Comparing Use of Radiographs Versus Patient Empowerment (CURVE)

NCT ID: NCT05379127

Last Updated: 2023-11-18

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

NA

Total Enrollment

812 participants

Study Classification

INTERVENTIONAL

Study Start Date

2022-07-17

Study Completion Date

2025-12-31

Brief Summary

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Objective: To evaluate the (cost-)effectiveness of a new patient-empowered follow up (FU) protocol in patients with Adolescent idiopathic Scoliosis (AIS) that is based on patient-reported outcome measures (PROMs), self-assessment tools and physical examination, which is compared to standard FU care by: 1) Effect evaluation, 2) Economic evaluation, 3) Implementation (process) evaluation.

Study design: A multicentre pragmatic randomized trial design with two arms, combined with a patient preference cohort for each arm (partially randomized preference trial \[PRPT\]).

Study population: A total of 812 AIS patients (age 10-18 years) treated by the Dutch AIS Consortium, representing the scoliosis treatment centres in the Netherlands, will be included.

Three subgroups of AIS patients are distinguished, which are monitored over two years:

1. Pre-treatment group: adolescents with curve 10-25° (n=132 per arm; total n=264)
2. Post-brace treatment group (n=122 per arm; total n=244)
3. Post-surgery group (n=152 per arm; total n=304)

Intervention: The new patient-empowered FU protocol (PE-FU) is based on PROMs, self-assessment tools and clinical assessment including physical examination. The protocol aims to detect curve progression or postoperative complications based on these patient-based and clinical parameters to substitute the need to obtain routine x-rays. X-rays will only be taken when progression or postoperative complications are suspected in the pre- and post-intervention groups based on predefined criteria. The standard FU protocol consists of routine full-spine radiographs and routine clinical evaluations.

Detailed Description

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Conditions

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Adolescent Idiopathic Scoliosis

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

A multicentre pragmatic randomized trial design with two arms, combined with a patient preference cohort for each arm (partially randomized preference trial; PRPT).

The PRPT consists of three separate randomized controlled trials (RCTs) including patients in the pre-treatment phase, post-brace phase or post-operative phase. Alongside the RCTs prospective preference cohorts are included for each treatment arm (patient empowered follow up \[PE-FU\] or standard follow up \[standard FU\]). In the preference cohorts all patients are monitored who are not willing (i.e. who have a preference for either the standard FU or PE-FU) to be randomized to either treatment arm, but who are still willing to participate in the study. By including preference cohorts the generalizability of study results is studied while the internal validity is assured.

* Half of participants (n=406) allocation: randomized (RCT)
* Half of participants (n=406) allocation: based on preference (preference cohorts)
Primary Study Purpose

HEALTH_SERVICES_RESEARCH

Blinding Strategy

SINGLE

Outcome Assessors

Study Groups

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Standard follow-up

standard care during follow-up

Group Type OTHER

Standard follow-up

Intervention Type OTHER

Routine radiographs are taken at each follow up visit during standard care (to detect possible curve progression or rule out postoperative complications).

Patient-empowered follow-up

Group Type EXPERIMENTAL

Patient-empowered follow up

Intervention Type OTHER

The patient-empowered follow-up protocol consists of patient-reported outcome measures (PROMs), self-assessment tools and clinical assessment including physical examination. Radiographs will only be taken when progression of the scoliosis (curve progression) or postoperative complications are suspected based on test results and based on the criteria of so called 'sense of alarm'.

Note: Sense of alarm ('niet pluis') is based on any deterioration on the above-mentioned PROMs, self-assessment tool, and clinician-based measurement instruments, which is a signal for the treating physician to consider when a radiograph is appropriate. Sense of alarm is described as any other concern by the orthopaedic surgeon, parent or child which warrants a radiograph. For both the Bunnell Scoliometer (clinical assessment tool) and the Scolioscoop (patient self-assessment tool) a threshold of ≥4° is used.

Interventions

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Patient-empowered follow up

The patient-empowered follow-up protocol consists of patient-reported outcome measures (PROMs), self-assessment tools and clinical assessment including physical examination. Radiographs will only be taken when progression of the scoliosis (curve progression) or postoperative complications are suspected based on test results and based on the criteria of so called 'sense of alarm'.

Note: Sense of alarm ('niet pluis') is based on any deterioration on the above-mentioned PROMs, self-assessment tool, and clinician-based measurement instruments, which is a signal for the treating physician to consider when a radiograph is appropriate. Sense of alarm is described as any other concern by the orthopaedic surgeon, parent or child which warrants a radiograph. For both the Bunnell Scoliometer (clinical assessment tool) and the Scolioscoop (patient self-assessment tool) a threshold of ≥4° is used.

Intervention Type OTHER

Standard follow-up

Routine radiographs are taken at each follow up visit during standard care (to detect possible curve progression or rule out postoperative complications).

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* Patients with adolescent idiopathic scoliosis (AIS).
* Age: 10-18 years old.
* Patients scheduled for follow up in one of the participating centres.
* Understanding of the Dutch language.
* Signed informed consent.
* Biplanar (Posterior-Anterior \[PA\] and Lateral) full-spine x-rays within the last 3 months.

