Non-invasive Measurement of Compartment Pressure: Reliability

NCT ID: NCT05720182

Last Updated: 2024-11-26

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

COMPLETED

Clinical Phase

NA

Total Enrollment

70 participants

Study Classification

INTERVENTIONAL

Study Start Date

2023-01-15

Study Completion Date

2024-02-15

Brief Summary

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The investigators want to investigate the reliability (variability) of a new device, that should be able to measure lower leg compartment pressure non-invasively. Therefore the tool is used under different circumstances. The introduced differences in circumstances are:

* Measurements at several time points
* Measurements using different anatomical landmarks
* Measurements by different researchers
* Measurements in rest and after exercise

This study's results are important to create a reliable measurement tools for patients with lower leg symptoms. In this way the diagnosis can be improved and as well the treatments given to the patients.

It is expected that the variability of the device will be low compared to current techniques.

Detailed Description

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Chronic Exertional Compartment Syndrome (CECS) is one of the exercise-induced lower leg pathologies. Recognition by patients and physicians is not optimal. As a consequence, many patients are undiagnosed and are forced to stop their sporting activities. To diagnose CECS, a doctor should be alerted by a patient's history and a physical examination. If both suggestive of CECS, an invasive intra compartmental pressure measurement (ICPM) in the affected compartment may be performed. During the ICPM a catheter is placed into the muscle via a hollow needle. The ICPM is not flawless in terms of accuracy and reproducibility and has a low intra-observer reproducibility. Moreover, haematoma or other tissue damage may occur following an ICPM. Nevertheless, this invasive ICPM is in 2022 still considered the 'gold-standard' diagnostic tool for CECS, in the absence of a better one.

A novel non-invasive tool for CECS is possibly provided by measuring muscle tissue compressibility. The idea is, that muscle tissue with a high pressure (as in CECS patients) requires more external force to compress, compared to tissue with a low pressure. The study device used in this study, the CPM#1 device, is based on this principle. The CPM#1 device is non-invasive, not painful, very user friendly, and the measurement can be executed as an 'office procedure' in a couple of minutes. This study will focus on determining the reliability of the device in healthy volunteers.

The primary objective is

\- To validate the inter-observer reliability of compressibility measurements with the CPM#1 device during rest in healthy volunteers.

Secondary objectives are

* To validate the intra-observer reliability of compressibility measurements with the CPM#1 device during rest in healthy volunteers.
* To investigate the effect of exercise on compressibility immediately, one minute, and five minutes after exercise in healthy volunteers.
* To map the invasiveness of the compressibility measurement with the CPM#1 device.

Nature and extent of the burden and risks associated with participation, benefit and group relatedness:

Healthy subjects will undergo several compressibility measurements, both before and after a treadmill exercise. They will also complete a NIAPS (Netwerk Inspannings Afhankelijke PijnSyndromen) questionnaire and an 'experience' questionnaire. The harm associated with the CPM#1 device is none. However, the subjects will not benefit from this study

Conditions

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CEC Syndrome

Study Design

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Allocation Method

NA

Intervention Model

SINGLE_GROUP

A performance validation pilot of the CPMX1 device in healthy volunteers. There will only be one study arm, no comparator, and no randomization.
Primary Study Purpose

OTHER

Blinding Strategy

NONE

No true masking possible, as the study only uses healthy participants and all participants will get measurements to both legs.

Study Groups

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Healthy Volunteers

Healthy subjects are not subjected to any type of treatment besides non-invasive lower leg muscle compressibility measurements in rest and after exercise.

All 35 healthy subjects will undergo four times four measurements in rest (m. tibialis anterior of both legs, using two different internal landmarks). These four times four measurements in rest will each be done by three observers.

To measure the effect of exercise, compressibility will be measured immediately, one minute, and five minutes after a standard treadmill exercise at just one leg. The treadmill exercise and the corresponding measurements will be performed twice to address for measurements of both legs.

Group Type EXPERIMENTAL

Compremium Compressibility Measurement

Intervention Type DEVICE

CPM#1 measurements:

Step 1: Manual investigation to identify the compartment for compressibility measurements

Step 2: Marking the location for compressibility measurements

Step 3 - Examination with CPM#1

* Place the probe on the target area
* Identify correct landmark
* Compress the compartment
* Increase steadily the pressure applied by the CP probe to 80 mmHg.

