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Trial registered on ANZCTR
Registration number
ACTRN12615000764538
Ethics application status
Approved
Date submitted
27/06/2015
Date registered
23/07/2015
Date last updated
30/06/2016
Type of registration
Retrospectively registered
Titles & IDs
Public title
Preoperative group shoulder program for patients awaiting shoulder surgery
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Scientific title
Effect of SPrEE (Shoulder Prehabilitation Exercise and Education Program) for patients awaiting rotator cuff surgery on function and quality of life - a randomised, controlled, clinical trial.
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Secondary ID [1]
286989
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Nil
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Universal Trial Number (UTN)
U1111-1171-6130
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Trial acronym
SPrEE
(Shoulder Prehabilitation Exercise and Education program)
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Linked study record
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Health condition
Health condition(s) or problem(s) studied:
rotator cuff surgery
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Condition category
Condition code
Musculoskeletal
295703
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0
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Other muscular and skeletal disorders
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Intervention/exposure
Study type
Interventional
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Description of intervention(s) / exposure
PREHABILITATION- 8 week GROUP program
EDUCATION - 1 x one hour per week
EXERCISE - twice per week, one hour sessions
both administered by qualified physiotherapists in a group setting
EDUCATION- topics include shoulder anatomy, operative procedure, patient and therapist expectations, post-operative protocol and exercise technique
EXERCISE - neuromuscular control exercises for rotator cuff and scapular stabilisers (50% of allocated time of one hour) interspersed with moderate intensity (max 60% HR) general fitness exercise (25% of time) and Tai Chi (25% of time)
Attendance log will be used to monitor adherence
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Intervention code [1]
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Rehabilitation
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Comparator / control treatment
normal care: no active treatment
on waiting list for surgery
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Control group
Active
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Outcomes
Primary outcome [1]
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Shoulder Pain and Disability Index (SPADI)
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Assessment method [1]
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Timepoint [1]
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baseline, 8 weeks post randomisation, preadmission clinic, 3, 6 and 12 month post surgery
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Primary outcome [2]
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Western Ontario Rotator Cuff Index (WORC)
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Assessment method [2]
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Timepoint [2]
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baseline, 8 weeks post randomisation, preadmission clinic, 3, 6 and 12 month post surgery
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Primary outcome [3]
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Short Form 36 (SF36) to measure quality of life
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Assessment method [3]
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Timepoint [3]
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baseline, 8 weeks post randomisation, preadmission clinic, 3, 6 and 12 month post surgery
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Secondary outcome [1]
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Depression, Anxiety, Stress Scales (DASS)
(primary outcome)
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Assessment method [1]
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Timepoint [1]
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Timepoint: baseline, 8 weeks post randomisation, preadmission clinic, 3, 6 and 12 month post surgery
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Secondary outcome [2]
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Shoulder Surgery Expectation Survey
(primary outcome)
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Assessment method [2]
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Timepoint [2]
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baseline, 3, 6 and 12 month post surgery
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Secondary outcome [3]
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Visual Analogue Scale (VAS) to assess intensity of pain
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Assessment method [3]
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Timepoint [3]
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baseline, 8 weeks post randomisation, preadmission clinic, 3, 6 and 12 month post surgery
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Secondary outcome [4]
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Shoulder range of motion- forward flexion; hand-behind-back
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Assessment method [4]
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Timepoint [4]
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baseline, 8 weeks post randomisation, preadmission clinic, 3 (as per surgeon protocol), 6 and 12 month post surgery
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Secondary outcome [5]
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Shoulder strength using a dynamometer
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Assessment method [5]
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Timepoint [5]
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baseline, 8 weeks post randomisation, preadmission clinic, 3 (as per surgeon protocol) , 6 and 12 month post surgery
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Secondary outcome [6]
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Aerobic capacity- 6 minute walk test
Chester Step test
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Assessment method [6]
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Timepoint [6]
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baseline, 8 weeks post randomisation, preadmission clinic, 3, 6 and 12 month post surgery
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Eligibility
Key inclusion criteria
Aged 18 years and over
Rotator cuff pathology, calcific tendinitis, rotator cuff tear
of any size, subacromial impingement, subscapularis tendon tear; on waiting list for surgery
Willingness to give informed consent and to participate
and comply with study
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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 with insufficient ability to understand the English language
Recent or previous fractures of the shoulder complex
Previous shoulder surgery on the affected side or both
Radiologically verified malignancy
Adhesive capsulitis
Symptoms referred from the cervical spine
Clinically verified polyarthritis, rheumatoid arthritis, fibromyalgia
Failed medical clearance to participate in exercises
Unable to agree to participate in the research protocol for 8 weeks
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Study design
Purpose of the study
Treatment
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Allocation to intervention
Randomised controlled trial
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Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
allocation concealment procedures using sealed opaque envelopes
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Methods used to generate the sequence in which subjects will be randomised (sequence generation)
simple randomisation using a randomisation table created by computer software
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Masking / blinding
Blinded (masking used)
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Who is / are masked / blinded?
