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Trial registered on ANZCTR
Registration number
ACTRN12624000841572
Ethics application status
Approved
Date submitted
17/06/2024
Date registered
8/07/2024
Date last updated
8/07/2024
Date data sharing statement initially provided
8/07/2024
Type of registration
Prospectively registered
Titles & IDs
Public title
An Interventional Trial for Persisting Post-Concussive Symptoms after Mild Traumatic Brain Injury
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Scientific title
Intervention for Persisting Post-Concussive Symptoms after Mild Traumatic Brain Injury in adults aged 18 - 65 years
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Secondary ID [1]
312339
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Nil known
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Universal Trial Number (UTN)
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Trial acronym
PPCS
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Linked study record
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Health condition
Health condition(s) or problem(s) studied:
Concussion
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Mild traumatic brain injury
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Persistent post-concussion symptoms
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Condition category
Condition code
Neurological
330781
330781
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0
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Other neurological disorders
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Injuries and Accidents
330862
330862
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0
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Other injuries and accidents
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Intervention/exposure
Study type
Interventional
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Description of intervention(s) / exposure
Group 1: Neurofeedback
Neurofeedback sessions will train brain specific brain regions using real-time feedback of the individual’s electrophysiological brain activity. Participants allocated to the neurofeedback group will attend the Sarich Neuroscience Research Institute – Curtin University laboratory for 18 neurofeedback sessions (3 sessions/week for 6 weeks). Each neurofeedback session is expected to take approximately 40 minutes, including time to fit the Electro-Cap, fill the electrodes and achieve good impedance, and perform rounds of neurofeedback. Neurofeedback will be conducted in 7 rounds, with 3 minutes of training and 30-second breaks in between, for a total neurofeedback time of 24.5 minutes.
Participants will sit facing a computer monitor and see an electroencephalography (EEG) map on the screen. A research team member will remain with the participant, directly observing the participant as the complete the intervention. They will be given instruction on what the training will involve (i.e. meeting a target), but as an operant conditioning method will not receive specific instruction on how that is to be achieved. Instead, when the target brain behaviour is achieved, the participant is rewarded with a sound and appearance of a circle on the screen. The participant receives a score for each round which indicates their performance in achieving that target. Over time, the participant learns to regulate their own brain activity, though often they are not consciously aware of the learning mechanism. Target Z scores will be gradually reduced over each session based on improvement in performance. For example, a participant with a Z score of +3 (over-activation) will train to reduce brain activation in that area with a target Z score of 2.5. When this is achieved and maintained, the Z score will be reduced to 2, then 1.5, and so on, until the Z score is returned to a ‘normal’ score of 0.
Group 2: Concentration
This group will be recruited as a comparator to neurofeedback, to allow delineation of neurofeedback effects from effects of repeated focused concentration on a screen, participant-therapist interaction, environment, or other factors which may be associated with neurofeedback (but are not, in themselves, neurofeedback). This group will be informed that they are participating in a trial of concentration as a therapy for persistent post-concussive symptoms (PPCS). Participants allocated to the concentration group will attend the Sarich Neuroscience Research Institute – Curtin University laboratory for 18 concentration sessions (3 sessions/week for 6 weeks). To match the neurofeedback experience, each session is expected to take approximately 40 minutes (including fitting and filling of the Electro-Cap, etc.), with 7 rounds of 3 minute concentration and 30-second breaks in between, for a total time of 24.5 minutes.
Participants will sit facing a computer monitor and see an EEG map on the screen. They will be given instruction to look at the screen and pay particular attention when a sound plays and circle appears on the screen. A research team member will remain with the participant, directly observing the participant as the complete the intervention. For this group, the sound and circle will appear at random.
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Intervention code [1]
328826
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Treatment: Other
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Comparator / control treatment
Group 3: Control
This group will be recruited as a separate control comparator to neurofeedback, to allow us to examine whether participants would demonstrate natural improvement relative to baseline assessments over the same period without any specific intervention. In the few neurofeedback studies in traumatic brain injury (TBI) that have included a control group, this is the most common scenario. Participants allocated to the control group will attend the Sarich Neuroscience Research Institute – Curtin University laboratory for baseline and follow-up testing, and are not required to perform any training or attend for other sessions.
