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Stroke, AcuteNCT05004389

Biomarkers of Independent Walking Post-Stroke

An observational study of Stroke, Acute and Gait, Hemiplegic, run by University of Vermont at 1 site in United States.

Unknown status

Status not confirmed. The sponsor has not verified this record for over two years, so it may be out of date.

Official record
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Trial summary

Prediction of walking recovery after stroke can inform patient-centered care and support discharge planning. The accuracy of current prediction models is limited, however, due to small study designs and narrow predictors assessed. Read more about this study

Who is it for?
Ages 18 years and older
Conditions the study is for
Stroke, Acute, Gait, Hemiplegic
What is being tested?
MRI, blood draw and Clinical assessments
How many people
35 participants
Where
1 siteUnited States
Study dates
2 Dec 2021to May 2023
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 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Study population: Adults (age ≥ 18 years old) with acute ischemic or intracerebral hemorrhagic stroke from the local medical center.

Inclusion criteria: 1) individuals with acute (≤ 7 days) ischemic or intra-cerebral hemorrhagic stroke; 2) ≥18 years of age; 3) presence of new lower limb weakness (less than 5/5 on manual muscle testing) on one side of the body or notation of weakness by MD or PT) on one side of the body; 4) unable to walk or requires supervision or assistance for walking.

Exclusion criteria: 1) cerebellar or bilateral stroke; 2) requirement for supervision or physical assistance to walk prior to admission; 3) other neurological disorders such as Parkinson's Disease or Multiple Sclerosis, 4) severe hearing impairment, 5) blindness, 6) actively receiving treatment for cancer, 7) not expected to survive for duration of the study, and 8) diagnosis of current clinical definition of active COVID-19.

Trial locations and contacts

1 site in 1 country.

Denise Peters, DPT, PhD contact

802-656-1709

denise.peters@med.uvm.edu

United States1 site, 1 recruiting
  • University of Vermont Medical Center

    Burlington, Vermont, 05405

    Swapna Research Coordinator, swapna.balakrishnan@uvm.edu

    Recruiting

Other trials in United States

About this study

Official title: Investigation of Clinical, Blood, and Neuroimaging Biomarkers as Predictors of Independent Walking Post-Stroke

Prediction of walking recovery after stroke can inform patient-centered care and support discharge planning. The accuracy of current prediction models is limited, however, due to small study designs and narrow predictors assessed. The investigators propose a comprehensive evaluation of a novel combination of biomarkers to improve prediction of walking recovery and guide rehabilitation efforts after stroke. These include acute structural brain network disruption (utilizing MRI); blood biomarker levels (e.g., brain-derived neurotrophic factor and vascular endothelial growth factor); and clinical assessments of strength and mobility. The overall study objectives are to assess protocol feasibility and investigate relationships between select biomarkers and walking recovery to provide strong justification for a larger study on predictors of independent walking after stroke. The proposed objectives will be pursued through the following specific aims: 1) Assess feasibility of a larger study and develop methods for telehealth data collection; 2) Establish baseline levels of biomarkers and average change over time; and 3) Elucidate relationships between baseline levels of biomarkers and walking gains across time in persons after stroke. A longitudinal, observational study design will be utilized for this study. Thirty-five persons with acute (≤7 days) stroke will be recruited from the local medical center. Select inclusion criteria include presence of new lower limb weakness and assistance for walking; select exclusion criteria include cerebellar stroke or other neurological disorders such as Parkinson's Disease. Subjects will undergo clinical evaluation at week 1, 4, 9, 12, and 26 weeks post-stroke. MRI scans will occur within 12 days post-stroke and at 12 weeks post-stroke, and blood draws within 1 week, 1 to 2 weeks and at 12 weeks post-stroke. To assess feasibility the investigators will examine study processes, recruitment, resources, study management, and scientific assessment. To examine the role of acute clinical, neuroimaging, and physiological measures in predicting walking recovery, the investigators will examine relationships between these measures and walking outcome at 12-weeks post-stroke. The proposed research is expected to provide strong scientific support for future clinical trials designed to target therapies based on predicted functional potential. Such knowledge has the potential of enhancing mobility gains and patient independence following stroke.

Read the detailed description

The investigators will utilize a longitudinal, observational study design to investigate predictors of walking recovery post-stroke. Subjects will undergo clinical evaluation at week 1, 4, 9, 12, and 26 weeks after the initial onset of stroke symptoms; MRI scan within 12 days and at 12 weeks post-stroke; and blood draws at 1 week, 1 to 2 weeks and at 12 weeks post-stroke. Subjects will be recruited from the University of Vermont Medical Center (UVMMC), with a goal sample of 35 patients (accounts for 15% attrition). Subjects will provide written consent before participation.