Treadmill Running

Intervention Type PROCEDURE

Exercise:

Step 1: Participants will walk on a treadmill with standardized walking speed (5.0 km/hour) and slope (15%) for 5 minutes.

Step 2: Immediate, one minute, and five minutes post-exercise CPM#1 measurements will be performed at one leg.

Exercise and post-exercise CPM#1 measurements will be repeated for the other leg.

Questionnaire

Intervention Type OTHER

Questionnaires NIAPS questionnaire: Baseline NIAPS questionnaire with one additional question about leg dominance.

Experience questionnaire: Scores 1-5, questioning the intensity, how painful, the nuisance, the duration of the study and the non-invasive pressure measurements.

Interventions

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Compremium Compressibility Measurement

CPM#1 measurements:

Step 1: Manual investigation to identify the compartment for compressibility measurements

Step 2: Marking the location for compressibility measurements

Step 3 - Examination with CPM#1

* Place the probe on the target area
* Identify correct landmark
* Compress the compartment
* Increase steadily the pressure applied by the CP probe to 80 mmHg.

Intervention Type DEVICE

Treadmill Running

Exercise:

Step 1: Participants will walk on a treadmill with standardized walking speed (5.0 km/hour) and slope (15%) for 5 minutes.

Step 2: Immediate, one minute, and five minutes post-exercise CPM#1 measurements will be performed at one leg.

Exercise and post-exercise CPM#1 measurements will be repeated for the other leg.

Intervention Type PROCEDURE

Questionnaire

Questionnaires NIAPS questionnaire: Baseline NIAPS questionnaire with one additional question about leg dominance.

Experience questionnaire: Scores 1-5, questioning the intensity, how painful, the nuisance, the duration of the study and the non-invasive pressure measurements.

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* ≥ 18 years
* Proficient in speaking and reading Dutch

Exclusion Criteria

* Presence of complaints suggestive of CECS, previously diagnosed with CECS or previous positive ICPM
* History of surgery or other trauma which penetrated the fascia of the leg
* Other concurrent limb pathologies or anomalies amongst others:
* Peripheral arterial or venous disease
* Muscle disorders, diabetes mellitus, peripheral neuropathies
* Unable to exercise for five minutes
* Open wound or painful bruise less than one week ago at site of measurement
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

Yes

Sponsors

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CPM Sport AG Bern

UNKNOWN

Sponsor Role collaborator

Kay van Heeswijk

OTHER

Sponsor Role lead

Responsible Party

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Kay van Heeswijk

Coordinating Investigator

Responsibility Role SPONSOR_INVESTIGATOR

Principal Investigators

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Marc RM Scheltinga, Dr

Role: PRINCIPAL_INVESTIGATOR

Máxima Medisch Centrum

Locations

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Máxima Medisch Centrum

Veldhoven, North Brabant, Netherlands

Site Status

Countries

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Netherlands

References

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Orlin JR, Lied IH, Stranden E, Irgens HU, Andersen JR. Prevalence of chronic compartment syndrome of the legs: Implications for clinical diagnostic criteria and therapy. Scand J Pain. 2016 Jul;12:7-12. doi: 10.1016/j.sjpain.2016.01.001. Epub 2016 Mar 4.

Reference Type BACKGROUND
PMID: 28850498 (View on PubMed)

Maksymiak R, Ritchie E, Zimmermann W, Maliko N, van der Werve M, Verschure M, Hoencamp R. Historic cohort: outcome of chronic exertional compartment syndrome-suspected patients. BMJ Mil Health. 2021 Dec;167(6):387-392. doi: 10.1136/jramc-2019-001290. Epub 2020 Feb 3.

Reference Type BACKGROUND
PMID: 32019808 (View on PubMed)

Vogels S, VAN Ark W, Janssen L, Scheltinga MRM. Fasciectomy for Recurrent Chronic Exertional Compartment Syndrome of the Anterior Leg. Med Sci Sports Exerc. 2021 Aug 1;53(8):1549-1554. doi: 10.1249/MSS.0000000000002631.