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Control group
Active
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Outcomes
Primary outcome [1]
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Change in Persistent Post-concussive Symptoms (PPCS) as determined by overall score on the Post-concussion symptom scale (PCSS)
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Assessment method [1]
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Post-concussion symptom scale (PCSS)
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Timepoint [1]
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Baseline (pre-treatment), follow-up (week 7 post-treatment)
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Secondary outcome [1]
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Change in quality of life as determined by overall score on Quality of Life After Brain Injury (QOLIBRI)
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Assessment method [1]
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Quality of Life After Brain Injury (QOLIBRI)
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Timepoint [1]
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Baseline (pre-treatment), follow-up (week 7 post-treatment)
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Secondary outcome [2]
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Change in coping strategies as determined by overall score on Utrecht Coping Test
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Assessment method [2]
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Utrecht Coping Test
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Timepoint [2]
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Baseline (pre-treatment), (week 7 post-treatment)
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Secondary outcome [3]
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Change in resilience as determined by overall score on Brief Resilience Scale
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Assessment method [3]
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Brief Resilience Scale
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Timepoint [3]
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Baseline (pre-treatment), follow-up (week 7 post-treatment)
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Secondary outcome [4]
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Change in the impact of headaches as determined by overall score on the Headache Disability Index
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Assessment method [4]
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Headache Disability Index
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Timepoint [4]
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Baseline (pre-treatment), follow-up (week 7 post-treatment)
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Secondary outcome [5]
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Change in the impact of dizziness as determined by overall score on the Dizziness Handicap Inventory
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Assessment method [5]
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Dizziness Handicap Inventory
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Timepoint [5]
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Baseline (pre-treatment), follow-up (week 7 post-treatment)
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Secondary outcome [6]
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Change in depression as determined by overall score on the Depression Anxiety Stress Scales – Short From (DASS-21)
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Assessment method [6]
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Depression Anxiety Stress Scales – Short From (DASS-21)
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Timepoint [6]
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Baseline (pre-treatment), follow-up (week 7 post-treatment)
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Secondary outcome [7]
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Change in cognitive functioning as assessed using the Repeatable Battery for Neuropsychological Status (RBANS)
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Assessment method [7]
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Repeatable Battery for Neuropsychological Status (RBANS) assessing executive functioning, attention, language and memory.
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Timepoint [7]
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Baseline (pre-treatment), follow-up (week 7 post-treatment)
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Secondary outcome [8]
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Exploratory outcome: Abnormal biomarkers in blood and saliva samples
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Assessment method [8]
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Blood draw will be collected by a researcher and processed for serum and plasma samples, then frozen at -80 degrees until use. Saliva samples will be collected by passive drool, which is painless and self-administered by the participant.
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Timepoint [8]
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Baseline (pre-treatment), follow-up (week 7 post-treatment)
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Secondary outcome [9]
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Exploratory outcome: Changes in MRI structure
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Assessment method [9]
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The MRI sequences acquired will be T1-weighted and fluid-attenuated inversion recovery (FLAIR) to assess anatomy.
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Timepoint [9]
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Baseline (pre-treatment), follow-up (week 7 post-treatment)
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Secondary outcome [10]
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Exploratory outcome: Changes in EEG brain network dysfunction
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Assessment method [10]
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EEG acquisition will be conducted using a 19-channel Electro-cap and an amplifier, and quantitative analysis will be conducted using NeuroGuide software.
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Timepoint [10]
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Baseline (pre-treatment), follow-up (week 7 post-treatment)
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Secondary outcome [11]
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Change in anxiety as determined by overall score on the Depression Anxiety Stress Scales – Short From (DASS-21)
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Assessment method [11]
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Depression Anxiety Stress Scales – Short From (DASS-21)
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Timepoint [11]
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Baseline (pre-treatment), follow-up (week 7 post-treatment)
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Secondary outcome [12]
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Change in stress as determined by overall score on the Depression Anxiety Stress Scales – Short From (DASS-21)
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Assessment method [12]
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Depression Anxiety Stress Scales – Short From (DASS-21)
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Timepoint [12]
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Baseline (pre-treatment), follow-up (week 7 post-treatment)
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Secondary outcome [13]
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Exploratory outcome: Changes in MRI function
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Assessment method [13]
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The MRI sequences acquired will be resting state functional MRI to assess functional brain networks.
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Timepoint [13]
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Baseline (pre-treatment), follow-up (week 7 post-treatment)
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Secondary outcome [14]
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Exploratory outcome: Changes in MRI brain metabolites
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Assessment method [14]
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The MRI sequences acquired will be magnetic resonance spectroscopy to assess brain metabolites.
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Timepoint [14]
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Baseline (pre-treatment), follow-up (week 7 post-treatment)
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Secondary outcome [15]
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Exploratory outcome: Changes in trauma index scores
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Assessment method [15]
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Low resolution electromagnetic tomography analysis (LORETA) will be used to identify areas of dysfunction relative to an age- and sex-matched normative population.
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Timepoint [15]
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Baseline (pre-treatment), follow-up (week 7 post-treatment)
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Eligibility
Key inclusion criteria
i) Clinical diagnosis of concussion made by a medical practitioner
ii) Concussion experienced 6 months to 4 years ago
iii) Experiencing persistent post-concussion symptoms (PPCS)
iv) Aged 18 – 65 years
v) Willing and able to attend Sarich Neuroscience Research Institute – Curtin University precinct for the required time commitment (3x40 minute sessions per week for 6 weeks, baseline and follow up testing)
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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?