Aim 1: Assess feasibility of a larger study and develop methods for telehealth data collection

Data Collection: To assess feasibility the investigators will examine study processes, recruitment, resources, study management, and scientific assessment.

Data Analyses: Feasibility questions will be examined using descriptive statistics and qualitative analyses. To ensure collection and dissemination of high quality data, the "CONSORT 2010 checklist of information to include when reporting a pilot or feasibility trial" will be used to guide data collection and analysis.

Aim 2: Establish baseline levels of biomarkers (clinical, neuroimaging, blood) and average change over time.

Experimental Protocol: Subjects will undergo baseline clinical assessment (within 1-week post-stroke), MRI scan (within 12 days post-stroke), and blood draw (within 1 week post-stroke). These same measures will be repeated 12 weeks after stroke (primary predictive outcome).

Data Analyses:

  1. Establishing baseline levels of clinical measures, neuroimaging and blood biomarkers: To determine the variability in participants' walking ability/balance/strength, post-stroke preservation of sensorimotor connectivity, and acute changes in blood markers associated with immune response (IL-6, IL-10, cross-reacting protein, TNF alpha), neural function (BDNF), and blood vessel/ circulation (VEGF, matrix metalloproteinase, insulin like growth factor-1, cGP), descriptive statistics will be obtained. Results will be stratified by stroke characteristics and NIHSS score.
  2. Quantifying change over time for clinical measures: defined as the average difference between 1-4-,9-,12-, and 26-week values. To examine change over time, the investigators will perform paired t-tests (or non-parametric equivalent) and effect size calculations on all outcome measures, using the 12 week post-stroke timepoint as the primary outcome. The investigators will also use the following minimal clinically important difference (MCID) or minimal detectable change (MDC) values to determine if observed statistical differences are clinically relevant: 0.16 m/s change in gait speed, 6-point change in Berg Balance Scale, and a change of three repetitions in 30 second Sit-To-Stand.
  3. Quantifying change over time for neuroimaging and blood biomarkers: defined as the average difference between baseline and 12-week values. To examine change over time, the investigators will perform paired t-tests (or non-parametric equivalent) and effect size calculations.
  4. Secondary analyses: will be performed with assistance and training from Core C (e.g., 5 dimensions spatial-temporal maps of walking biomechanics and/or muscle activation).

Aim 3: Elucidate relationships between baseline levels of biomarkers and walking gains across time in persons after stroke.

Experimental Protocol: Subjects will undergo the same experimental procedures as in Aims 1 and 2.

Data Analysis: To study the role of acute clinical, neuroimaging, and physiological measures in predicting recovery of independent walking post-stroke, the investigators will examine relationships between these measures and walking outcome as defined by the Functional Ambulation Category (FAC).

  1. Identifying the time to regaining independent walking after stroke: defined as the time post-stroke (as measured at 1, 4, 9, 12, or 26 weeks post-stroke) at which a participant achieves a score of ≥4 on the FAC.
  2. Quantifying the relationship between acute measures and walking outcome at 12 weeks post-stroke (primary predictive outcome): the relationship between clinical, MRI, and blood biomarkers and walking outcome at 12 weeks post-stroke (± independently walking) will be examined using logistic regression, correcting for potential confounders [age, sex, stroke severity (NIHSS)]. Secondary analyses will be performed by evaluating trends over time (repeated measures model).
Being tested
MRI, blood draw, Clinical assessments
Medical subject headings
Stroke, Gait Disorders, Neurologic

What participants receive

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

  • MRIDiagnostic test

    white matter integrity and brain structural connectivity metrics

  • blood drawDiagnostic test

    post-stroke serum/plasma levels of BDNF, VEGF, IL-6, IL-10, CRP, TNFalpha, MMPs, IGF-1, cGP

  • Clinical assessmentsOther

    measures of strength, balance, and mobility

Study groups in NCT05004389
Study groupRoleWhat they receive
Acute StrokePersons ≥ 18 years of age with acute (≤ 7 days) ischemic or intracerebral hemorrhagic stroke.
Receives: Diagnostic Test: MRI; Diagnostic Test: blood draw; Other: Clinical assessments

What is being measured

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

  1. Change in Functional Ambulation Category

    Assessment of walking assistance

    Measured: week 1, week 4, week 9, week 12, and week 26 s/p stroke

  2. Change in diffusion tensor imaging

    fractional anisotropy and structural connectivity metrics

    Measured: within 12 days and at 12 weeks post-stroke

  3. Change in blood markers - BDNF

    serum BDNF

    Measured: within week 1, at 1-2 weeks and at 12 weeks post-stroke

  4. Change in blood markers - VEGF

    serum VEGF

    Measured: within week 1, at 1-2 weeks and at 12 weeks post-stroke

Secondary outcomes (21)
  1. Change in National Institutes of Health Stroke Scale

