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Trial registered on ANZCTR
Registration number
ACTRN12623000138684
Ethics application status
Approved
Date submitted
20/12/2022
Date registered
9/02/2023
Date last updated
9/02/2023
Date data sharing statement initially provided
9/02/2023
Type of registration
Prospectively registered
Titles & IDs
Public title
Upper limb rehabilitation in Parkinson’s disease; matching motor learning strategies and the person’s cognitive profile
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Scientific title
Upper limb rehabilitation in Parkinson’s disease; matching motor learning strategies- motor imagery and cross education - and the person’s cognitive profile
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Secondary ID [1]
308503
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Nil known
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Universal Trial Number (UTN)
U1111-1285-5249
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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:
Parkinson's Disease
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Condition category
Condition code
Neurological
325391
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0
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Parkinson's disease
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Physical Medicine / Rehabilitation
325392
325392
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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
Intervention program will be administered twice a week, 45 minute sessions, for 5 weeks by a qualified Occupational Therapist with experience with Parkinson's Disease (PD). both groups (intervention and comparator group) will receive intervention in one-on-one sessions once a week face to face in the Clinic or the patient's home and once a week on zoom from the patient’s home.
intervention description: Motor Imagery intervention- practice of dexterity exercises will be performed after imagining the exercise in the first person. After imagining the movement, the patient will perform the activity with the hand that he was instructed to imagine using. For Activities of Daily Living (ADL) which are unilateral practice will be performed only with the dominant arm – following imagery of the activity. For bilateral ADL’s practice will be performed after imagining the activity. Motor imagery will be performed with the verbal guidance of the Occupational Therapist.
After 3 weeks both groups will be asked to give 2-3 dexterity based activities that are meaningful and difficult for them in daily function, those activities will be integrated into the intervention.
Session attendance will be followed and reported.
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Intervention code [1]
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Rehabilitation
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Comparator / control treatment
comparator group: Cross Education intervention - practice of dexterity exercises (e.g. versatile manipulation exercises such as collecting toilet paper etc.) will be performed several times with the unaffected side and only thereafter with the more affected side to facilitate cross education. For ADL’s that are unilateral practice will be performed only with the dominant arm. For ADL’s which are bilateral (e.g. cutting food or buttoning), practice of dexterity exercises mentioned above will precede their practice, after which bilateral ADL’s will be practiced with both hands with dominance and previous patient’s function determining each hand’s function within the activity (e.g. a patient that is accustomed to cutting food with the knife in the right hand and the fork in the left will practice with the same laterality in the intervention).
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Control group
Active
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Outcomes
Primary outcome [1]
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The Canadian Occupational Performance measure (COPM) is a semi-structured interview measuring self-perceived performance.
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Assessment method [1]
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Timepoint [1]
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Prior to intervention initiation, at intervention end and at a 4 week follow up.
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Primary outcome [2]
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Time of completion of a functional task will be recorded (and videotaped conditioned on the participant’s consent): Taking out 2 coins, 2 bills and a credit card from a wallet and placing them on the table.
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Assessment method [2]
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Timepoint [2]
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Prior to intervention initiation, at intervention end and at a 4 week follow up.
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Primary outcome [3]
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Time of completion of a functional task will be recorded (and videotaped conditioned on the participant’s consent): Writing/typing task.
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Assessment method [3]
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Timepoint [3]
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Prior to intervention initiation, at intervention end and at a 4 week follow up.
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Secondary outcome [1]
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The dexterity questionnaire (DextQ-36 - revised) : The DextQ-36 - revised is a patient-reported dexterity questionnaire regarding ADL functions that require complex UL function. It is based on the dextQ-24 and approval was attained from the main author to perform an official translation process as well as changes to items.
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Assessment method [1]
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Timepoint [1]
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Prior to intervention initiation, at intervention end and at a 4 week follow up.
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Secondary outcome [2]
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The Movement Disorder Society - Unified Parkinson’s Disease Rating Scale (MDS-UPDRS). In this research the ADL section (part II) as well as the upper limb items and the pull test from the MDS-UPDRS motor test (III) will be administered.
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Assessment method [2]
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Timepoint [2]
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Prior to intervention initiation, at intervention end and at a 4 week follow up.
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Secondary outcome [3]
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The Coin Rotation Task is a test measuring hand dexterity. The task requires the participant to rotate a U.S. nickel (in Israel will be performed with a 10 agorot coin) through consecutive 1800 turns using the thumb, index and middle fingers, as rapidly as possible for 20 rotations.
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Assessment method [3]
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Timepoint [3]
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Prior to intervention initiation, at intervention end and at a 4 week follow up.
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Secondary outcome [4]
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The TATOO is a touchscreen assessment tool that measures hand dexterity abilities (developed by Danial-Saad& Chiari, 2017). It tests intentional movements aimed at touchscreen use such as tapping, swiping, pinching and other motor activities of the hand.
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Assessment method [4]
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Timepoint [4]
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Prior to intervention initiation, at intervention end and at a 4 week follow up.
