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Trial registered on ANZCTR
Registration number
ACTRN12619001776190
Ethics application status
Approved
Date submitted
2/12/2019
Date registered
16/12/2019
Date last updated
20/03/2020
Date data sharing statement initially provided
16/12/2019
Type of registration
Prospectively registered
Titles & IDs
Public title
Altering body image in chronic low back pain using virtual reality: A proof of concept randomised clinical trial
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Scientific title
Altering body image in chronic low back pain using virtual reality: A proof of concept randomised clinical trial
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Secondary ID [1]
299272
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Nil
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Universal Trial Number (UTN)
U1111-1240-1469
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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:
Chronic Low Back Pain
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Condition category
Condition code
Physical Medicine / Rehabilitation
312744
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0
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Physiotherapy
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Musculoskeletal
312745
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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
Intervention: Body Image-VR
The VR experience will involve three enhanced embodiment experiences: 1. A muscular boxer, 2. A super hero, 3. A rock climber.
Notably, all phases can be performed sitting and/or standing to suit the tolerance of the individual. All components of the intervention will be conducted and/or supervised by a qualified clinician (physiotherapist and/or clinical exercise physiologist).
Three bodily experiences will be completed in a single session with a 5-minute interval between each. At the beginning of each experience the experimenter will assist the user to operate the hand controls and facilitate avatar embodiment by encouraging the user to move and observe their virtual body before talking the participant through the activity. Before, after, and during each experience, participants will rate their perceived strength, vulnerability, agility & confidence (Pain-related Body Image Scale) and pain intensity using 0-10 numerical rating scales. Between each activity participants will exit VR for instruction on the next activity.
Boxing Avatar (6-minutes)
Prior to entering VR, the experimenter will demonstrate a series of ‘muscle poses’ and 'boxing actions' that they will be encouraged to do once in VR to embody the avatar and it's characteristics. When in VR, participants will observe their body, make muscle poses, and interact with a virtual boxing bag.
Rock Climbing Avatar (6-minutes)
Prior to entering VR the experimenter will demonstrate the controls needed to climb. Participants will then scale a virtual cliff by reaching, grasping, and pulling on hand-holds in the cliff face. Immediately prior, during, and immediately following, participants will rate the body image and pain scales.
Super Hero: The Incredible Hulk Avatar (6-minutes)
Prior to entering VR, the experimenter will demonstrate the activity and how to use the controls in order to use the avatars 'special strength powers' that they will perform when in VR. When in VR, participants will do activities such as lift and throw 'heavy' virtual objects and create earth quakes using their 'strength'.
To ensure fidelity to the intervention protocol, a senior researcher from the research team will observe the first three participants from each group.
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Intervention code [1]
315557
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Treatment: Other
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Comparator / control treatment
General VR.
Participants in the General VR group will engage with an interactive 3D environments, but without a physically enhanced virtual body. A single clinic-based session of interactive VR will be undertaken using the application 'Job or Vacation Simulator', for 18 minutes (in 3-blocks of 6 minutes). Participants will be placed in vacation and/or work place scenarios and encouraged to explore (e.g. create a virtual painting, build a virtual sand castle, make coffee, photocopy virtual documents) while remaining within normal self-selected movement. The control intervention can be completed in sitting and/or standing to suit the tolerance of the individual. All components of the intervention will be conducted and/or supervised by a qualified clinician (physiotherapist and/or clinical exercise physiologist).
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Control group
Active
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Outcomes
Primary outcome [1]
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Change in pain-related body image scale score (average of four numerical ratings of perceived bodily strength, agility, vulnerability, and confidence with activities).
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Assessment method [1]
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Timepoint [1]
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1. Pre-VR (immediately before VR)
2. During-VR (rated during, and averaged across, the three 6-minute VR experiences)
3. Post-VR (immediately after VR)
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Primary outcome [2]
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Change in pain on a 0-10 Numerical Rating Scale, where 0=no pain, and 10=the worst imaginable pain.
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Assessment method [2]
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Timepoint [2]
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1. Pre-VR (immediately before VR)
2. During-VR (rated during, and averaged across, the three 6-minute VR experiences)
3. Post-VR (immediately after VR)
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Secondary outcome [1]
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Change in pain-related body image scale and pain at 1-week followup, to assess carry-over from a single session.
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Assessment method [1]
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Timepoint [1]
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1. Pre-VR (immediately before VR)
2. 1-week followup
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Secondary outcome [2]
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Modified Embodiment Questionnaire (used to assess strength of embodiment which may be modulate other outcomes)
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Assessment method [2]
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Timepoint [2]
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1. Post-VR: Modified Embodiment Questionnaire will be assessed during each VR experience.
