Comparative Study of the Effects of Dry Needling and Botulinum Toxin Type A as a Treatment for Lower Limb Post-stroke Spasticity

NCT ID: NCT06296082

Last Updated: 2025-02-20

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/PHASE3

Total Enrollment

90 participants

Study Classification

INTERVENTIONAL

Study Start Date

2024-09-01

Study Completion Date

2025-12-31

Brief Summary

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This is a randomized parallel group clinical trial which will be conducted in three countries (Spain, Canada and Belgium) comparing Botulinum Toxin type A (BTX-A) and Dry Needling (DN) effectiveness for post-stroke spasticity in participants who had a first stroke in the previous 12 months and have plantar flexor spasticity. Participants will be randomly allocated to receive either one session of BTX-A or 12 weekly sessions of DN. Blinded evaluators will assess the effects before, during, and after treatment, and at a 4-week follow-up.

Detailed Description

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The primary hypothesis is that the effects of DN on post-stroke spasticity in the lower limbs at the spinal level is comparable to BTX-A in reducing spasticity by decreasing stretch reflex excitability.

Sample size: Spain, Canada and Belgium will recruit 90 participants (30 per country)

The platform used for randomization and electronic data collection will be Research Electronic Data Capture (REDcap): https://www.project-redcap.org/. A shared license will be used among the countries involved in the study.

Data dictionary:

* DN: Dry Needling
* BTX-A: Botulinum toxin type A
* TSRT: Tonic Stretch Reflex Threshold
* MAS: Modified Ashworth Scale
* 10MWT: 10 Metre Walk Test
* TUG: Timed Up \& Go
* PPI: Public and Patient Involvement
* SOP: Standard Operating Procedure

Conditions

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Stroke

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

A prospective randomized, controlled, multiple-baseline, and assessor blinded multicenter equivalence trial with two parallel groups.
Primary Study Purpose

TREATMENT

Blinding Strategy

DOUBLE

Investigators Outcome Assessors
Assessments will be conducted by blinded assessors for treatment allocation. Participants and staff cannot be blinded due to the nature of the intervention, but are instructed not to disclose their treatment allocation. Data will be anonymized and an independent researcher will enter coded data into secure databases. Data will be analyzed by a blinded statistician. Code breaks will only be allowed in crucial cases for patient management.

Study Groups

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Botulinum Toxin type A

The BTX-A group will receive onabotulinumtoxinA (Botox®, Allergan) with mandatory muscles getting 300 units and optional muscles getting up to 100 additional units (maximum dose of 400 units) (14) delivered with a 27-gauge (0.45 mm) beveled needle. Target muscles will be identified by ultrasound imaging or muscle stimulation. Local anesthesia will not be used. Patient positioning will be standardized.

Group Type ACTIVE_COMPARATOR

Botulinum toxin type A

Intervention Type DRUG

Botulinum toxin type A injections are a treatment technique to treat the spastic muscles in patients with stroke that targets on the neuromuscular endplate zone provoking a chimical disruption of dysfunctional endplates.

Dry Needling

For Dry Needling group solid, filiform non-beveled 0.30 mm caliber needles will be used. Target muscles will be identified by ultrasound imaging or muscle stimulation. Local anesthesia will not be used. Patient positioning will be standardized.

Group Type ACTIVE_COMPARATOR

Dry Needling

Intervention Type OTHER

Dry Needling is a treatment technique to treat the spastic muscles in patients with stroke that targets on the neuromuscular endplate zone provoking a mechanical disruption of dysfunctional endplates.

Interventions

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Botulinum toxin type A

Botulinum toxin type A injections are a treatment technique to treat the spastic muscles in patients with stroke that targets on the neuromuscular endplate zone provoking a chimical disruption of dysfunctional endplates.

Intervention Type DRUG

Dry Needling

Dry Needling is a treatment technique to treat the spastic muscles in patients with stroke that targets on the neuromuscular endplate zone provoking a mechanical disruption of dysfunctional endplates.

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

1. aged 18-75 years.
2. post-stroke spasticity in ankle plantar flexors (Modified Ashworth Scale (MAS) scores of 1-2).
3. first stroke.
4. 0-12 months evolution.
5. no previous BTX-A or DN treatment for spasticity.
6. ankle passive range of motion ≥ 20° (approximately) with knee flexion \~30°.
7. independent ambulation with or without aids.

Exclusion Criteria

1. medical conditions interfering with data interpretation.
2. contraindications for BTX-A or DN treatment.
3. changes in anti-spasticity medication dosage (if appropriate), either during the trial or within the 3 months prior to participation.
4. pregnant or breastfeeding.
Minimum Eligible Age

18 Years

Maximum Eligible Age

75 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Instituto de Investigación Sanitaria Aragón

OTHER

Sponsor Role collaborator

McGill University

OTHER

Sponsor Role collaborator

Instituto de Salud Carlos III

OTHER_GOV

Sponsor Role collaborator

Fonds de la Recherche en Santé du Québec

OTHER_GOV

Sponsor Role collaborator

Research Foundation Flanders

OTHER

Sponsor Role collaborator

Universiteit Antwerpen

OTHER

Sponsor Role lead

Responsible Party

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Dr. Pablo Herrero Gallego

Prof. Dr.

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Pablo Herrero Gallego, PhD

Role: PRINCIPAL_INVESTIGATOR

Universidad de Zaragoza

Locations

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Universiteit Antwerpen

Antwerp, Flanders, Belgium

Site Status RECRUITING

Jewish Rehabilitation Hospital

Montreal, Quebec, Canada

Site Status RECRUITING

Hospital Clínico Universitario Lozano Blesa

Zaragoza, Zaragoza, Spain

Site Status NOT_YET_RECRUITING

Countries

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Belgium Canada Spain

Central Contacts

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Pablo Herrero Gallego, PhD

Role: CONTACT

+34646168248

Clara Pujol Fuentes, Msc

Role: CONTACT

+34661075990

Facility Contacts

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Wim Saeys, PT

Role: primary

+32496804347

Bart Eeckhaut, PT

Role: backup

+32486543747

Mindy F. Levin, PT

Role: primary

+972505204734

Pablo Herrero Gallego, PT

Role: primary

+34646168248

Clara Pujol Fuentes, PT

Role: backup

+34661075990

Related Links

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https://www.itonus.eu/

Web site of the project.

Other Identifiers

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49317

Identifier Type: -

Identifier Source: org_study_id

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