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Trial registered on ANZCTR
Registration number
ACTRN12624001229561
Ethics application status
Approved
Date submitted
21/11/2022
Date registered
9/10/2024
Date last updated
9/10/2024
Date data sharing statement initially provided
9/10/2024
Type of registration
Retrospectively registered
Titles & IDs
Public title
Comparison of Two Types of Upper Limb Rehabilitation for Acute Stroke Patients
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Scientific title
Effects of Computer-Based Upper Limb Therapy Using AbleX on arm function for Acute Stroke Patients: A Randomised Controlled Trial
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Secondary ID [1]
308462
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Nil known
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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:
Acute stroke
328266
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Upper limb impairment
328268
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Quality of life
328269
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Condition category
Condition code
Stroke
325309
325309
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0
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Haemorrhagic
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Stroke
325310
325310
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0
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Ischaemic
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Physical Medicine / Rehabilitation
325311
325311
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0
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Occupational therapy
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Intervention/exposure
Study type
Interventional
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Description of intervention(s) / exposure
The intervention will be set-up by accredited Occupational Therapists (OTs) working within a regional public hospital and trained in standardisation of the intervention. Therapists will work with participants across both the acute stroke unit and subacute rehabilitation wards. Participants in the experimental group will receive 30 minutes of conventional therapist-facilitated task-specific practice for the upper limb as well as 30 minutes of individualised computer-based upper limb rehabilitation using the AbleX. The AbleX is a computer-based therapy tool that consists of games and activities accessed using a handheld controller or armskate for patients with more severe arm weakness. Therapists will engage in collaborative goal setting and functional task analysis to personalise specific rehabilitation routines for their patients based on the available activities and games within the AbleX computer-based program. An example of a game that may be undertaken as part of AbleX includes solitaire with the use of the AbleX handlebar to click, move and release cards appropriately on the computer screen. Therapists will also engage in collaborative goal setting and functional task analysis to set-up personalised conventional upper limb therapy routines as part of the conventional upper limb therapy completed. An example of an activity that may be undertaken as part of conventional task-specific practice includes patients using their affected upper limb to stack cones in order to improve arm coordination and strength. Once participants are appropriately set-up with their programs, these may be subsequently delegated to the Allied Health Assistants (AHA’s) and/or OT students. Both groups will perform their respective programs five days a week (Monday to Friday) via semi-supervised practice for the duration of their inpatient stay. Both 30 minute components can be completed within the same 1 hour period or separated and completed at any time of the day. Both groups will perform their respective programs for the duration of their inpatient stay or until their upper limb function is deemed to have plateaued by an OT. An audit of the participants medical record / chart will be undertaken fortnightly by an OT or research assistant to monitor adherence.
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Intervention code [1]
324904
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Rehabilitation
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Comparator / control treatment
Participants in the control group will receive one hour of therapist-facilitated, repetitive, task-specific practice relevant to their upper limb goals. Therapists will also engage in collaborative goal setting and functional task analysis to set-up personalised conventional upper limb therapy routines as part of the conventional upper limb therapy completed. An example of an activity that may be undertaken as part of conventional task-specific practice includes patients using their affected upper limb to stack cones in order to improve arm coordination and strength. Participants may complete the one hour of upper limb therapy all together or complete it over two x 30 minute sessions completed at any time of the day. Both groups will perform their respective programs for the duration of their inpatient stay or until their upper limb function is deemed to have plateaued by an OT. An audit of the participants medical record / chart will be undertaken fortnightly by an OT or research assistant to monitor adherence.
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Control group
Active
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Outcomes
Primary outcome [1]
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Upper limb function. The primary outcome of the study will be any change in scores on the upper extremity subscale of the Fugl-Meyer Assessment of Motor Recovery after Stroke (UE-FMA).
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Assessment method [1]
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Timepoint [1]
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At baseline and at the end of the participant’s inpatient stay.
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Secondary outcome [1]
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Participant quality of life. Any change in participant quality of life assessed using the Stroke Impact Scale (SIS-16).
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Assessment method [1]
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Timepoint [1]
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At baseline and at the end of the participant’s inpatient stay.
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Secondary outcome [2]
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Amount of completed upper limb therapy repetitions. This outcome will be assessed through review of participant's medical record / chart.
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Assessment method [2]
416053
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Timepoint [2]
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At the end of the participant’s inpatient stay.
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Secondary outcome [3]
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The amount of required direct therapist time. This outcome will be assessed through review of participant's medical record / chart.
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Assessment method [3]
416054
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Timepoint [3]
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At the end of the participant’s inpatient stay.
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Eligibility
Key inclusion criteria
1) Diagnosis of acute stroke confirmed by magnetic resonance imaging and/or computed tomography brain scan received within less than three months
2) Mild-moderate upper limb motor impairment as determined by a score of 23-53 on the upper extremity subscale of the Fugl-Meyer Assessment of Motor Recovery after Stroke (UE-FMA) completed by an occupational therapist (OT)
3) Score of 24 or greater on the Mini-Mental State Examination indicating adequate cognition and communication for participation
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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
1) Comorbidities that contraindicate upper limb rehabilitation or exercise
2) Pre-existing/chronic upper limb impairment
3) Severe hemispatial neglect identified through completion of the Visual Perceptual Screen
4) Been given a palliative diagnosis
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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)
Participants will be provided with a participant information sheet and consent form upon arrival to the acute stroke unit or subacute rehab ward by the Clinical Nurse Consultant (CNC) of the acute stroke unit or clinical nurse (CN) of the subacute rehabilitation ward. Group allocation will be provided to participants in a sealed envelope by the CNC, CN or OT.
