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Trial registered on ANZCTR
Registration number
ACTRN12607000326493
Ethics application status
Approved
Date submitted
13/06/2007
Date registered
19/06/2007
Date last updated
13/04/2012
Type of registration
Prospectively registered
Titles & IDs
Public title
A randomised controlled trial to determine the optimum frequency of Botulinum Toxin injections to the calf in children with cerebral palsy
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Scientific title
A randomised controlled trial to determine the optimum frequency of Botulinum Toxin A injections to the calf in children with cerebral palsy
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Secondary ID [1]
280296
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None
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Universal Trial Number (UTN)
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Trial acronym
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Linked study record
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Health condition
Health condition(s) or problem(s) studied:
Cerebral palsy in children
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Condition category
Condition code
Neurological
1969
1969
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Other neurological disorders
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Intervention/exposure
Study type
Interventional
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Description of intervention(s) / exposure
Intervention group: Botulinum Toxin A calf muscle injections every 4 months over a 2 year period.
Dose: 6 U/kg per gastrocnemius in diplegia or per gastrocnemius and soleus in hemiplegia with 6 U/kg available for use elsewhere as clinically indicated. Total upper dose of 18 U/kg.
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Intervention code [1]
1776
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Treatment: Drugs
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Comparator / control treatment
Active control group: Botulinum Toxin A calf muscle injections every 12 months over a 2 year period.
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Control group
Active
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Outcomes
Primary outcome [1]
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Passive length of gastrocnemius in degrees of dorsiflexion
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Assessment method [1]
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Timepoint [1]
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At 0, 12 and 26 months
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Secondary outcome [1]
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Level of Function measured using the Functional Mobility Scale
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Assessment method [1]
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Timepoint [1]
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0, 12, 26 months
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Secondary outcome [2]
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Quality of Life measured using the Child Health Questionnaire
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Assessment method [2]
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Timepoint [2]
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0, 12, 26 months
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Secondary outcome [3]
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Secondary Unresponsiveness to Botulinum Toxin A measured in two ways:
Assessing for the presence of neutralising antibodies to Botulinum Toxin A
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Assessment method [3]
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Timepoint [3]
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Blood collected prior to botulinum Toxin injections and assessed every 6 months.
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Secondary outcome [4]
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Assessing the amount of dynamic gastrocnemius shortness measured by gait analysis
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Assessment method [4]
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Timepoint [4]
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Pre/post final injection at 26 and 27 months
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Secondary outcome [5]
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3D ultrasound of medial gastrocnemius to determine muscle volumes
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Assessment method [5]
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Timepoint [5]
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0, 12 and 26 months
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Eligibility
Key inclusion criteria
Level I, II, or III on the Gross Motor Function Classification System for cerebral palsyGastrocnemius muscle length greater than 5 degrees with the knee extendedGastrocnemius spasticity (no heel contact during the stance phase of gait)
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Minimum age
2
Years
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Maximum age
5
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
Previous Botulinum Toxin A injections to the calf musclePrevious calf surgeryContraindications to the use of Botulinum Toxin A such as known hypersensitivity to any ingredient in the formulation, presence of Myasthenia Gravis or Eaton Lambert syndrome, or the presence of infection at the proposed injection site(s).
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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 involves contacting the holder of the allocation schedule who is "off-site"
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Methods used to generate the sequence in which subjects will be randomised (sequence generation)
The dynamic (adaptive) random allocation method of minimisation will be used with subjects categorised according to classification of cerebral palsy, severity of cerebral palsy and Botulinum toxin injections to muscles other than the calf.
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Masking / blinding
Blinded (masking used)
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Who is / are masked / blinded?
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Intervention assignment
Parallel
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Other design features
Two groups are blinded in this study, the assessor assessing the outcomes and the data analyst analysing the results.