Reference Type BACKGROUND
PMID: 33731658 (View on PubMed)

Houston A, Cosma G, Turner P, Bennett A. Predicting surgical outcomes for chronic exertional compartment syndrome using a machine learning framework with embedded trust by interrogation strategies. Sci Rep. 2021 Dec 20;11(1):24281. doi: 10.1038/s41598-021-03825-4.

Reference Type BACKGROUND
PMID: 34931008 (View on PubMed)

Pedowitz RA, Hargens AR, Mubarak SJ, Gershuni DH. Modified criteria for the objective diagnosis of chronic compartment syndrome of the leg. Am J Sports Med. 1990 Jan-Feb;18(1):35-40. doi: 10.1177/036354659001800106.

Reference Type BACKGROUND
PMID: 2301689 (View on PubMed)

Vogels S, Ritchie ED, Bakker EWP, Vogels MAJM, Zimmermann WO, Verhofstad MHJ, Hoencamp R. Measuring intracompartmental pressures for the chronic exertional compartment syndrome: Challenging commercially available devices and their respective accuracy. J Biomech. 2022 Apr;135:111026. doi: 10.1016/j.jbiomech.2022.111026. Epub 2022 Feb 28.

Reference Type BACKGROUND
PMID: 35288313 (View on PubMed)

Large TM, Agel J, Holtzman DJ, Benirschke SK, Krieg JC. Interobserver Variability in the Measurement of Lower Leg Compartment Pressures. J Orthop Trauma. 2015 Jul;29(7):316-21. doi: 10.1097/BOT.0000000000000317.

Reference Type BACKGROUND
PMID: 25756911 (View on PubMed)

Bloch A, Tomaschett C, Jakob SM, Schwinghammer A, Schmid T. Compression sonography for non-invasive measurement of lower leg compartment pressure in an animal model. Injury. 2018 Mar;49(3):532-537. doi: 10.1016/j.injury.2017.11.036. Epub 2017 Nov 27.

Reference Type BACKGROUND
PMID: 29195681 (View on PubMed)

Herring MJ, Donohoe E, Marmor MT. A Novel Non-invasive Method for the Detection of Elevated Intra-compartmental Pressures of the Leg. J Vis Exp. 2019 May 31;(147). doi: 10.3791/59887.

Reference Type BACKGROUND
PMID: 31205299 (View on PubMed)

Marmor MT, Barker JP, Matz J, Donohoe E, Herring MJ. A dual-sensor ultrasound based method for detecting elevated muscle compartment pressures: A prospective clinical pilot study. Injury. 2021 Aug;52(8):2166-2172. doi: 10.1016/j.injury.2021.02.054. Epub 2021 Feb 19.

Reference Type BACKGROUND
PMID: 33640161 (View on PubMed)

Anwander H, Buchel L, Krause F, Siebenrock K, Schmid T. Tibial anterior compartment compressibility in healthy subject, measured using compression sonography. Injury. 2022 Feb;53(2):719-723. doi: 10.1016/j.injury.2021.12.014. Epub 2021 Dec 17.

Reference Type BACKGROUND
PMID: 34963511 (View on PubMed)

Provided Documents

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Document Type: Study Protocol and Statistical Analysis Plan

View Document

Document Type: Informed Consent Form

View Document

Related Links

Access external resources that provide additional context or updates about the study.

https://www.sealedenvelope.com/

Sealed Envelope LTD. Create a blocked randomisation list

https://www.physios.nl/artikelen/artikel/t/het-chronisch-inspanningsgebonden-compartimentsyndroom-van-het-onderbeen

Winkes MB, Bloo H, Hoogeveen AR, Scheltinga M. Het chronisch inspanningsgebonden compartimentsyndroom van het onderbeen. Physios. 2018;4:9.

https://www.uptodate.com/contents/chronic-exertional-compartment-syndrome

Meehan WP, O'Brien MJ. Chronic exertional compartment syndrome UpToDate: UpToDate; 2020

Other Identifiers

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NL.82601.015.22

Identifier Type: OTHER

Identifier Source: secondary_id

2022-MMC-098

Identifier Type: -

Identifier Source: org_study_id

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