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Secondary outcome [3]
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Change in strength, measured using a hand-held dynamometer (kg)
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Assessment method [3]
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Timepoint [3]
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1. Pre-VR (immediately before VR)
2. During-VR (average of strength during the three VR conditions)
3. Post-VR (immediately after VR)
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Secondary outcome [4]
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Perceived harmfulness of activity (examined with the Photograph Series of Daily Activities (PHODA-SEV)) which uses photographs to determine the threat value of different physical activities and movements.
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Assessment method [4]
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Timepoint [4]
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1. Pre-VR (immediately before VR)
2. Post-VR (immediately after VR)
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Secondary outcome [5]
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Qualitative analysis of patient experiences, including:
1. What are patients’ experiences of using VR in the clinical context?
2. To what extent do patients perceive VR as an acceptable, feasible, and tolerable mode of therapy?
4. What are the perceived benefits and detriments of the VR intervention?
5. What facilitators and barriers exist to the future use of VR as a therapy?
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Assessment method [5]
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Timepoint [5]
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A semi-structured interview will be undertaken within 7-days following the VR session (intervention group participants only).
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Eligibility
Key inclusion criteria
Adults (>18 years of age) who have been referred to the Metro South Health Persistent Pain Management Service (Bourke Street Centre) for the management of chronic low back pain (duration at least 6 months), who have scores of at least “moderate” on questions 7 (“How much bodily pain have you had during the past 4 weeks?”), and question 8 (“During the past 4 weeks, how much did pain interfere with your normal work (including both work outside the home and housework)?”) of the SF-36 (Ware & Sherbourne 1992), are able to read and understand English language, can operate a computer, and are able to provide informed consent, will be eligible for inclusion in the 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
Exclusion criteria will comprise a diagnosis of, or the presence of red flags indicating, serious spinal pathology (i.e. infection, tumour, recent fracture, significant structural deformity such as unstable/unstabilised spondylolisthesis or progressive scoliosis, inflammatory disorder, and neuropathic radicular syndrome or cauda equina syndrome with clear neurological impairment). Inability to tolerate visual stimulation (i.e. susceptibility to migraines aggravated by light) or inability to tolerate the head mounted display (i.e. sensitivity to touch around the face and head) will also result in exclusion.
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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)
Clinicians will refer patients to the study and the experimenter will then make contact with participants by phone to provide information and arrange an appointment. These steps will occur prior to group allocation, and as such neither the clinician nor the experimenter will have knowledge of group allocation before the day of the experiment. On the day of testing, the experimenter will open a sealed opaque envelope, pre-prepared by a third party, containing the participants allocation.
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Methods used to generate the sequence in which subjects will be randomised (sequence generation)
A concealed allocation approach will be employed, where participants are allocated to the intervention or control croup with a 2:1 ratio. The random allocation sequence will be generated using Microsoft excel by an experimenter not involved in data collection. The allocation of participants 1-30 will then be recorded on dark, non-transparent card, and inserted into opaque envelopes that will be numbered consecutively.
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Masking / blinding
Blinded (masking used)
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Who is / are masked / blinded?
The people receiving the treatment/s
The people analysing the results/data
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Intervention assignment
Parallel
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Other design features
A limited deception approach is used to maintain participant blinding. While participants understand they will be randomised to one of two groups, the existence of a 'control' group is with-held. That is, both groups understand that they will be trying a type of virtual reality that may have clinic effects. This is only limited deception, since we expect some effect of both 'types' of virtual reality, at least in the short-term.
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Phase
Not Applicable
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Type of endpoint/s
Efficacy
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Statistical methods / analysis
Primary research questions:
Question1: Is there an effect of VR body illusion on body image scale score
Analysis: Mixed model 2(Group: Body Image-VR vs. General-VR) x 3(Time: Pre-VR vs. during-VR vs. post-VR) ANOVA.
Question2: Is there an effect of VR body illusion on current pain
Analysis: Mixed model 2(Group: Body Image-VR vs. General-VR) x 3(Time: Pre-VR vs. during-VR vs. post-VR) ANOVA
Secondary research questions
Question3: Is there an effect of VR body illusion at 1-week followup on body image scale score, perceived harmfulness of activity (PHODA) or pain (NRS) at 1-week follow up?
Analysis: Mixed model 2(Group: Body Image-VR vs. General-VR) x 2(Time: Pre-VR vs. 1-week followup) ANOVA for each outcomes.
