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Trial registered on ANZCTR
Registration number
ACTRN12623000783628
Ethics application status
Approved
Date submitted
16/06/2023
Date registered
18/07/2023
Date last updated
18/07/2023
Date data sharing statement initially provided
18/07/2023
Type of registration
Prospectively registered
Titles & IDs
Public title
Efficacy of mobilization with movement plus best care advice versus best care advice for patients with subacromial shoulder pain: a pilot randomized controlled trial
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Scientific title
Mobilization with movement versus best care advice for patients with subacromial shoulder pain: a pilot randomized controlled trial
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Secondary ID [1]
309238
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Nil Know
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Universal Trial Number (UTN)
U1111-1289-9959
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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:
Shoulder pain
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Condition category
Condition code
Musculoskeletal
326340
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0
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Other muscular and skeletal disorders
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Intervention/exposure
Study type
Interventional
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Description of intervention(s) / exposure
Participants allocated to this group will receive a best practice advice plus tailored Mobilization With Movement (MWM).
The best practice advice will consists of a one-off clinician consultation session, with the session lasting for approximately 40 min. During that session, the clinician will provide brief information about shoulder pain and will discuss strategies to avoid aggravating their shoulder pain and to self-manage pain. The clinician will answer any questions participants may have and will re-assure participants that their condition should improve over time. Participants will receive a pamphlet with information about their condition and basic self-management strategies. The pamphlet will be developed for this study based on the literature and after consulting with clinicians. In that same session, the clinician will deliver the first intervention of MWM.
After the first session, participants will receive 15 additional MWM interventions. Those interventions will last approximately 10 min. The MWM technique will be applied over 8 weeks, with two treatment sessions per week (i.e., 1st session lasting for 40 min, followed by 15 sessions lasting 10 min).
During each treatment session, 3-5 sets of 6-10 repetitions will be applied, with a rest interval of 1 minute between sets. Information about the MWM technique used will be recorded on a customized sheet by the clinician and will include participants’ position (e.g. sitting, lying, or standing), the MWM techniques used, and the number of sets and repetitions performed.
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Intervention code [1]
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Rehabilitation
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Comparator / control treatment
Participants allocated to this group will receive best practice advice.
The best practice advice will consists of a one-off clinician consultation session during which the clinician will provide brief information about shoulder pain and will discuss strategies to avoid aggravating their shoulder pain and to self-manage pain. The clinician will answer any questions participants may have and will re-assure participants that their condition should improve over time. Participants will receive a pamphlet with information about their condition and basic self-management strategies. This one-off consultation will last approximately 30 min.
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Control group
Active
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Outcomes
Primary outcome [1]
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Participant’s recruitment rate (number of participants per month)
Data collected from study database.
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Assessment method [1]
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Timepoint [1]
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Baseline
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Primary outcome [2]
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Proportion of participants enrolled from the total number screened (number of enrolled participants /total number of screened participants, with reasons).
Data collected from study database.
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Assessment method [2]
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Timepoint [2]
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Baseline
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Primary outcome [3]
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Adherence to the allocated intervention (number of sessions attended, expressed as a percentage of the total number of sessions).
Data collected from study database.
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Assessment method [3]
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Timepoint [3]
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12th week after baseline.
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Secondary outcome [1]
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Patient Specific Functional Scale (PSFS);
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Assessment method [1]
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Timepoint [1]
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Baseline, 4th, 8th, and 12th week after baseline.
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Secondary outcome [2]
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Shoulder Pain and Disability Index (SPADI);
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Assessment method [2]
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Timepoint [2]
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Baseline, 4th, 8th, and 12th week after baseline.
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Secondary outcome [3]
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Average pain in the last 7 days: numeric rating pain scale (NRPS);
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Assessment method [3]
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Timepoint [3]
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Baseline, 4th, 8th, and 12th week after baseline.
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Secondary outcome [4]
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Pain-free active shoulder abduction range of motion (ROM).
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Assessment method [4]
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Timepoint [4]
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Baseline, 4th, 8th, and 12th week after baseline.
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Secondary outcome [5]
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Drop-out rate (number of participants who withdrew from the study).
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Assessment method [5]
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Timepoint [5]
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12th week after baseline.
Data collected from study database.
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Eligibility
Key inclusion criteria
We will include participants aged 18-75 years old with subacromial shoulder pain, who present immediate reduction in shoulder pain following the application of MWM to the shoulder complex (glenohumeral, sternoclavicular, acromioclavicular, and scapulothoracic), cervical spine, or thoracic region.
We have defined subacromial shoulder pain and we will screen participants following the British Elbow and Shoulder Society (BESS) guidelines. We will include participants who present with a painful arc movement during shoulder flexion or abduction; or pain on resisted lateral rotation or abduction; or positive Jobe’s test.
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Minimum age
18
Years
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Maximum age
75
Years
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Sex
Both males and females
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Can healthy volunteers participate?
No
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Key exclusion criteria
We will exclude participants who have acute rotator cuff tear, unreduced dislocation, tumour or infection; or the history of shoulder, cervical surgeries, shoulder subluxation and dislocation; or localised acromioclavicular joint pain, frozen shoulder, hemiplegic shoulder pain, systematic inflammation or disease; or clinical signs of full thickness of rotator cuff tear.
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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)
The allocation schedule will be concealed by a research administrator (not involved with recruitment, assessment, or intervention) who will inform the research team about treatment allocation once screening is complete.
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Methods used to generate the sequence in which subjects will be randomised (sequence generation)
The allocation schedule will be computer-generated by a research administrator (not involved with recruitment, assessment, or intervention).
