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Active, not recruitingNCT03444454Updated May 3, 2024

Telerehabilitation in Multiple Sclerosis

An interventional study of VRRS Khymeia and Usual care program in Multiple Sclerosis, sponsored by Fondazione Don Carlo Gnocchi Onlus. Active, not recruiting at 1 site in Italy. Open to participants aged 25 Years to 70 Years. Per ClinicalTrials.gov, last updated 2024-05-03.

Sponsored by Fondazione Don Carlo Gnocchi Onlus · Not applicable, Interventional, and Treatment

Phase
Not applicable
Study type
Interventional
Enrollment
136
Allocation
Randomized
Ages
25 Years to 70 Years
Sex
All
01

Study summary

The main aim of the study is to evaluate the efficacy of the Virtual Reality Rehabilitation System (VRRS, Khymeia) compared to usual care treatment for patients with MS at home.

The effects of the intervention on outcome variables will be assessed using a randomized controlled trial design with a comparison group receiving usual care training. The investigators will assess the effect of VRRS system on the quality of life, motor, and cognitive abilities. (Phase I) In the second phase of the present study we aim to evaluate the effects induced by the treatment of active (anodal) transcranial Direct Current Stimulation (tDCS) applied to the left dorsolateral prefrontal cortex (lDLPFC) combined with VRRS compared to placebo tDCS stimulation combined with VRRS. The effects of the intervention patient-relevant outcomes will be assessed using a randomized controlled trial design with four groups. The investigators will assess the effect of VRRS system on patient-relevant outcomes motor, cognitive and participation. (Phase II)

02

Conditions studied

  • Multiple Sclerosis

Keywords

  • Telerehabilitation
  • Virtual reality
  • Quality of life
  • transcranial Direct Current Stimulation
03

Who can participate

Ages eligible
25 Years to 70 Years
Sexes eligible
All
Accepts healthy volunteers
No

Inclusion criteria

  • Confirmed diagnosis of Multiple Sclerosis (RR and SP) based on McDonald criteria
  • Education ≥ 8 ages
  • Italian mother language
  • Right-handedness
  • Use of corticosteroids for three months prior to the study, having and no acute exacerbations of symptoms within three months of the study.

Exclusion criteria

Exclusion Criteria:

  • Existence of visual acuity and acoustic perception problems, to prevent performance of VRRS activities
  • Relapses next to the time of enrolment (3 months)
  • EDSS > 6.5.
04

Study design

Phase
Not applicable
Primary purpose
Treatment
Allocation
Randomized
Intervention model
Parallel assignment
Masking
Triple (Participant, Investigator, Outcomes assessor)
Enrollment
136 participants (actual)

Study arms

  • Experimental
    VRRS Khymeia

    The group will receive a kit home-based (a tablet home, an exercise equipment, access to a daily individualized training program). The exercise program will be remotely charged by therapist on the patient's computer. Each patient's performed session will be reviewed remotely by the therapist.

    Behavioral: VRRS Khymeia

  • Active comparator
    Usual care program

    The usual care group will have written, home-based exercise program, provided to them at an initial face-to-face assessment.

    Behavioral: Usual care program

  • Experimental
    VRRS Khymeia plus active tDCS

    The group will receive 5 sessions each lasting 45 minutes of an individualized home-based VRRS training combined with active (anodal) tDCS applied to the left dorsolateral prefrontal cortex over 1 week, followed by 5 weeks of home-based VRRS training

    Behavioral: VRRS Khymeia plus active tDCS

  • Active comparator
    VRRS Khymeia plus placebo tDCS

    The group will receive 5 sessions of an individualized home-based VRRS training combined with placebo tDCS applied to the left dorsolateral prefrontal cortex over 1 week, followed by 5 weeks of home-based VRRS training

    Behavioral: VRRS Khymeia plus placebo tDCS

Interventions

  • BehavioralVRRS Khymeia

    Participants will receive an individualized exercise program set up by the therapist. The intervention applied to the experimental group will consist of 30 sessions of Khymeia VRRS training distributed in five sessions for week, each lasting 45 minutes. Each session is constructed by alternating physical with cognitive activities. The sessions will initially be tailored to the patient's baseline characteristics. Remotely, the therapist will then adjust the participant's exercise program as appropriate, by changing exercises, level of difficulty or number of repetitions.

  • BehavioralUsual care program

    The usual care group will have written, home-based exercise program, provided to them at an initial face-to-face assessment.

  • BehavioralVRRS Khymeia plus active tDCS

    Participants will receive 5 sessions each lasting 45 minutes of an individualized home-based VRRS training combined with active (anodal) tDCS applied to the left dorsolateral prefrontal cortex over 1 week, followed by 5 weeks of home-based VRRS training. The sessions of VRRS will initially be tailored to the patient's baseline characteristics. Remotely, the therapist will then adjust the participant's exercise program as appropriate, by changing exercises, level of difficulty or number of repetitions.

