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Trial registered on ANZCTR
Registration number
ACTRN12616000411448
Ethics application status
Approved
Date submitted
23/03/2016
Date registered
31/03/2016
Date last updated
5/12/2016
Type of registration
Prospectively registered
Titles & IDs
Public title
Open, non-deceptive placebo administration for wound healing
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Scientific title
Open, non-deceptive placebo administration to improve the re-epithelialisation rate of 4mm punch biopsy wounds in healthy participants
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Secondary ID [1]
288830
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None
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Universal Trial Number (UTN)
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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:
Healthy participants: measuring wound healing rate of a 4mm punch biopsy wound to the upper inner arm.
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Condition category
Condition code
Skin
298276
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0
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Other skin conditions
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Mental Health
298330
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0
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Studies of normal psychology, cognitive function and behaviour
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Intervention/exposure
Study type
Interventional
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Description of intervention(s) / exposure
The initial meeting with the study dermatologist will use a scripted introduction to the placebo effect to establish an expectation that placebo administration will be effective. In summary the script describes the following information: The placebo effect is any type of treatment – in this case, a pill – that doesn’t actually contain any drugs or active ingredients. The scientific evidence shows the placebo effect is powerful for conditions like pain and headaches, and previous research has demonstrated that open placebo administration (with participants knowing they were taking placebos) was beneficial for physical health outcomes. This may be because the body is conditioned to respond to taking medications, or because taking the pills increases expectations of an effect. As the brain and immune system are highly interconnected, placebos can affect immune functioning and therefore wound healing. Psychological factors have been shown to affect wound healing in previous research, so it is plausible that expecting benefits through taking placebos would enhance healing.
After this introduction and a final consent form for the wounding procedure, the dermatologist will make the punch biopsy wound. The procedure involves creating a 4 mm punch biopsy wound 7 cm superior to the medial epicondyle of the inner upper arm (the participant chooses which arm), delivered under local anaesthetic and covered with a hydrocolloid dressing and an additional opsite dressing. This wound will be cleaned and the dressing changed at 7 days post-wounding, and again at 10 days.
Treatment will consist of placebo tablets containing lactose monohydrate, microcrystalline cellulose and magnesium stearate as the only 3 ingredients, Participants will be aware that they are receiving inert placebo tablets without active ingredients. Dosage will be two tablets twice per day, starting on the evening of the wounding procedure and continuing daily until the morning of the 10th day after wounding, which is the day the final measures will be taken. Adherence will be measured with a self-report item on the final questionnaire administered at 10 days post-wounding.
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Intervention code [1]
294285
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Treatment: Other
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Comparator / control treatment
Participants randomised to the control group will take no treatment subsequent to the wounding procedure.
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Control group
Active
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Outcomes
Primary outcome [1]
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Wound healing will be measured from photographs, operationalised as the percentage of the wound area re-epithelialised out of the whole wound area. Wounds are 4mm punch biopsy wounds 7 cm superior to the medial epicondyle of the inner upper arm.
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Assessment method [1]
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Timepoint [1]
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Photographs will be taken at 7 days and 10 days after wounding.
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Secondary outcome [1]
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None
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Assessment method [1]
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Timepoint [1]
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N/A
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Eligibility
Key inclusion criteria
Healthy participants who are able to understand and write in English.
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Minimum age
18
Years
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Maximum age
65
Years
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Sex
Both males and females
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Can healthy volunteers participate?
Yes
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Key exclusion criteria
Participants will be excluded if they smoke, have medical conditions that would affect wound healing (e.g. eczema, psoriasis, anemia, diabetes, etc.), regular use of other treatments affecting wound healing (e.g. anticoagulants, non-steroidal anti-inflammatories), or any surgery or tattoos within the last 30 days.
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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 is not concealed to the study dermatologist, who will randomise participants subsequent to the wounding procedure. All follow up measurements and photographs will be taken by the study researcher, who is not aware of allocation, and photographs will not have identifying information by which the dermatologist will be able to determine group allocation of the participant when measuring wound healing.
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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 (i.e. computerised sequence generation).
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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
A two-tailed independent samples t-test will be conducted comparing wound area between the open placebo group and the no-treatment control group. Separate analyses will be conducted for 7 days and 10 days post-wounding.
G*Power (version 3.1.9.2) was used to conduct a power analysis to determine the number of participants required. Given an expected effect size of d = 0.7 based on a meta-analysis of wound healing studies (Robinson et al., unpublished manuscript) and a = .05, 68 participants will be required to achieve a power of 80% (i.e. 1-beta = 0.8).
