Incobotulinumtoxin A and Yoga-like Isometric Exercise in Adolescent Idiopathic Lumbar Scoliosis

NCT ID: NCT04922983

Last Updated: 2023-10-19

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Clinical Phase

PHASE2

Total Enrollment

42 participants

Study Classification

INTERVENTIONAL

Study Start Date

2021-07-01

Study Completion Date

2026-01-01

Brief Summary

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The study uses a yoga-like isometric posture and botulinum injections to reduce the curves in adolescent idiopathic lumbar scoliosis. Three previous studies show that the yoga pose is effective for reversing scoliotic curves; Botulinum toxin has been approved by the FDA for teenagers. However, no studies using the two of them together have been done until this one.

Detailed Description

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The randomized control 6-month study employs an isometric yoga-like posture to strengthen the weak side, and one set of botulinum injections to weaken the strong side of adolescent idiopathic lumbar scoliosis between 25 and 60 degrees. It is open to people between 12 and 18 years of age who are willing to do the pose every day for three months.

This is a crossover study: After 3 months, every patient who was placebo will be offered the actual proven yoga pose and botulinum toxin injections. Two additional free X-rays at 3 weeks and 3 months following the botulinum injection will also be available to each placebo patient.

In this way every patient - placebo or not - will receive the full proper treatment within 3 months.

Conditions

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Scoliosis Idiopathic Scoliosis; Adolescence Scoliosis; Lumbar Region

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

CROSSOVER

Three groups: Group I: Placebo isometric measure, no injection Group II True isometric exercise, placebo injection Group III: True isometric exercise, botulinum injection
Primary Study Purpose

TREATMENT

Blinding Strategy

QUADRUPLE

Participants Caregivers Investigators Outcome Assessors
Participants will understand they may receive placebo, and that they will not be told Investigators will know whether they give injections or not, but will not know if injection is placebo.

Outcomes assessors will be blinded to the entire procedure (radiologists reading X-rays).

Study Groups

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Group I: Placebo isometric measure, no injection

Group I: no isometric yoga-like exercise, no injection given.

Group Type SHAM_COMPARATOR

Placebo

Intervention Type BEHAVIORAL

Used as placebo

Group II Isometric yoga-like exercise, placebo injection given

Group II isometric yoga-like exercise, injection of preservative-free normal saline.

Group Type PLACEBO_COMPARATOR

Isometric Yoga-like exercise

Intervention Type BEHAVIORAL

Extended torso and legs held diagonally by one straight arm, back against wall if necessary

Group III: True isometric exercise, botulinum injection

Group III: Isometric yoga-like exercise, botulinum injection given

Group Type ACTIVE_COMPARATOR

Botulinum toxin type A

Intervention Type DRUG

A position similar to the side-plank (Vasisthasana) held for maximal time at least once daily (usual duration: 30 - 90 seconds).

Isometric Yoga-like exercise

Intervention Type BEHAVIORAL

Extended torso and legs held diagonally by one straight arm, back against wall if necessary

Crossover

After the three months, Arm I and Arm II patients will be given botulinum injections, and Group I will be given the proper yoga-like exercise. These two arms will constitute a further comparator with their own performances in the first 3 months of the study.

Group Type ACTIVE_COMPARATOR

Botulinum toxin type A

Intervention Type DRUG

A position similar to the side-plank (Vasisthasana) held for maximal time at least once daily (usual duration: 30 - 90 seconds).

Isometric Yoga-like exercise

Intervention Type BEHAVIORAL

Extended torso and legs held diagonally by one straight arm, back against wall if necessary

Interventions

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Botulinum toxin type A

A position similar to the side-plank (Vasisthasana) held for maximal time at least once daily (usual duration: 30 - 90 seconds).

Intervention Type DRUG

Isometric Yoga-like exercise

Extended torso and legs held diagonally by one straight arm, back against wall if necessary

Intervention Type BEHAVIORAL

Placebo

Used as placebo

Intervention Type BEHAVIORAL

Other Intervention Names

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Incobotulinumtoxin A Side-Plank, Vasisthasana no active intervention by drug or yoga-like exercise

Eligibility Criteria

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Inclusion Criteria

1\. Fourteen - 18 years of age, 2. Scoliotic curve greater than 25 degrees, less than 45 degrees, 3. Stated willingness to do the yoga and yoga-like poses daily, 4. Written, signed consent by patient and parent/guardian 5. Pre-test Cobb films no less than 3 months old read by independent radiologists.

Exclusion Criteria

1. Neurological, muscular or neuromuscular disease, (e.gs., cerebral palsy, myopathy, stroke),
2. Genetic abnormalities that affect limb growth, proportionality or metabolism, (e.gs., mucopolysaccharidoses, Marfan's syndrome, Refsums disease).
3. Pregnancy and other conditions prohibiting X-rays or minute(s)-long exertion (e.gs., congestive heart failure, great weakness, COPD).
4. Previous exposure to botulinum neurotoxin Type A. Sexually active female subjects must present a recent negative pregnancy test.
Minimum Eligible Age

14 Years

Maximum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

Yes

Sponsors

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Manhattan Physical Medicine and Rehabilitation, LLP

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Loren M Fishman

Role: PRINCIPAL_INVESTIGATOR

Columbia University

Locations

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Manhattan Physical Medicine and Rehabilitation, PLLC

Manhattan, New York, United States

Site Status RECRUITING

Countries

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United States

Central Contacts

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Loren M Fishman, MD

Role: CONTACT

646-642-0700

Cara M Cipriano, BA

Role: CONTACT

(2120 472-0077

Facility Contacts

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Cara Cipriano, BA, MA

Role: primary

212-472-0077

Loren Fishman, MD

Role: backup

646-642-0700

References

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Fishman LM, Groessl EJ, Sherman KJ. Serial case reporting yoga for idiopathic and degenerative scoliosis. Glob Adv Health Med. 2014 Sep;3(5):16-21. doi: 10.7453/gahmj.2013.064.

Reference Type RESULT
PMID: 25568820 (View on PubMed)

Fishman LM. Isometric Yoga-Like Maneuvers Improve Adolescent Idiopathic Scoliosis-A Nonrandomized Control Trial. Glob Adv Health Med. 2021 Feb 24;10:2164956120988259. doi: 10.1177/2164956120988259. eCollection 2021.

Reference Type RESULT
PMID: 33717658 (View on PubMed)

Fishman LM, Groessl EJ, Bernstein P.Two Isometric Yoga Poses Reduce the Curves in Degenerative and Adolescent Idiopathic Scoliosis. Topics in Geriatric Rehabilitation. 33(4):231-237, October/December, 2017.

Reference Type RESULT

Related Links

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Other Identifiers

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Pro00047989

Identifier Type: -

Identifier Source: org_study_id

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