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Methods used to generate the sequence in which subjects will be randomised (sequence generation)
Participants admitted to the acute stroke unit who provide informed consent will be randomised to either the experimental or control group via block randomisation to ensure equal numbers in both groups.
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Masking / blinding
Blinded (masking used)
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Who is / are masked / blinded?
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 sample size estimate resulting in 34 required participants was made based off previous effect research in the use of virtual reality (VR) as an adjunct to improve upper limb (UL) function post stroke, most of which used a two-tailed a=0.05 and power of 0.8 to detect a small to medium effect size (Ahmad et al., 2019; El-Kafy et al., 2021; Hegazy et al., 2022; Hsu et al., 2019; Schuster-Amft et al., 2018; Wang et al., 2017). This study aims to recruit at least 41 participants to account for a potential dropout rate of 20%. The assessor’s past experience working within the acute stroke unit of Toowoomba Hospital and reviewing approximately two – four new stroke patients with UL weakness per week has also been utilised to ensure a feasible sample size has been selected.
SPSS Statistics will be used for statistical analysis. Independent t-test will be used to compare baseline patient demographic data. The level of statistical significance will be set at p = < .05. Data will be presented as mean ± standard deviation, with p values and confidence intervals reported for each outcome measure (change in UL function and change in participant quality of life) for both groups (intervention and control) between baseline and post-intervention. Between group differences at baseline and post-intervention will also be presented with p values and confidence intervals for each outcome measure. A paired t-test will be used to compare the changes between baseline and post-intervention results within each group for both outcomes. An independent t-test will be used to then compare the results between each group at baseline and post-intervention for both outcomes. Following this, effect sizes will be calculated using Cohen’s d for differences between baseline and post-intervention for both groups to determine the clinical significance of the results. Two independent t-tests will also be completed to compare completed UL repetitions and required direct therapist time between the intervention and control groups.
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Recruitment
Recruitment status
Recruiting
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Date of first participant enrolment
Anticipated
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Actual
2/07/2024
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Date of last participant enrolment
Anticipated
2/07/2025
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Actual
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Date of last data collection
Anticipated
1/08/2025
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Actual
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Sample size
Target
41
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Accrual to date
7
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Final
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Recruitment in Australia
Recruitment state(s)
QLD
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Recruitment hospital [1]
23619
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Toowoomba Hospital - Toowoomba
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Recruitment postcode(s) [1]
39038
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4350 - Toowoomba
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Funding & Sponsors
Funding source category [1]
312704
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Charities/Societies/Foundations
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Name [1]
312704
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Toowoomba Hospital Foundation
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Address [1]
312704
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Country [1]
312704
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Australia
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Primary sponsor type
Individual
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Name
Georgia Parsons - OT Toowoomba Hospital Subacute Rehabilitation Ward
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Address
Toowoomba Hospital, Pechey Street, Toowoomba 4350
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Country
Australia
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Secondary sponsor category [1]
314323
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None
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Name [1]
314323
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Address [1]
314323
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Country [1]
314323
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Ethics approval
Ethics application status
Approved
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Ethics committee name [1]
312005
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Darling Downs Hospital and Health Service Human Research Ethics Committee
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Ethics committee address [1]
312005
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https://www.health.qld.gov.au/darlingdowns/html/ddhhs-hrec.asp
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Ethics committee country [1]
312005
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Australia
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Date submitted for ethics approval [1]
312005
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16/05/2024
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Approval date [1]
312005
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20/05/2024
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Ethics approval number [1]
312005
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Summary
Brief summary
This study aims to compare an individualised, repetitive computer-based therapy program delivered using the AbleX with a conventional therapist-facilitated task-specific practice program on upper limb (UL) function and quality of life (QoL) for patients with acute stroke. To achieve this aim, the following objectives will be considered. 1. To compare change in UL function of patients with UL motor impairment post stroke between the intervention and control groups. 2. To compare change in patient QoL between the intervention and control groups. 3. To compare the amount of completed UL therapy repetitions between the intervention and control groups. 4. To compare the amount of required direct therapist time between the intervention and control groups. Research question: How effective is virtual reality (VR) at improving UL function and patient QoL when delivered as an adjunct to conventional UL therapy in the acute stage of recovery post stroke? Hypothesis: It is hypothesised that UL rehabilitation incorporating the AbleX will improve patient UL function and QoL when compared to conventional upper limb therapy alone.
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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 Georgia Parsons
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Address
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Toowoomba Hospital, Pechey Street, Toowoomba, Queensland 4350
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Country
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Australia
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Phone
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+617 4616 4327
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Fax
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Email
123142
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[email protected]
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Contact person for public queries
Name
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Georgia Parsons
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Address
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Toowoomba Hospital, Pechey Street, Toowoomba, Queensland 4350
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Country
123143
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Australia
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Phone
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+617 4616 4327
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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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Georgia Parsons
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Address
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Toowoomba Hospital, Pechey Street, Toowoomba, Queensland 4350
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Country
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Australia
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Phone
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+617 4616 4327
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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)?
No
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No/undecided IPD sharing reason/comment
Data will not be shared or published with any stakeholders external to Queensland Health for confidentiality reasons.
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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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