Specifically for the pre-treatment group:

* Girls aged ≤14 years (i.e. 10-14 years) and boys \<16 years (i.e. 10-15 years). These patients still have generally 2 years of remaining skeletal growth. Patients above this age with a curve below 25 degrees have a limited risk for progression
* Girls: pre-menarche up to 6 months post-menarche (to estimate end of growth)
* A primary coronal curve of 10-25 degree.

Specifically for the post-brace group:

* Patients aged 12-18 years
* Within 3 months after termination of brace treatment
* Minimum of 6 months of brace treatment

Specifically for the post-surgery group:

• Patients aged 12-18 years

Exclusion Criteria

* Patients with juvenile or infantile idiopathic scoliosis with the diagnosis of onset under the age of 10.
* Patients who are undergoing brace treatment. These patients are not included because of the need to monitor brace therapy with radiographs.
* Patients who have undergone previous spinal surgery and are undergoing revision surgery.
* Skeletally mature patients.
Minimum Eligible Age

10 Years

Maximum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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ZonMw: The Netherlands Organisation for Health Research and Development

OTHER

Sponsor Role collaborator

Trialbureau Zorgevaluatie Nederland

UNKNOWN

Sponsor Role collaborator

Nederlandse Orthopaedische Vereniging

UNKNOWN

Sponsor Role collaborator

Vereniging Scoliose Patiënten

UNKNOWN

Sponsor Role collaborator

Dutch Adolescent Idiopathic Scoliosis (AIS) Consortium

UNKNOWN

Sponsor Role collaborator

Radboud University Medical Center

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Miranda L van Hooff, PhD

Role: PRINCIPAL_INVESTIGATOR

Radboud University Medical Center

Marinus de Kleuver, MD, PhD

Role: PRINCIPAL_INVESTIGATOR

Radboud University Medical Center

Locations

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Isala

Zwolle, Drenthe, Netherlands

Site Status RECRUITING

Flevo ziekenhuis

Almere Stad, Flevoland, Netherlands

Site Status RECRUITING

Rijnstate

Arnhem, Gelderland, Netherlands

Site Status NOT_YET_RECRUITING

St Jansdal

Harderwijk, Gelderland, Netherlands

Site Status NOT_YET_RECRUITING

Maastricht UMC+

Maastricht, Limburg, Netherlands

Site Status RECRUITING

Viecuri

Venlo, Limburg, Netherlands

Site Status RECRUITING

Sint Maartenskliniek

Boxmeer, North Brabant, Netherlands

Site Status RECRUITING

Amphia

Breda, North Brabant, Netherlands

Site Status RECRUITING

ETZ Elisabeth

Tilburg, North Brabant, Netherlands

Site Status NOT_YET_RECRUITING

Noordwestziekenhuis groep

Alkmaar, North Holland, Netherlands

Site Status NOT_YET_RECRUITING

OLVG

Amsterdam, North Holland, Netherlands

Site Status RECRUITING

Amsterdam UMC

Amsterdam, North Holland, Netherlands

Site Status RECRUITING

Spaarne Gasthuis

Haarlem, North Holland, Netherlands

Site Status RECRUITING

Dijklander

Hoorn, North Holland, Netherlands

Site Status NOT_YET_RECRUITING

Albert Schweitzer ziekenhuis

Dordrecht, South Holland, Netherlands

Site Status RECRUITING

Groene Hart ziekenhuis

Gouda, South Holland, Netherlands

Site Status NOT_YET_RECRUITING

Leiden UMC

Leiden, South Holland, Netherlands

Site Status RECRUITING

Erasmus MC

Rotterdam, South Holland, Netherlands

Site Status RECRUITING

Maasstad ziekenhuis

Rotterdam, South Holland, Netherlands

Site Status RECRUITING

Juliana kinderziekenhuis

The Hague, South Holland, Netherlands

Site Status RECRUITING

Meander

Amersfoort, Utrecht, Netherlands

Site Status RECRUITING

UMC Groningen

Groningen, , Netherlands

Site Status RECRUITING

UMC Utrecht

Utrecht, , Netherlands

Site Status RECRUITING

Countries

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Netherlands

Central Contacts

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Miranda L van Hooff, PhD

Role: CONTACT

+31 24 361 3366

Jurre Baetsen, MSc

Role: CONTACT

+31 6 55742308

Facility Contacts

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A Mostert, Dr.

Role: primary

B Blom, drs.

Role: primary

J van Susante

Role: primary

P Lammers, drs.

Role: primary

P Willems, prof. dr.

Role: primary

M Hulsbosch, drs.

Role: primary

P Bisseling, Dr.

Role: primary

E Hoebink, dr.

Role: primary

R Geuze, dr.

Role: primary

H Graat

Role: primary

D Kempen, dr.

Role: primary

R Hoogendoorn, dr.

Role: primary

E Kraaneveld, drs.

Role: primary

W.J. Marijnissen, dr.

Role: primary

P Haen, drs.

Role: primary

P.B. de Witte, dr.

Role: primary

J Rutgens, dr.

Role: primary

H van West, drs.

Role: backup

W Bakker, drs.

Role: primary

J van Linge, drs.

Role: primary

T.D. Berendes, dr.

Role: primary

C Faber, dr.

Role: primary

T Schlösser, dr.

Role: primary

Other Identifiers

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80-87600-98-19048

Identifier Type: -

Identifier Source: org_study_id

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