No
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Key exclusion criteria
i) Significant history of pre-existing conditions that would interfere with assessment, intervention and follow-up (e.g. Substance abuse/alcohol abuse, homelessness, terminal illness)
ii) Significant debilitating pre-concussion diagnosed mental health disorder (e.g. schizophrenia, bipolar disorder)
iii) Significant pre-existing neurological condition which may interfere with ability to complete outcome measures, intervention or follow up (e.g. stroke, dementia)
iv) Pre-existing cognitive impairment (e.g. intellectual disability) which may interfere with ability to undertake assessment, intervention and follow up
v) Non-English speakers or poor English language skills which may interfere with ability to undertake assessment, intervention and follow up
vi) Pregnant women
vii) Prisoners in custody or people known to be involved in illegal activity
viii) Epilepsy or history of seizure
ix) Presence of surgical or other materials which may interfere with EEG signal e.g. aneurism clips, plates or screws, electronic inner ear implants, shrapnel or other foreign body.
x) Meets exclusion criteria to undertake MRI, which can be any of the following:
Has cardiac pacemaker or pacing wire in situ
Has metal surgical clips or staples of any kind (particularly aneurysm clips) in situ
Has had lap band surgery
Has electronic inner ear implants (bionic ears)
Has metal fragments in your eyes (past or present)
Has electronic stimulators
Has implanted pumps
Has metal pins or rods in bones
Has an IUCD (intrauterine contraceptive device) fitted
Has shrapnel, bullets or foreign bodies .
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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 randomised to study groups prior to baseline assessment using the sealed envelope system, in which randomly generated treatment allocations will be placed within sealed opaque envelopes. To further minimise potential bias or tampering, a member of the study team who will not interact with participants in recruitment, consent, training or assessments will select and open one envelope on the day of each participant's baseline testing. The participant will then be offered the allocated treatment or control.
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Methods used to generate the sequence in which subjects will be randomised (sequence generation)
Participants will be randomised to study groups prior to baseline assessment using the sealed envelope system, in which treatment allocations will be placed within sealed opaque envelopes that will then be selected at random by a researcher who is not involved with the participant or their treatment.
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Masking / blinding
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Who is / are masked / blinded?
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Intervention assignment
Factorial
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Other design features
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Phase
Not Applicable
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Type of endpoint/s
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Statistical methods / analysis
All statistical analyses will be carried-out using SPSS Statistics (version 24). Groups will be initially compared for baseline PPCS symptom, demographic information, cognitive and questionnaire scores and MRI findings, with subsequent within-group comparisons between baseline and follow-up testing. Analysis of EEG values within individual brain regions will be by change in Z score at that location. Nonparametric Monte-Carlo permutation inference will be performed to investigate regional alterations in power using FBRIB software library (FSL) “randomise” tool. These will be entered into a multivariate general linear model in order to control for demographic variables and tested for association with MRI, cognitive, questionnaire and biomarker scores in a linear regression model.
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Recruitment
Recruitment status
Not yet recruiting
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Date of first participant enrolment
Anticipated
22/07/2024
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Actual
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Date of last participant enrolment
Anticipated
21/07/2025
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Actual
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Date of last data collection
Anticipated
1/09/2025
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Actual
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Sample size
Target
84
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Accrual to date
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Final
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Recruitment in Australia
Recruitment state(s)
WA
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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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Bryant Stokes Neurological Research Foundation
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Address [1]
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Country [1]
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Australia
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Funding source category [2]
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Government body
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Name [2]
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Western Australian Future Health Research and Innovation Fund
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Address [2]
316756
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Country [2]
316756
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Australia
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Primary sponsor type
University
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Name
Curtin University
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Address
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Country
Australia
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Secondary sponsor category [1]
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Charities/Societies/Foundations
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Name [1]
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Perron Institute for Neurological Research and Translation
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Address [1]
318946
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Country [1]
318946
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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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Curtin University Human Research Ethics Committee
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Ethics committee address [1]
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https://www.curtin.edu.au/students/essentials/higher-degree-by-research/ethics-safety/human/
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Ethics committee country [1]
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Australia
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Date submitted for ethics approval [1]
315510
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20/04/2021
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Approval date [1]
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30/07/2021
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Ethics approval number [1]
315510
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HRE2021-0451
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Summary
Brief summary
This purpose of this study is to examine whether new brain training regimes (active interventions) can influence brain function and reduce persistent post-concussion symptoms. This study will compare two different types of brain training to the “standard treatment”, which for mTBI is no treatment other than symptom management (control with no intervention). This will aid in determining whether people in the brain training groups have less symptoms because of brain training, or whether they would have had a reduction in symptoms anyway during that time.
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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 Sarah Hellewell
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Address
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Curtin University Level 3, Sarich Neuroscience Institute 8 Verdun st, Nedlands WA 6009
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Country
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Australia
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Phone
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+61434053674
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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 Sarah Hellewell
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Address
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Curtin University Level 3, Sarich Neuroscience Institute 8 Verdun st, Nedlands WA 6009
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Country
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Australia
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Phone
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+61434053674
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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 Sarah Hellewell
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Address
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Curtin University Level 3, Sarich Neuroscience Institute 8 Verdun st, Nedlands WA 6009
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Country
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Australia
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Phone
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+61434053674
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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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