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Trial registered on ANZCTR
Registration number
ACTRN12615000436572
Ethics application status
Approved
Date submitted
21/04/2015
Date registered
7/05/2015
Date last updated
8/01/2019
Date data sharing statement initially provided
8/01/2019
Date results provided
8/01/2019
Type of registration
Prospectively registered
Titles & IDs
Public title
The influence of cerebellar transcranial direct current stimulation (tDCS) on motor learning in swallowing rehabilitation.
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Scientific title
The effect of skill training and simultaneous cerebellar tDCS on swallowing in patients with swallowing disorders.
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Secondary ID [1]
286572
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Nil
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Universal Trial Number (UTN)
U1111-1168-9523
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Trial acronym
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Linked study record
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Health condition
Health condition(s) or problem(s) studied:
Dysphagia
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Condition category
Condition code
Physical Medicine / Rehabilitation
295100
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0
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Speech therapy
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Intervention/exposure
Study type
Interventional
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Description of intervention(s) / exposure
The study is an interventional case series investigation that will evaluate the influence of cerebellar tDCS on motor skill acquisition as a component of rehabilitation in patients with swallowing disorders (dysphagia).
Two previously published skill training treatment procedures will be used to restore swallowing function: Biofeedback in Strength and Skill Training (BiSSkiT) (Athukorala et al., 2014) or mis-sequencing therapy using manometry (Huckabee et al., 2014).
The BiSSkiT protocol involves one treatment session daily for up to an hour maximum. The patient will be verbally guided to control temporal and amplitude characteristics of the floor-of-mouth muscles such that the observed sEMG waveform gets as close to a target on the screen during swallowing as possible. The manometry treatment will be twice daily for up to an hour maximum for each session. It involves measurement of pharyngeal pressure using low-resolution manometry. The skill based rehabilitation approach will be assigned based on their evaluation of swallowing function. The treatment will be administered by a qualified and trained Speech-language therapist.
Cerebellar tDCS will be applied during these usual treatment procedures at the EATS (Evaluation and Treatment of Swallowing) Clinic, situated at the University of Canterbury Rose Centre for Stroke Recovery and Research. Cerebellar tDCS will be applied for 20 min during the skill training protocol in daily, or twice daily, treatment sessions for two weeks (weekdays only). Stimulation will be applied at 2 mA, delivered via three rectangular saline-soaked sponge electrodes (5×5 cm, surface area 25 cm^2). Stimulation via these parameters induces a current at a density of 0.08 mA/cm^2, which is considered to be safe for human participants (Iyer et al., 2005).
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Intervention code [1]
291685
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Rehabilitation
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Intervention code [2]
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Treatment: Devices
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Comparator / control treatment
Pre-existing data out of the patients previous swallowing treatment and evaluation measures collected within the last five years will serve as control treatment.
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Control group
Historical
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Outcomes
Primary outcome [1]
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Timing and magnitude of the sEMG waveform in correlation to the target will be outcome measures for the BiSSkiT treatment.
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Assessment method [1]
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Timepoint [1]
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Pre and post treatment measures will be gathered in the first and last session. Furthermore, follow-up measures after week one and two will be collected when available.
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Primary outcome [2]
294953
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Latency between the peaks of the pharyngeal manometry waveform will be analysed as outcome for the manometry treatment.
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Assessment method [2]
294953
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Timepoint [2]
294953
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Pre and post treatment measures will be gathered in the first and last session. Furthermore, follow-up measures after week one and two will be collected when available.
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Secondary outcome [1]
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Videofluoroscopic evaluation of swallowing (VFSS) will be performed to asses the overall swallowing function.
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Assessment method [1]
314237
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Timepoint [1]
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Pre and post treatment VFSS measures will be gathered before and after the first and last session. Furthermore, follow-up VFSS measures after week one and two will be collected when available.
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Secondary outcome [2]
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Timed water swallow test (TWST) (Hughes & Wiles, 1996)
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Assessment method [2]
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Timepoint [2]
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Pre and post treatment TWST measures will be gathered before and after the first and last session. Furthermore, follow-up TWST measures after week one and two will be collected when available.
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Secondary outcome [3]
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Test of Mastication and Swallowing of Solids (TOMASS)
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Assessment method [3]
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Timepoint [3]
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Pre and post treatment TOMASS measures will be gathered before and after the first and last session. Furthermore, follow-up TOMASS measures after week one and two will be collected when available.
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Secondary outcome [4]
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Swallowing related quality of life questionnaire (SWAL-QOL)
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Assessment method [4]
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Timepoint [4]
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Pre and post treatment the patient will be asked to complete the SWAL-QOL before and after the first and last session. Furthermore, the patient will be asked to complete the SWAL-QOL as a follow-up after week one and two, when available.
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Eligibility
Key inclusion criteria
This study will include patients with oropharyngeal dysphagia, aged 18 years or older, who have not resumed functional oral intake following previous swallowing treatment.
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Minimum age
18
Years
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Maximum age
No limit
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Sex
Both males and females
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Can healthy volunteers participate?
No
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Key exclusion criteria
Patients that have undergone recent brain surgery (within the last 6 month), metallic implants in the skull, and a history of drug use will be excluded. Further exclusion criteria for participation include difficulties following instructions because of cognitive impairment, or limitations in visual function (acuity in both eyes < 6/12).