Question4: Is there an effect of VR body illusion on strength
Analysis: Mixed model 2(Group: Body Image-VR vs. General-VR) x 3(Time: Pre-VR vs. during-VR vs. post-VR) ANOVA
Question5: Does change in primary outcome depend on strength of virtual avatar embodiment during VR
Analysis: Series of linear regression comparing Modified Embodiment Questionnaire score, and change (pre-VR vs. post-VR) for each of the primary outcomes.
Question6: Is there an effect of VR body illusions on perceived harmfulness of activity (PHODA)
Analysis: Mixed model 2(Group: Body Image-VR vs. General-VR) x 2(Time: Pre-VR, vs. post-VR) ANOVA
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Recruitment
Recruitment status
Not yet recruiting
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Date of first participant enrolment
Anticipated
27/03/2020
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Actual
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Date of last participant enrolment
Anticipated
25/05/2020
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Actual
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Date of last data collection
Anticipated
8/06/2020
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Actual
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Sample size
Target
30
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Accrual to date
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Final
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Recruitment in Australia
Recruitment state(s)
QLD
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Recruitment hospital [1]
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Princess Alexandra Hospital - Woolloongabba
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Recruitment postcode(s) [1]
28404
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4102 - Woolloongabba
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Funding & Sponsors
Funding source category [1]
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Other Collaborative groups
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Name [1]
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The Hopkins Centre
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Address [1]
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Menzies Health Institute Queensland
Wayne Goss Centre,
Griffith University, Logan Campus,
Meadowbrook QLD 4131
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Country [1]
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Australia
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Primary sponsor type
University
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Name
Griffith University
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Address
1 Parklands Dr, Southport QLD 4215
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Country
Australia
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Secondary sponsor category [1]
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Hospital
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Name [1]
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Princess Alexandra Hospital
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Address [1]
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199 Ipswich Road, Woolloongabba, QLD
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Country [1]
303927
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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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Metro South Human Research Ethics Committee
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Ethics committee address [1]
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Metro South Research
Level 7, Translational Research Institute
37 Kent Street
Woolloongabba QLD 4102
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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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12/09/2019
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Approval date [1]
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30/10/2019
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Ethics approval number [1]
304323
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HREC/2019/QMS/53077
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Summary
Brief summary
A randomised controlled proof of concept and feasibility study will investigate whether virtually embodying hyper-muscular and hyper-capable avatars in virtual reality (VR) can augment body image as it relates to the perception of bodily integrity and vulnerability, and whether these changes relate to short-term improvements in clinical outcomes. Thirty adults with chronic low back pain will be recruited from the Metro South Health Persistent Pain Management Service and randomised to receive a single session VR intervention targeting body image ‘Body Image-VR’ (n=20), or single session of general virtual reality ‘General-VR’ (n=10). Primary outcome measures of body image, pain, and strength, will be assessed: (1) Immediately pre- and post-intervention, and (2) At one week follow-up to assess carry-over effects. A qualitative interview will be conducted with Intervention participants to investigate VR experience, acceptability, feasibility, and tolerability. We hypothesise that embodying hyper-capable avatars in VR will improve body image, pain and strength. We expect outcomes to inform future research and clinical implementation.
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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 Daniel Harvie
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Address
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Griffith University
Room G05_2.44A
1 Parklands Dr, Southport QLD 4215
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Country
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Australia
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Phone
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+61755527898
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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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Dr Daniel Harvie
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Address
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Griffith University
Room G05_2.44A
1 Parklands Dr, Southport QLD 4215
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Country
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Australia
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Phone
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+61 755527898
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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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Dr Daniel Harvie
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Address
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Griffith University
Room G05_2.44A
1 Parklands Dr, Southport QLD 4215
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Country
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Australia
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Phone
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+61 755527898
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Fax
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Email
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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)?
Yes
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What data in particular will be shared?
De-identified primary and secondary outcome data for each participant will be available on request.
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When will data be available (start and end dates)?
Data will be available following publication. Estimated start date: 1/12/2020. No end date determined.
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Available to whom?
Researchers with justification.
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Available for what types of analyses?
Meta-analyses, exploratory analyses.
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How or where can data be obtained?
By email request:
[email protected]
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What supporting documents are/will be available?
No Supporting Document Provided
Doc. No.
Type
Citation
Link
Email
Other Details
Attachment
5564
Study protocol
[email protected]
5565
Clinical study report
[email protected]
5566
Ethical approval
[email protected]
378370-(Uploaded-06-11-2019-11-46-38)-Study-related document.pdf
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