The people assessing the outcomes
The people analysing the results/data
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Intervention assignment
Parallel
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Other design features
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Phase
Not Applicable
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Type of endpoint/s
Efficacy
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Statistical methods / analysis
Sample size calculation was performed
primary outcome measure was the Shoulder Pain And Disability Index (SPADI), whereby 18 points was considered a clinically relevant difference between the two groups, with a standard deviation of 25, alpha set on 5% and power on 80%.
Statistical Analysis Plan*
*Data double entered. Analysis by intention-to-treat and outcomes analysed in terms of change from baseline.
*Descriptive statistics (means, quartiles, standard deviations, ranges and proportions) generated for all variables included in the study.
*Standard bivariate tests (T tests and chi-square) will evaluate any potential systematic differences at baselines.
*Paired T tests to measure changes within-groups and between-groups between the preoperative and postoperative assessments.
*Changes that occur in continuous data over the entire study period analysed using a 2-way repeated measures analysis of covariance (ANCOVA) to estimate the change between the randomised groups, with baseline values of the response variables as the covariate along with group allocation.
*Demographic and other baseline characteristics will be summarised by assigned treatment group.
*Categorical variables will be summarised by frequencies and percentages. Percentages will be calculated according to the number of patients for whom data are available.
*Continuous variables will be summarised by mean and standard deviation as well as quartiles.
*Regression analysis will be undertaken to account for potential confounding variables such as age, co-morbidities, dominant arm and type of tear.
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Recruitment
Recruitment status
Recruiting
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Date of first participant enrolment
Anticipated
6/07/2015
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Actual
6/07/2015
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Date of last participant enrolment
Anticipated
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Actual
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Date of last data collection
Anticipated
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Actual
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Sample size
Target
74
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Accrual to date
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Final
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Recruitment in Australia
Recruitment state(s)
NSW
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Funding & Sponsors
Funding source category [1]
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Charities/Societies/Foundations
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Name [1]
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The Prince of Wales Hospital Foundation
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Address [1]
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Barker Street
Randwick
NSW 2031
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Country [1]
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Australia
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Primary sponsor type
Individual
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Name
Dr Judy Chen
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Address
The Prince of Wales Hospital
Barker Street
Randwick
NSW 2031
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Country
Australia
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Secondary sponsor category [1]
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Individual
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Name [1]
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Prof Bill Walsh
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Address [1]
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The Prince of Wales Hospital
Barker Street
Randwick
NSW 2031
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Country [1]
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Australia
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Ethics approval
Ethics application status
Approved
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Ethics committee name [1]
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South Eastern Sydney Local Health District Human Research Ethics Committee
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Ethics committee address [1]
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Room G71 East Wing Edmund Blacket Building Prince of Wales Hospital RANDWICK NSW 2031
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Ethics committee country [1]
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Australia
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Date submitted for ethics approval [1]
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Approval date [1]
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19/08/2014
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Ethics approval number [1]
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HREC/14/POWH/327
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Summary
Brief summary
Rotator cuff tears are the most common condition affecting the shoulder. Conservative treatment can involve pain medication, corticosteroid injection, activity modification and physiotherapy. Surgical treatment is considered when conservative management has failed and quality of life is significantly impacted by shoulder dysfunction. In the rehabilitation phase following rotator cuff repair, patients follow a set protocol determined by the surgeon. There is currently no agreement on whether one rehabilitation approach is better than the other. One study found that patients that underwent a shoulder program for 4-6 weeks before surgery had better function and reduced pain in the rehabilitation phase compared to a delayed program group. Pre-operative programs for patients scheduled for spinal surgery and total knee replacements have demonstrated some encouraging results. This type of program has not been used for patients awaiting rotator cuff surgery. The effects of such a program on patient post-operative expectations, function and quality of life have not been investigated. The purpose of this research is to investigate whether the addition of a prehabilitation program to routine pre-operative care will result in better function, quality of life and post-operative expectations for patients awaiting shoulder surgery. The second aim of this research is to study the effect of prehabilitation on pain, shoulder range of movement, strength and exercise endurance. In addition, it may possibly reduce the need for surgery. It is hypothesised that addition of prehabilitation to optimise physical and mental preparation will improve post-operative outcome than usual care (waiting list).
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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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Dr Judy Chen
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Address
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The Prince of Wales Hospital
Physiotherapy Department
Barker Street
Randwick
NSW 2031
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Country
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Australia
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Phone
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61-2-93822850
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Fax
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61-2-93822868
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Email
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[email protected]
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Contact person for public queries
Name
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Judy Chen
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Address
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The Prince of Wales Hospital
Physiotherapy Department
Barker Street
Randwick
NSW 2031
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Country
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Australia
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Phone
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61-2-93822850
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Fax
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61-2-93822868
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Email
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[email protected]
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Contact person for scientific queries
Name
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Judy Chen
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Address
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The Prince of Wales Hospital
Physiotherapy Department
Barker Street
Randwick
NSW 2031
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Country
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Australia
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Phone
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61-2-93822850
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Fax
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61-2-93822868
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Email
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[email protected]
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No information has been provided regarding IPD availability
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.
Download to PDF