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Trial registered on ANZCTR
Registration number
ACTRN12621000442808
Ethics application status
Approved
Date submitted
3/03/2021
Date registered
16/04/2021
Date last updated
29/09/2022
Date data sharing statement initially provided
16/04/2021
Type of registration
Prospectively registered
Titles & IDs
Public title
The Effects of Relaxation on Wound Healing
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Scientific title
The Effects of Relaxation on Stress and Skin Barrier Recovery
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Secondary ID [1]
303556
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Nil known
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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:
Wound Healing
320944
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Stress
321448
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Condition category
Condition code
Skin
318748
318748
0
0
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Other skin conditions
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Injuries and Accidents
319211
319211
0
0
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Other injuries and accidents
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Mental Health
319212
319212
0
0
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Studies of normal psychology, cognitive function and behaviour
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Intervention/exposure
Study type
Interventional
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Description of intervention(s) / exposure
Intervention: Participating in a Brief Relaxation Session
Participants will be exposed to a tape-stripping procedure to measure skin barrier recovery (SBR), as an index of wound healing in humans. Tape-stripping is a non-invasive, simple and minimally painful procedure used to measure the rate at which the top layer of skin recovers after a disruption (i.e., SBR).
After the tape-stripping procedure, participants will be randomly assigned to one of three types of relaxation delivery methods: magazines (control), audiotapes, or a digital human. They will be asked to follow the instructions given by the audiotapes and digital human, or read magazines during a 20 minute recovery period to determine how each method influences the rate at which the skin barrier recovers. The researcher will not be in the room during this recovery period but will be nearby if participants need assistance. When alone in the room, participants will be video-recorded to assess and monitor adherence to the audiotapes and digital human, as well as whether they touched their wound.
Both the digital human and audiotapes condition follow the same relaxation script which includes deep breathing exercises and guided progressive muscle relaxation. This script is based on the script used in a previous study looking at relaxation before and after tape-stripping (Robinson et al., 2015).
The relaxation interventions will only be delivered in a one-off, 90-minute session at the Clinical Research Centre on Grafton Campus at the University of Auckland.
Digital humans are a form of embodied conversational agent (ECA) that includes a computer-based dialogue system and a virtual embodiment (Cassell et al., 2000; Sagar et al., 2014). A virtual embodiment refers to an animated face or body presented on a computer screen. Digital humans use artificial intelligence in the form of neural networks to learn and respond to user input, such as human facial expressions, movement, and speech (Loveys et al., 2020; Sagar et al., 2016). For this study, a digital human will deliver the relaxation script to participants on the computer for 20 minutes. During this time, the digital human will introduction themselves before guiding participants through deep breathing and progressive muscle relaxation exercises.
For the audiotapes condition, participants will be asked to listen to the audio recording of a human voice on the computer which will passively guide them through the relaxation script for 20 minutes.
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Intervention code [1]
319861
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Treatment: Other
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Comparator / control treatment
The control condition will not be provided with a relaxation intervention, only magazines while participants are told to wait and see how their skin recovers. Magazines have been used as a control condition in previous studies as a neutral activity to prevent participants from becoming too bored (Robinson et al., 2017).
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Control group
Active
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Outcomes
Primary outcome [1]
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Change in trans-epidermal water loss (TEWL), measured by the Tewameter TM 300.
The TWEL readings from the three time-points determines the final SBR value for each site.
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Assessment method [1]
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Timepoint [1]
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Baseline, immediately post tape-stripping and immediately post-recovery
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Secondary outcome [1]
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Changes in salivary cortisol
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Assessment method [1]
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Timepoint [1]
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Baseline, immediately post tape-stripping and immediately post-recovery
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Secondary outcome [2]
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Changes in salivary alpha-amylase
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Assessment method [2]
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Timepoint [2]
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Baseline, immediately post tape-stripping and immediately post-recovery
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Secondary outcome [3]
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Changes in skin conductance: Participants will wear a wrist sensor (Empatica E4) which will continuously measure blood volume pulse for the duration of the session. A button will be pressed to timestamp the continuous data at each of the three time points. Electrodermal activity will be used to measure changes in electrical resistance in the skin (skin conductance)
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Assessment method [3]
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Timepoint [3]
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Baseline, immediately post tape-stripping and immediately post-recovery
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Secondary outcome [4]
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Changes in heart rate: Participants will wear a wrist sensor (Empatica E4) which will continuously measure blood volume pulse for the duration of the session. A button will be pressed to timestamp the continuous data at each of the three time points. Blood volume pulse will be converted into a measure of heart rate.