  • BehavioralVRRS Khymeia plus placebo tDCS

    Participants will receive 5 sessions each lasting 45 minutes of an individualized home-based VRRS training combined with active (anodal) tDCS applied to the left dorsolateral prefrontal cortex over 1 week, followed by 5 weeks of home-based VRRS training. The sessions of VRRS will initially be tailored to the patient's baseline characteristics. Remotely, the therapist will then adjust the participant's exercise program as appropriate, by changing exercises, level of difficulty or number of repetitions.

05

What researchers measure

Primary outcomes

  1. Change in measure of quality of life

    Quality of life will be measured by 54-item Multiple Sclerosis Quality of Life (MSQOL-54) questionnaire There is no single overall score for the MSQOL-54. Two summary scores - physical health and mental health - can be derived from a weighted combination of scale scores. In addition, there are 12 subscales: physical function, role limitations-physical, role limitations-emotional, pain, emotional well-being, energy, health perceptions, social function, cognitive function, health distress, overall quality of life, and sexual function. There are also two single-item measures: satisfaction with sexual function and change in health. Administration forms and scoring instructions can be downloaded (https://www.nationalmssociety.org/NationalMSSociety/media/MSNationalFiles/Brochures/MSQOL54_995.pdf ). Higher values represent a better outcome

    Time frame: Baseline up to 6 weeks and 6 months

Secondary outcomes

  1. Change in balance

    Mini-Balance Evalutation System (mini-BES) Test

    Time frame: Baseline up to 6 weeks and 6 months

  2. Change in gait

    12-item Multiple Sclerosis Walking Scale

    Time frame: Baseline up to 6 weeks and 6 months

  3. Change gross manual dexterity

    Box and Block Test

    Time frame: Baseline up to 6 weeks and 6 months

  4. Change in global cognitive status

    Montreal Cognitive Assessment (MoCA) test

    Time frame: Baseline up to 6 weeks and 6 months

  5. Change cognitive status

    Symbol Digit Modalities Test (Form Brief Repeatable Battery of Neuropsychological Tests )

    Time frame: Baseline up to 6 weeks and 6 months

  6. Change in fatigue

    Fatigue Severity Scale A questionnaire with 9 items (questions) Grading of each FSS item ranges from 1 to 7, where 1 indicates strong disagreement and 7 strong agreement, and the final score represents the mean value of the 9 items Higher values represent a worse outcome

    Time frame: Baseline up to 6 weeks and 6 months

  7. Change in Emotional Traits

    The Regulatory Emotional Self-Efficacy (RESE) scale The RESE scale assesses self-efficacy in expressing positive emotions and self-efficacy in managing negative emotions. With this scale, participants rate (ranging from 1 \[not well at all\] to 5 \[very well\]) their capability to manage their emotional life. RESE scale consists of 12 items and are calculated 3 scores: 1) self-efficacy in expressing positive emotions (POS) score; 2)self-efficacy in managing negative emotions (NEG) score; 3)self-efficacy in managing despondency/distress (DES) score Higher values within each score represent a better outcome

    Time frame: Baseline up to 6 weeks and 6 months

  8. Change in Behavioral (depression)

    Beck Depression Inventory

    Time frame: Baseline up to 6 weeks and 6 months

  9. Change in Behavioral (anxiety)

    State-trait anxiety inventory

    Time frame: Baseline up to 6 weeks and 6 months

06

Study locations

1 site
  • Irccs Fondazione Don Carlo Gnocchi
    Milano, MI 20148, Italy
07

References and documents

Publications

  • Di Tella S, Pagliari C, Blasi V, Mendozzi L, Rovaris M, Baglio F. Integrated telerehabilitation approach in multiple sclerosis: A systematic review and meta-analysis. J Telemed Telecare. 2020 Aug-Sep;26(7-8):385-399. doi: 10.1177/1357633X19850381. Epub 2019 May 27. PubMed 31132909 ↗
  • Pagliari C, Di Tella S, Jonsdottir J, Mendozzi L, Rovaris M, De Icco R, Milanesi T, Federico S, Agostini M, Goffredo M, Pellicciari L, Franceschini M, Cimino V, Bramanti P, Baglio F. Effects of home-based virtual reality telerehabilitation system in people with multiple sclerosis: A randomized controlled trial. J Telemed Telecare. 2024 Feb;30(2):344-355. doi: 10.1177/1357633X211054839. Epub 2021 Dec 1. PubMed 34851211 ↗

Individual participant data

Plan to share: Undecided

08

Registry details

Key details

Study ID
NCT03444454
Lead sponsor
Fondazione Don Carlo Gnocchi Onlus
Collaborators
IRCCS Centro Neurolesi Bonino Pulejo, IRCCS Fondazione Istituto Neurologico Casimiro Mondino, Pavia (IT), IRCCS San Camillo, Venezia, Italy, IRCCS San Raffaele Roma, Istituti Clinici Scientifici Maugeri SpA
Responsible party
Francesca Baglio (MD, researcher, Fondazione Don Carlo Gnocchi Onlus) — Principal investigator
First posted
Feb 23, 2018
Start date
Feb 26, 2018
Primary completion
Dec 31, 2018
Completion
Jun 30, 2024 (estimated)
Last update
May 3, 2024

Oversight

FDA-regulated drug
No
FDA-regulated device
No
View the source record on ClinicalTrials.gov ↗

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