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Secondary outcome [5]
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The Nine Hole Peg Test (NHPT) assesses finger dexterity by measuring the time it takes to insert and remove nine small pegs into a wooden board.
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Assessment method [5]
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Timepoint [5]
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Prior to intervention initiation, at intervention end and at a 4 week follow up.
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Eligibility
Key inclusion criteria
Inclusion criteria: PD diagnosis of at least two years, Hoehn and Yahr =>2, existence of lateralization determined by the Unified Parkinson’s Disease Rating Scale motor examination and the patient subjective report.
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Minimum age
50
Years
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Maximum age
90
Years
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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: existence of other neurological diagnosis (e.g., stroke, dementia).
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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 will be concealed- the person who determines if a subject was eligible for inclusion in the trial will be unaware of the allocation- when the decision will be made and to which group the subject will be allocated.
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Methods used to generate the sequence in which subjects will be randomised (sequence generation)
block randomization with computerised sequence generation and stratification.
Stratification will be according to the UPDRS II score (cut off point 17).
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Masking / blinding
Blinded (masking used)
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Who is / are masked / blinded?
The people assessing the outcomes
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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
Repeated measure ANOVA mixed design with a within factor (time) and between factor (intervention type) will be used to examine the first aim and Pearson correlations for the second aim (p<.05).
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Recruitment
Recruitment status
Not yet recruiting
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Date of first participant enrolment
Anticipated
12/02/2023
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Actual
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Date of last participant enrolment
Anticipated
15/12/2024
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Actual
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Date of last data collection
Anticipated
1/03/2025
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Actual
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Sample size
Target
40
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Accrual to date
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Final
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Recruitment outside Australia
Country [1]
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Israel
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State/province [1]
25160
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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 Haifa
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Address [1]
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199 Aba Khoushy Ave. Mount Carmel, Haifa, Israel
Zip code: 3498838
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Country [1]
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Israel
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Primary sponsor type
University
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Name
University of Haifa
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Address
199 Aba Khoushy Ave. Mount Carmel, Haifa, Israel
Zip code: 3498838
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Country
Israel
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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]
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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 Haifa ethics comittee
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Ethics committee address [1]
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199 Aba Khoushy Ave. Mount Carmel, Haifa, Israel Zip code: 3498838
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Ethics committee country [1]
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Israel
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Date submitted for ethics approval [1]
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09/03/2021
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Approval date [1]
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18/04/2021
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Ethics approval number [1]
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121/22
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Summary
Brief summary
Parkinson’s Disease (PD) leads to complex pathological characteristics demonstrated in versatile motor and cognitive profiles. The symptoms which develop over the course of the disease changes the person with Parkinson’s ability to carry out everyday activities. Functional decline in PD has a large impact on QOL, is first characterized by difficulties in ADL’s such as house work, dressing and writing and was found to decline in connection with cognition. In regard to motor function dexterity was found to be associated with ADL independence more than tasks related to lower limb function or gross upper limb (UL) function. In order to maximize the benefits of rehabilitation of PWP’s, it is essential to better understand the interaction between cognition and motor learning strategies. This will be performed by designing and comparing between two intervention programs - Motor Imager (MI) and Cross Education (CE) - focused on improvement in Upper Limb (UL) functional ability (i.e. dressing, eating, etc.). efficacy of intervention will be assessed in regard to the participant’s personal improvement, additionally cognition will be analyzed as a potential mediating factor in the efficacy of the intervention type. Our ultimate goal is to enhance knowledge translation by creating a manual for clinicians whereby a cognitive exam administered at the beginning of an intervention period, will facilitate clinical reasoning in choosing the most efficient motor learning strategy for a specific patient. Aims: 1. Comparing lasting effects of MI and CE strategies in improving UL motor performance and ADL function in PWP’s. 2. Examine associations between cognitive profile and improvement in UL motor performance and daily function due to implementation of each strategy. 3. Creating a manual for therapists to facilitate clinical reasoning in choosing the most efficient motor learning strategy for a specific patient. Hypothesis: 1. MI will be less beneficial than CE in improving overall motor functional performance. 2. Better cognitive abilities will be associated with higher improvement in motor performance and ADL in both strategies: executive function will be associated with higher MI benefits, lower cognitive ability will benefit more from CE.
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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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Miss Rachel Kizony
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Address
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University of Haifa
199 Aba Khoushy Ave. Mount Carmel, Haifa, Israel
Zip code: 3498838
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Country
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Israel
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Phone
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+972 543550898
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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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Noa Cohen
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Address
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University of Haifa
199 Aba Khoushy Ave. Mount Carmel, Haifa, Israel
Zip code: 3498838
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Country
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Israel
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Phone
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+972 543516048
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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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Noa Cohen
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Address
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University of haifa
199 Aba Khoushy Ave. Mount Carmel, Haifa, Israel
Zip code: 3498838
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Country
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Israel
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Phone
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+972 543516048
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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
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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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