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Assessment method [4]
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Timepoint [4]
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Baseline, immediately post tape-stripping and immediately post-recovery
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Secondary outcome [5]
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Changes in current stress levels as measured by 100mm visual analogue scales
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Assessment method [5]
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Timepoint [5]
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Baseline, immediately post tape-stripping and immediately post-recovery
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Secondary outcome [6]
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Changes in current anxiety levels measured by a 100mm visual analogue scale
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Assessment method [6]
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Timepoint [6]
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Baseline, immediately post tape-stripping and immediately post-recovery
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Secondary outcome [7]
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Changes in current relaxation levels measured by a 100mm visual analogue scale
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Assessment method [7]
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Timepoint [7]
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Baseline, immediately post tape-stripping and immediately post-recovery
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Secondary outcome [8]
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Changes in current pain levels measured by a 100mm visual analogue scales
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Assessment method [8]
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Timepoint [8]
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Baseline, immediately post tape-stripping and immediately post-recovery
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Secondary outcome [9]
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Relaxation Session Feedback as measured by two 100mm visual analogue scales and two open-ended questions. The visual analogue scales will measure levels of satisfaction and relaxation after the relaxation session. The open-ended questions have been adapted from Loveys and colleague's feasibility study investigating digital humans and CBSM (in prep).
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Assessment method [9]
392436
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Timepoint [9]
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Immediately post recovery
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Eligibility
Key inclusion criteria
Participants will be eligible for inclusion if they:
- Are over the age of 18
- Can speak, read, and write in fluent English.
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Minimum age
18
Years
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Maximum age
60
Years
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Sex
Both males and females
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Can healthy volunteers participate?
Yes
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Key exclusion criteria
Participants will be excluded from the study if they:
- Are allergic to adhesive tape
- Have any inflammatory skin diseases/immunological-related health problems
- Are taking medication that affects immune functioning (e.g., prednisone)
- Are pregnant
- Over the age of 60
- Have hearing difficulties or vision loss.
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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)
Participants will be randomised to one of three conditions in advance by a researcher not involved in the study. After the tape- stripping procedure, group allocation will be revealed after the researcher opens the sealed, opaque envelope containing each participant's assigned condition. After this, the researcher and participant will no longer be blinded to the conditions
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Methods used to generate the sequence in which subjects will be randomised (sequence generation)
Simple randomisation using a random online number generator on the computer.
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Masking / blinding
Open (masking not used)
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Who is / are masked / blinded?
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Intervention assignment
Parallel
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Other design features
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Phase
Not Applicable
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Type of endpoint/s
Efficacy
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Statistical methods / analysis
Power analysis:
Using a f value of .275, power of .80 and a of .05, with three groups and five covariates, the required sample size is 131. Like previous tape-stripping studies, this will be increased by 20% to account for possible errors in the TEWL measurements (Law et al., 2020), giving a final sample size of 159 participants (53 participants per group).
Outcome analysis:
A between groups ANOVA will be conducted to assess differences in SBR between conditions, in addition to an ANCOVA (to control for covariates related to SBR rates such as age, number of strips of tape, and levels of skin barrier impairment; Law et al., 2020; Robinson et al., 2017). For the secondary outcomes (biological, physiological, and psychological measures), mixed factorial ANOVAs will be conducted to analyse the main and interaction effects of time-point and condition. The data will be checked for violations of the normality assumption before analysis. To investigate whether psychological and physiological stress levels mediate the relationship between the delivery condition and SBR, separate exploratory mediational analyses will be conducted.