    Stroke severity assessment; scores range from 0 (min) to 42 (max), with higher values indicating greater stroke severity (worse outcome)

    Measured: within 72 hours and 1 week post-stroke

  2. Mini-Mental Status Exam

    Cognition

    Measured: 1 week post-stroke

  3. Change in 3-meter walk test

    Assessment of gait speed

    Measured: week 1, week 4, week 9, week 12, and week 26 s/p stroke

  4. Change in Trunk Control Test

    Assessment of trunk/postural control

    Measured: week 1, week 4, week 9, week 12, and week 26 s/p stroke

  5. Change in lower extremity muscle strength as assessed by Medical Research Council grades

    Assessment of specific muscle strength; scores range from 0 (no muscle contraction) to 5 (normal power)

    Measured: week 1, week 4, week 9, week 12, and week 26 s/p stroke

  6. Change in Berg Balance Scale

    Assessment of static/dynamic sitting and standing balance; scores range from 0 (min) to 56 (max), with higher values indicating better balance/outcome

    Measured: week 1, week 4, week 9, week 12, and week 26 s/p stroke

  7. Change in Motricity Index (lower limb portion)

    assessment of motor function/strength of the lower limbs

    Measured: week 1 , week 4, week 9, week 12, and week 26 s/p stroke

  8. Change in Modified 30 second sit to stand

    Assessment of lower limb power

    Measured: week 1, week 4, week 9, week 12, and week 26 s/p stroke

  9. Change in Fatigue Severity Scale

    Assessment of fatigue level; scores range from 9 (min) to 63 (max), with higher values indicating greater fatigue severity (worse outcome)

    Measured: week 1, week 4, week 9, week 12, and week 26 s/p stroke

  10. Change in Barthel Index

    Assessment of activities of daily living

    Measured: week 12 and 26 s/p stroke

  11. Change in Modified Rankin Scale

    Assessment of level of disability; scores range from 0 (min) to 5 (max), with higher values indicating greater disability (worse outcome)

    Measured: week 12 and 26 s/p stroke

  12. Change in physical activity levels as assessed by the Physical Activity Vital Sign questionnaire

    Assessment of physical activity levels; self-report of average number of days and minutes engaged in physical activity per week

    Measured: week 12 and 26 post-stroke

  13. Change in Opal sensor metric - gait

    Assessment of spatiotemporal parameters of gait

    Measured: week 1, week 4, week 9, week 12, and week 26 s/p stroke

  14. Change in Opal sensor metric - posture

    Assessment of postural sway

    Measured: week 1, week 4, week 9, week 12, and week 26 s/p stroke

  15. Change in blood markers - IL-6

    IL-6

    Measured: within week 1,at 1-2 weeks and at 12 weeks post-stroke

  16. Change in blood markers - IL-10

    IL-10

    Measured: within week 1,at 1-2 weeks and at 12 weeks post-stroke

  17. Change in blood markers - C reactive protein

    CRP

    Measured: within week 1 ,at 1-2 weeks and at 12 weeks post-stroke

  18. Change in blood markers - TNFalpha

    TNFalpha

    Measured: within week 1, at 1-2 weeks and at 12 weeks post-stroke

  19. Change in blood markers - matrix metalloproteinase

    MMP

    Measured: within week 1, at 1-2 weeks and at 12 weeks post-stroke

  20. Change in blood markers - insulin-like growth factor-1

    IGF-1

    Measured: within 1 week, at 1-2 weeks and at 12 weeks post-stroke

  21. Change in blood markers - cGP

    cGP

    Measured: within 1 week, at 1-2 weeks and at 12 weeks post-stroke

Timeline

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

  1. First posted13 Aug 2021
  2. Study start2 Dec 2021
  3. Primary completionMay 2023 (estimated)
  4. Study completionMay 2023 (estimated)

Resources

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
35 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT05004389
Sponsor's protocol ID
00000696
Other IDs
P20GM135007
Status last verified
Mar 2023
First submitted
27 Jul 2021
Last updated
14 Mar 2023
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Undecided: Data to be shared: unidentified clinical assessment and imaging data; serum/plasma samples will be stored in repository for future use.

Questions about this trial

What is this clinical trial studying?

An observational study of Stroke, Acute and Gait, Hemiplegic, run by University of Vermont at 1 site in United States.

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

Who may be eligible to take part?

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: status not confirmed, as of the sponsor's last update on 14 Mar 2023. 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 States. 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?

Results are not available in the source record.

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

Contact Denise Peters, DPT, PhD (802-656-1709, denise.peters@med.uvm.edu), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Change in Functional Ambulation Category (time frame: week 1, week 4, week 9, week 12, and week 26 s/p stroke). 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 14 Mar 2023.

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