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Recruitment
Recruitment status
Completed
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Date of first participant enrolment
Anticipated
5/04/2016
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Actual
3/05/2016
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Date of last participant enrolment
Anticipated
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Actual
13/09/2016
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Date of last data collection
Anticipated
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Actual
23/09/2016
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Sample size
Target
68
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Accrual to date
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Final
70
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Recruitment outside Australia
Country [1]
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New Zealand
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State/province [1]
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Auckland Region
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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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University of Auckland
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Address [1]
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University of Auckland Grafton Campus,
85 Park Rd,
Grafton,
Auckland 1023
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Country [1]
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New Zealand
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Primary sponsor type
University
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Name
University of Auckland Masters Programme Funding
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Address
University of Auckland,
Room 12.017, Level 12,
Auckland Hospital Support Building,
2 Park Road,
Grafton,
Auckland 1023
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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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None
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Address [1]
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None
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Country [1]
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Ethics approval
Ethics application status
Approved
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Ethics committee name [1]
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University of Auckland Human Participants Ethics Committee (UAHPEC)
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Ethics committee address [1]
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The University of Auckland Private Bag 92019 Auckland, New Zealand Level 10, 49 Symonds Street, Grafton, Auckland 1010
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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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26/02/2016
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Approval date [1]
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04/04/2016
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Ethics approval number [1]
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Summary
Brief summary
Aim: The aim of the study is to establish if wound healing is faster for participants taking open-label placebo pills (i.e. known by the participant to be pharmacologically inert) than participants taking no treatment for their wound healing. Hypothesis: Photographs of a 4 mm diameter punch biopsy wound in the inner arm will show a greater area of re-epithelialisation at 7 days and 10 days after wounding for participants using daily open placebo treatment than participants using no treatment. Summary of the project: Placebo treatment can be effective for subjective complaints (Miller, Colloca, & Kaptchuk, 2009) and also results in physiological changes (Finniss et al., 2010), suggesting that it may be an effective treatment option for some people. However, it is currently unethical to prescribe placebo treatment, as this typically requires deception of patients, undermining the principle of informed consent. This study aims to establish whether open placebo treatment (i.e. placebo administration without deception, where participants are aware that they are taking placebos) is effective for wound healing, which would allow patients to benefit from harnessing placebo effects with full informed consent. Wound healing rates can be affected by psychosocial factors such as stress (Walburn et al., 2009), and psychosocial interventions can improve wound healing rates (Broadbent et al., 2012; Koschwanez et al., 2013). This means that a psychologically-based treatment such as placebo may affect wound healing rates through mechanisms such as expectation of improvement or conditioned physiological effects from ingesting medication (Benedetti & Amanzio, 2013). Kaptchuk et al. (2010) demonstrated that open placebo treatment was effective for improving symptoms and functioning for participants with Irritable Bowel Syndrome, setting a precedent for the use of open placebo treatment to improve participant outcomes. Given these results, it is worth investigating whether open placebo is effective in improving wound healing rates in healthy participants.
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Trial website
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Trial related presentations / publications
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Public notes
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Attachments [1]
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/AnzctrAttachments/370392-Open Placebo - Ethics submission.pdf
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Attachments [2]
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/AnzctrAttachments/370392-Open placebo (AM) - Research Protocol (v3.2).docx
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Contacts
Principal investigator
Name
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Prof Keith Petrie
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Address
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Room 12.017, Level 12,
Auckland Hospital Support Building,
2 Park Road,
Grafton,
Auckland 1023
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Country
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New Zealand
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Phone
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+64 9 923-6564
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Fax
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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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Keith Petrie
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Address
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Room 12.017, Level 12,
Auckland Hospital Support Building,
2 Park Road,
Grafton,
Auckland 1023
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Country
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New Zealand
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Phone
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+64 9 923-6564
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Fax
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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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Keith Petrie
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Address
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Room 12.017, Level 12,
Auckland Hospital Support Building,
2 Park Road,
Grafton,
Auckland 1023
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Country
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New Zealand
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Phone
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+64 9 923-6564
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Fax
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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
Source
Title
Year of Publication
DOI
Embase
Open-label Placebos for Wound Healing: A Randomized Controlled Trial.
2018
https://dx.doi.org/10.1093/abm/kax057
N.B. These documents automatically identified may not have been verified by the study sponsor.
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