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Recruitment
Recruitment status
Completed
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Date of first participant enrolment
Anticipated
3/05/2021
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Actual
26/05/2021
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Date of last participant enrolment
Anticipated
29/10/2021
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Actual
22/02/2022
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Date of last data collection
Anticipated
29/10/2021
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Actual
22/02/2022
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Sample size
Target
159
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Accrual to date
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Final
159
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Recruitment outside Australia
Country [1]
23495
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New Zealand
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State/province [1]
23495
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Auckland
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Funding & Sponsors
Funding source category [1]
307979
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University
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Name [1]
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The University of Auckland
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Address [1]
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The University of Auckland
Private Bag 92019
Auckland 1142
New Zealand
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Country [1]
307979
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New Zealand
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Primary sponsor type
University
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Name
The University of Auckland
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Address
The University of Auckland
Private Bag 92019
Auckland 1142
New Zealand
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Country
New Zealand
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Secondary sponsor category [1]
308717
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None
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Name [1]
308717
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Address [1]
308717
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Country [1]
308717
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Other collaborator category [1]
281677
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Commercial sector/Industry
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Name [1]
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Soul Machines
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Address [1]
281677
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Soul Machines Ltd
106 Customs Street West
Auckland CBD
Auckland 1142
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Country [1]
281677
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New Zealand
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Ethics approval
Ethics application status
Approved
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Ethics committee name [1]
307970
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Auckland Health Research Ethics Committee
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Ethics committee address [1]
307970
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Auckland Health Research Ethics Committee The University of Auckland Private Bag 92019 Auckland 1142
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Ethics committee country [1]
307970
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New Zealand
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Date submitted for ethics approval [1]
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25/01/2021
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Approval date [1]
307970
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03/03/2021
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Ethics approval number [1]
307970
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Summary
Brief summary
This study's primary aim is to investigate the effects of different delivery methods of a brief relaxation intervention, including audiotapes, a digital human and magazines (control), on wound healing, as indexed by skin barrier recovery (SBR) after tape stripping. Tape-stripping is a non-invasive and simple procedure used to measure the rate at which the top layer of skin recovers after a disruption (i.e., SBR). The relaxation method allocated to each participant will be completed after the tape-stripping procedure and during the recovery period to show how they affect skin barrier recovery. The study will also investigate the pathways through which relaxation influences SBR by measuring self-reported, physiological, and biological stress measures at three-time points during the session. It is hypothesised that both the digital human and audiotape conditions will have improved SBR after a tape-stripping wound, as assessed by trans-epidermal water loss (TEWL), compared to the control group (magazines). It is also hypothesised that there will be no differences in SBR after a tape-stripping wound, as assessed by TEWL, between the digital human and audiotape condition.
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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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Prof Elizabeth Broadbent
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Address
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Department of Psychological Medicine,
The University of Auckland,
Faculty of Medical and Health Sciences Building 507, Grafton
Auckland 1023
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Country
109090
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New Zealand
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Phone
109090
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+64 9 923 6756
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Fax
109090
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Email
109090
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[email protected]
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Contact person for public queries
Name
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Elizabeth Broadbent
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Address
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Department of Psychological Medicine,
The University of Auckland,
Faculty of Medical and Health Sciences Building 507, Grafton
Auckland 1023
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Country
109091
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New Zealand
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Phone
109091
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+64 9 923 6756
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Fax
109091
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Email
109091
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[email protected]
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Contact person for scientific queries
Name
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Elizabeth Broadbent
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Address
109092
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Department of Psychological Medicine,
The University of Auckland,
Faculty of Medical and Health Sciences Building 507, Grafton
Auckland 1023
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Country
109092
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New Zealand
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Phone
109092
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+64 9 923 6756
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Fax
109092
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Email
109092
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[email protected]
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Data sharing statement
Will individual participant data (IPD) for this trial be available (including data dictionaries)?
No
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No/undecided IPD sharing reason/comment
Due to ethics and participant privacy, we must keep all data anonymous and confidential.
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What supporting documents are/will be available?
No Supporting Document Provided
Doc. No.
Type
Citation
Link
Email
Other Details
Attachment
10852
Study protocol
381508-(Uploaded-02-03-2021-10-59-31)-Study-related document.pdf
10853
Informed consent form
381508-(Uploaded-02-03-2021-11-00-04)-Study-related document.pdf
10863
Ethical approval
381508-(Uploaded-03-03-2021-11-33-07)-Study-related document.pdf
Results publications and other study-related documents
Documents added manually
No documents have been uploaded by study researchers.
Documents added automatically
No additional documents have been identified.
Download to PDF