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Masking / blinding
Blinded (masking used)
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Who is / are masked / blinded?
The people receiving the treatment/s
The people assessing the outcomes
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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
Primary outcomes (recruitment rates, adherence to the rehabilitation program, proportion of participants enrolled from the total number screened, and drop-out rate) will be presented using descriptive statistics.
To obtain estimates of intervention effects, we will compare changes in pain and shoulder-related disability scores between the two intervention groups using a mixed-effects model with a random intercept will be used to compare the changes in outcome measures (from baseline to 12 weeks after baseline) between the MWM and best practice advice. The model will include baseline scores, time, treatment and an interaction between time and treatment as covariates. Outcome measures at follow-up (4th, 8th, and 12th week after baseline) will be retained as part of the outcome variable.
Since this is a pilot study, we will not adjust alpha for multiple comparisons. This will decrease the chance of Type II error, increasing the chance of identifying potentially important differences between groups. This statistical approach is considered appropriate for feasibility, pilot or exploratory studies. Alpha will be set at 0.05, and power at 80% for all statistical analysis.
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Recruitment
Recruitment status
Not yet recruiting
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Date of first participant enrolment
Anticipated
7/08/2023
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Actual
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Date of last participant enrolment
Anticipated
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Actual
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Date of last data collection
Anticipated
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Actual
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Sample size
Target
24
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Accrual to date
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Final
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Recruitment outside Australia
Country [1]
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New Zealand
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State/province [1]
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Otago
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Funding & Sponsors
Funding source category [1]
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University
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Name [1]
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School of Physiotherapy - University of Otago
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Address [1]
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325 Great King Street, Dunedin North, Dunedin 9016
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Country [1]
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New Zealand
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Primary sponsor type
University
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Name
University of Otago
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Address
325 Great King Street, Dunedin North, Dunedin 9016
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Country
New Zealand
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Secondary sponsor category [1]
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None
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Name [1]
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Address [1]
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Country [1]
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Ethics approval
Ethics application status
Approved
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Ethics committee name [1]
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University of Otago Human Ethics Committee (Health)
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Ethics committee address [1]
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325 Great King StreetDunedin North, Dunedin 9016
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Ethics committee country [1]
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New Zealand
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Date submitted for ethics approval [1]
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13/03/2023
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Approval date [1]
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27/03/2023
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Ethics approval number [1]
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H23/042
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Summary
Brief summary
Shoulder pain is a common musculoskeletal condition, affecting one third of the world population. The conservative treatment is the first-line intervention, with mobilization with movement being a commonly used intervention in the clinical setting. However, evidence on the effects of mobilization with movement are lacking in the literature. Previous laboratory-based studies have shown that: (1) clinician-administrated sustained shoulder posterolateral glide mobilization offloads shoulder muscles, providing mechanical support to the shoulder; (2) self-administrated sustained shoulder mobilizations lead to similar changes in muscle activity level as clinician-administrated mobilization, supporting the use of home-based mobilization for shoulder rehabilitation; (3) patients with shoulder pain present immediate reduction in pain levels, increased range of motion, and increased muscle activity levels in response to mobilization with movement. Those findings suggest that sustained mobilization temporarily changes the control of scapular and shoulder muscles in asymptomatic and individuals with subacromial shoulder pain. The present proposal aims to advance the current knowledge further by piloting the design of a full trial to test the effectiveness of mobilization with movement on the management of patients with shoulder subacromial pain. This study is a prospective, assessor-blind, parallel-group randomized controlled pilot trial. A total sample size of 24 participants with subacromial shoulder pain will be allocated to mobilization with movement group or a minimal intervention group. Patients in the mobilization with movement group will receive a tailored mobilization with movement technique over 8 weeks, with two treatment sessions per week. Primary outcomes will be participant’s recruitment rate; proportion of participants enrolled from the total number screened; adherence to the allocated intervention; drop-out rate, and treatment fidelity. Participants will be assessed 4 times over 12 weeks (baseline, 4, 8, and 12 weeks). An intention-to-treat analysis approach will be applied for all analyses. Primary outcomes will be presented using descriptive statistics. An independent mixed-model will be conducted for each outcome measure. An implementation-based process evaluation will be assessed by interviewing participants who take part in the study with a thematic qualitative analysis.
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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 Daniel Cury Ribeiro
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Address
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325 Great King Street, Dunedin North, Dunedin 9016
School of Physiotherapy, University of Otago
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Country
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New Zealand
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Phone
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+64 3 479 7455
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Fax
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Email
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[email protected]
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Contact person for public queries
Name
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Daniel Cury Ribeiro
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Address
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325 Great King Street, Dunedin North, Dunedin 9016
School of Physiotherapy, University of Otago
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Country
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New Zealand
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Phone
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+64 3 479 7455
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Fax
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Email
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[email protected]
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Contact person for scientific queries
Name
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Daniel Cury Ribeiro
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Address
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325 Great King Street, Dunedin North, Dunedin 9016
School of Physiotherapy, University of Otago
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Country
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New Zealand
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Phone
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+64 3 479 7455
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Fax
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Email
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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)?
Yes
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What data in particular will be shared?
Individual participant data collected during the trial, after de-identification.
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When will data be available (start and end dates)?
Beginning 3 months and ending 5 years following main results publication.
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Available to whom?
Case-by-case basis at the discretion of Primary Sponsor.
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Available for what types of analyses?
For IPD meta-analyses.
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How or where can data be obtained?
Access subject to approvals by Principal Investigator (e-mail:
[email protected]
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What supporting documents are/will be available?
No Supporting Document Provided
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.
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