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Phase
Phase 3
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Type of endpoint/s
Safety/efficacy
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Statistical methods / analysis
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Recruitment
Recruitment status
Completed
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Date of first participant enrolment
Anticipated
1/07/2007
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Actual
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Date of last participant enrolment
Anticipated
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Actual
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Date of last data collection
Anticipated
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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 in Australia
Recruitment state(s)
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Funding & Sponsors
Funding source category [1]
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Government body
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Name [1]
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National Health and Medical Research Centre (NHMRC), Grant Number: 454705
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Address [1]
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Level 1
16 Marcus Clarke Street
Canberra ACT 2601
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Country [1]
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Australia
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Primary sponsor type
Hospital
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Name
The Royal Children's Hospital, Melbourne, Victoria
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Address
Flemington Rd.
Parkville Victoria 3052
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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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Monash Medical Centre Southern Health
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Address [1]
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Monash Medical Centre
246 Clayton Road
Clayton, Victoria 3168
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Country [1]
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Australia
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Secondary sponsor category [2]
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Other
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Name [2]
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Murdoch Children's Research Institute
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Address [2]
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Royal Children's Hospital
Flemington Rd.
Parkville Victoria 3052
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Country [2]
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Australia
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Secondary sponsor category [3]
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University
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Name [3]
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Dept of Paediatrics University of Melbourne, Victoria
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Address [3]
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Royal Children's Hospital
Flemington Rd.
Parkville Victoria 3052
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Country [3]
1918
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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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Royal Children's Hospital Human Research Ethics Committee
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Ethics committee address [1]
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Royal Children's Hospital Flemington Rd, Parkville Victoria 3052
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Ethics committee country [1]
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Australia
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Date submitted for ethics approval [1]
287078
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Approval date [1]
287078
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09/11/2007
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Ethics approval number [1]
287078
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27062A
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Ethics committee name [2]
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Southern Health Research Directorate
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Ethics committee address [2]
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Level 4, Main Block, Monash Medical Centre 246 Clayton Road Clayton, Victoria 3168
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Ethics committee country [2]
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Australia
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Date submitted for ethics approval [2]
287079
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Approval date [2]
287079
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29/08/2007
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Ethics approval number [2]
287079
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07083C
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Summary
Brief summary
Cerebral Palsy (CP) is a disorder affecting around 2 in 1000 live births. Commonly, children with CP have spasticity in their muscles causing stiffness. When Botox (Botulinum Toxin A) is injected into a spastic muscle, it helps it to relax for around 3 months, after which the effect begins to wear off. During this relaxed time, the muscle is able to exercise through a greater range, helping to prevent contractures from forming. Botox is therefore used to both reduce spasticity in the short term, and to slow or prevent the development of contractures in the long term. This in turn, assists to delay corrective orthopaedic surgery until the later childhood years when surgical outcomes are more predictable and longer lasting. Currently, the most important clinical question is how often Botox should be used. More regular injections may provide additional time that the effects of Botox are working, and muscle contractures could be delayed more effectively. The aim of this study is to compare over a two-year period, the effects of Botox injections once a year compared to 3 times a year (every four months). The main measure will be the rate of development of contractures over the two years. Measurements (such as calf strength, questionnaires and blood tests) will also be made to determine whether either program negatively affects the muscle, whether the children in either group have a different level of function or quality of life and whether either program leads to the Botox having a reduced effect over 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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Address
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Country
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Phone
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Fax
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Email
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Contact person for public queries
Name
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Tandy Hastings-Ison
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Address
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Hugh Williamson Gait Analysis Laboratory
The Royal Children's Hospital
Flemington Rd
Parkville VIC 3052
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Country
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Australia
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Phone
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+61 3 93455354
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Fax
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+61 3 93455447
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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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Professor Kerr Graham
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Address
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Department of Orthopaedics
The Royal Children's Hospital
Flemington Rd
Parkville VIC 3052
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Country
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Australia
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Phone
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+61 3 93455399
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Fax
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+61 3 93455447
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Email
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[email protected]
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No information has been provided regarding IPD availability
What supporting documents are/will be available?
No Supporting Document Provided
Results publications and other study-related documents
Documents added manually
No documents have been uploaded by study researchers.
Documents added automatically
Source
Title
Year of Publication
DOI
Embase
Injection frequency of botulinum toxin A for spastic equinus: a randomized clinical trial.
2016
https://dx.doi.org/10.1111/dmcn.12962
N.B. These documents automatically identified may not have been verified by the study sponsor.
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