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Study design
Purpose of the study
Treatment
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Allocation to intervention
Non-randomised trial
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Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
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Methods used to generate the sequence in which subjects will be randomised (sequence generation)
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Masking / blinding
Open (masking not used)
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Who is / are masked / blinded?
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Intervention assignment
Single group
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Other design features
N/A
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Phase
Not Applicable
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Type of endpoint/s
Efficacy
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Statistical methods / analysis
A mixed effects model will be used to evaluate learning and transfer effects of the learned skill.
The results of this study will provide power calculation data for a more robust clinical trial of the same treatment.
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Recruitment
Recruitment status
Completed
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Date of first participant enrolment
Anticipated
15/05/2015
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Actual
25/05/2015
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Date of last participant enrolment
Anticipated
31/01/2017
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Actual
14/11/2016
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Date of last data collection
Anticipated
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Actual
25/11/2016
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Sample size
Target
6
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Accrual to date
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Final
6
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Recruitment outside Australia
Country [1]
6837
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New Zealand
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State/province [1]
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Canterbury
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Funding & Sponsors
Funding source category [1]
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University
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Name [1]
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The University of Canterbury Rose Centre for Stroke Recovery and Research
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Address [1]
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St George’s Medical Centre
Leinster Chambers, Level One
Private Bag 4737
249 Papanui Road
Christchurch 8140
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Country [1]
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New Zealand
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Funding source category [2]
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University
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Name [2]
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New Zealand Brain Research Doctoral Scholarship
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Address [2]
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Scholarships Office
University of Canterbury
Student Service Centre
Level 1, Matariki
Private Bag 4800
Christchurch 8140
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Country [2]
291196
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New Zealand
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Primary sponsor type
University
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Name
The University of Canterbury Rose Centre for Stroke Recovery and Research
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Address
St George’s Medical Centre
Leinster Chambers, Level One
Private Bag 4737
249 Papanui Road
Christchurch 8140
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Country
New Zealand
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Secondary sponsor category [1]
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None
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Name [1]
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Address [1]
289875
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Country [1]
289875
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Ethics approval
Ethics application status
Approved
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Ethics committee name [1]
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Health and Disability Ethics Committes (HDEC)
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Ethics committee address [1]
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Ministry of Health Ethics Department Freyberg Building Reception – Ground Floor 20 Aitken Street Wellington 6144
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Ethics committee country [1]
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New Zealand
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Date submitted for ethics approval [1]
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23/04/2015
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Approval date [1]
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06/05/2015
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Ethics approval number [1]
292712
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Summary
Brief summary
Swallowing disorders can occur due to neurologic or anatomic injury, such as stroke or head and neck cancer. It can lead to severe health problems, including chest infections, caused by misdirected food entering the lungs, malnutrition and dehydration. Therefore, effective treatment protocols are required to reduce the burden of swallowing disorders. In physical rehabilitation, the use of non-invasive brain stimulation has been shown to offer promising results in enhancing motor function and motor learning. Transcranial direct current stimulation (tDCS) is a form of non-invasive brain stimulation. This technique uses a low electrical current to induce changes in brain excitability. Wet sponge electrodes are placed on participants’ heads overlying the targeted brain region. Applying tDCS over the cerebellum has been shown to enhance motor skill-learning in limb rehabilitation. The cerebellum is responsible for the coordination and precision of movement. However, it is not known whether similar beneficial effects are evident for more reflexive behaviours, such as swallowing. The proposed research will investigate the effects of excitatory tDCS over the cerebellum on motor learning in patients with swallowing disorders. Comparison between swallowing training with and without tDCS will provide information about potential benefits of tDCS on motor learning over traditional swallowing therapy. These findings will be used to determine optimal stimulation parameters, by investigating dose, the duration of skill retention, and electrode placement. This information will guide the development of novel and innovative rehabilitation protocols for swallowing disorders.
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Trial website
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Trial related presentations / publications
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Public notes
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Contacts
Principal investigator
Name
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Ms Kerstin Erfmann
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Address
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The University of Canterbury Rose Centre for Stroke Recovery and Research at St George’s Medical Centre
Leinster Chambers, Level One
Private Bag 4737
249 Papanui Road
Christchurch 8140
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Country
56686
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New Zealand
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Phone
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+6433642307
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Fax
56686
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+64 3 375 6267
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Email
56686
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[email protected]
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Contact person for public queries
Name
56687
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Kerstin Erfmann
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Address
56687
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The University of Canterbury Rose Centre for Stroke Recovery and Research at St George’s Medical Centre
Leinster Chambers, Level One
Private Bag 4737
249 Papanui Road
Christchurch 8140
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Country
56687
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New Zealand
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Phone
56687
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+6433642307
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Fax
56687
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+64 3 375 6267
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Email
56687
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[email protected]
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Contact person for scientific queries
Name
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Kerstin Erfmann
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Address
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The University of Canterbury Rose Centre for Stroke Recovery and Research at St George’s Medical Centre
Leinster Chambers, Level One
Private Bag 4737
249 Papanui Road
Christchurch 8140
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Country
56688
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New Zealand
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Phone
56688
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+6433642307
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Fax
56688
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+64 3 375 6267
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Email
56688
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[email protected]
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Data sharing statement
Will individual participant data (IPD) for this trial be available (including data dictionaries)?
No
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No/undecided IPD sharing reason/comment
Data has not been published yet.
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What supporting documents are/will be available?
No Supporting Document Provided
Results publications and other study-related documents
Documents added manually
No documents have been uploaded by study researchers.
Documents added automatically
No additional documents have been identified.
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