Athens Insomnia Scale (AIS) score
Time frame: 12 weeks
Somatic Symptom Scale (SS-8) score
Time frame: 12 weeks
Average arm pain
Time frame: 12 weeks
Worst arm pain
Time frame: 12 weeks
Average neck pain
Time frame: 12 weeks
Worst neck pain
Time frame: 12 weeks
Neck disability index (NDI) score
Time frame: 12 weeks
Categorical response
Time frame: 12 weeks
Results and safety
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 10 Jun 2022.
- Background: PubMed 12911018Fishbain DA, Cole B, Cutler RB, Lewis J, Rosomoff HL, Rosomoff RS. A structured evidence-based review on the meaning of nonorganic physical signs: Waddell signs. Pain Med. 2003 Jun;4(2):141-81. doi: 10.1046/j.1526-4637.2003.03015.x.
- Background: PubMed 6446157Waddell G, McCulloch JA, Kummel E, Venner RM. Nonorganic physical signs in low-back pain. Spine (Phila Pa 1976). 1980 Mar-Apr;5(2):117-25. doi: 10.1097/00007632-198003000-00005.
- Background: PubMed 24730436Jorritsma W, Dijkstra PU, De Vries GE, Geertzen JH, Reneman MF. Physical dysfunction and nonorganic signs in patients with chronic neck pain: exploratory study into interobserver reliability and construct validity. J Orthop Sports Phys Ther. 2014 May;44(5):366-76. doi: 10.2519/jospt.2014.4715. Epub 2014 Apr 14.
- Derived from this study: PubMed 36803892Cohen SP, Doshi TL, Dolomisiewicz E, Reece DE, Zhao Z, Anderson-White M, Kasuke A, Wang EJ, Hsu A, Davis SA, Yoo Y, Pasquina PF, Moon JY. Nonorganic (Behavioral) Signs and Their Association With Epidural Corticosteroid Injection Treatment Outcomes and Psychiatric Comorbidity in Cervical Radiculopathy: A Multicenter Study. Mayo Clin Proc. 2023 Jun;98(6):868-882. doi: 10.1016/j.mayocp.2022.11.022. Epub 2023 Feb 15.
- Individual participant dataSharing planned: Yes. Upon request
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Steven P Cohen, MD principal investigator
Johns Hopkins University
3 sites in 2 countries: see every site and its status.
Questions about this trial
What is this clinical trial studying?
An observational study of Cervical Radiculopathy and Cervical Radicular Pain, run by Johns Hopkins University at 3 sites in 2 countries.
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 5 inclusion and 10 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: finished, as of the sponsor's last update on 10 Jun 2022. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 3 sites in United States, South Korea. 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. 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 is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
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?
Categorical response (time frame: 4 weeks). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT04320836, which also lists 4 linked publications.
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 10 Jun 2022.