Evaluation of NMES for Reducing Pain and Improving Functional Outcomes in Knee OA Patients

Study Overview
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Brief Summary
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The present prospective trial is designed to evaluate the efficacy of CyMedica Orthopedics e-vive™ system, a multifunctional electrotherapy device providing neuromuscular electrical stimulation (NMES) for reducing pain and accelerating functional recovery in patients with knee osteoarthritis. This post-market trial will involve patients who have been diagnosed with knee osteoarthritis, Kelgren-Lawrence Grades II, III, and IV. It is hypothesized that the use of the CyMedica e-vive NMES can reduce pain, improve knee function, and improve quality of life.

Detailed Description
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The study will be conducted at Lenox Hill Hospital, Northwell Health, located in New York, New York, and involve a total of 120 patients. All study patients will be evenly divided into two groups: (a) conductive garment and mobile app with NMES therapy; (b) conductive garment and mobile app without NMES therapy (sham). Eligible patients will be evaluated according to the time and events schedule. Clinical outcomes will be assessed from 1 to 10 days before day of intervention and followed up after intervention over a 24 weeks ± 1 week study period. These two groups will be analyzed using several outcome measures including validated patient-reported outcome measures including Visual Analogue Scale (VAS) pain level, the Knee Injury and Osteoarthritis Outcome Score (KOOS) JR., KOOS ADL, and WOMAC survey. Functional measures include isometric quadriceps strength, Time Up and Go (TUG), 6 minute walk test, repeated chair rise test, stair climb test, and number of steps recorded by an Apple Watch Series 3 or a Samsung watch. Reduction of use of anti-inflammatory medications (NSAIDS) and narcotics, use of ambulation assist devices, plan for TKA procedure survey, device compliance use, and patient satisfaction survey will be tracked The primary endpoint for the study is Visual Analogue Scale (VAS) pain The proprietary app for this product will be used to track device usage (intensity, duration of session, frequency of use), VAS, WOMAC, and KOOS JR.

Official Title
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Prospective Evaluation of Neuromuscular Electrical Stimulation (NMES) for Reducing Pain and Improving Functional Outcomes in Knee Osteoarthritis (OA) Patients

Conditions
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Knee Pain Chronic, Knee Osteoarthritis, Knee Arthritis

Intervention / Treatment
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* Device: Active NMES


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients with symptomatic Kellgren-Lawrence (KL) Grade 2, 3, or 4 OA by radiograph (AP tunnel view) within 30 days prior to day 0 visit, where the K-L grades are defined as: Grade 0: no radiographic features of OA are present Grade 1: doubtful joint space narrowing (JSN) and possible osteophytic lipping Grade 2: definite osteophytes and possible JSN on anteroposterior weight-bearing radiograph Grade 3: multiple osteophytes, definite JSN, sclerosis, possible bony deformity Grade 4: large osteophytes, marked JSN, severe sclerosis and definite bony deformity Patients who are between the ages of 18 - 85 years Patient has signed informed consent Patient has access to a smartphone or tablet (Android or iOS) Subject must be ambulatory. Subject must be willing to stop taking any pain medications 24 hours prior any scheduled study visit. Subjects must be proficient in English. Subject must be willing and able to sign an informed consent document. Subjects must be willing and able to comply with all study procedures for the duration of the clinical study. Exclusion Criteria: Subjects who have a body mass index > 40 at the time of consent. Exclusion of a patient with BMI>40 is up to the discretion of the PI. Subjects with a diagnosis of inflammatory arthritis (rheumatoid arthritis, gout, joint infection, Lyme disease, SLE, etc.). Subjects who have had an injury or an acute traumatic injury to the index knee within 6 months of screening will be excluded. Subject must NOT have had arthroscopy within 8 weeks of randomization. Subjects who have had treatment of the target knee with intra-articular injections of steroids within 8 weeks of screening. Subjects who have had intra-articular injections of hyaluronic acid within 12 weeks of screening. Subjects who have had a scheduled surgery on the target knee within the study period. (Note- Patients who are scheduled to go under surgery within the next 6 months will be excluded. Patients that are contemplating the surgery can be included.) Subjects who have used electrotherapy or acupuncture for OA of the target knee within 4 weeks of screening Subjects with significant and clinically evident mal-alignment of the target knee (> 10 degrees varus or valgus in the target knee). Subjects with surgical metallic hardware in the target knee. Subjects who have contraindications to MRI and X-rays, for example, implanted electrical devices (cardiac pacemakers, deep brain stimulators). Subjects with a current malignancy or who have received treatment for malignancy with the last 5 years, with the exception of resected basal cell carcinoma and squamous cell carcinoma of the skin. Subjects who have an active substance abuse problem (drugs or alcohol) or a history of chronic substance abuse (> 5 years). Subjects with skin breakdown or infection in the area where the study device will be placed. Subjects with any chronic conditions (e.g., diabetes, hypertension, congestive heart failure, etc.) that have not been well-controlled for at least 3 months prior to screening. Subjects who have any ongoing litigation for worker's compensation. Subjects with any condition, in the opinion of the Investigator that might interfere with the evaluation of the study objectives. Subjects who are pregnant. Subject must not have participated in a clinical study within the past 12 weeks that required the use of an investigational device, drug or biologic

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 85 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Crossover Assignment
Interventional Model Description: One-way crossover- Patients from the control cohort are allowed to crossover to the treatment cohort after 12 weeks of study enrollment, if a subject would request receiving knee intra-articular injections of hyaluronic acid (HA) or corticosteroids (CS) or opioids. Patients are also allowed to crossover to the treatment arm if they decide to drop out of the study due to the potential lack of clinical benefits from the sham treatment.
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Active NMES<br>Treatment arm receives an active NMES therapy including a conductive garment with NMES therapy, electrodes, and mobile app. | Device: Active NMES<br>* Daily home-based, mobile-app controlled, neuromuscular electrical stimulation (NMES) therapy<br>|
| Sham Comparator: Inactive NMES<br>Control arm receives inactive NMES therapy including a conductive garment (no NMES and no electrodes), and mobile app. | Device: Active NMES<br>* Daily home-based, mobile-app controlled, neuromuscular electrical stimulation (NMES) therapy<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Visual Analogue Scale (VAS) pain level | Pain for a nominated activity causing the worst knee pain | 12 weeks post intervention | 
| Visual Analogue Scale (VAS) pain level | Worst pain at rest | 12 weeks post intervention | 
| Visual Analogue Scale (VAS) pain level | Worst pain walking | 12 weeks post intervention | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Quadriceps strength | Isometric quadriceps strength or torque | 12 weeks post intervention | 
| TUG | Timed Up and Go test | 12 weeks post intervention | 
| Repeated chair rise | Repeated chair rise test | 12 weeks post intervention | 
| Stair climb | Stair climb | 12 weeks post intervention | 
| 6 min walk test | 6 min walk test | 12 weeks post intervention | 
| Activity | Average number of daily steps | 12 weeks post intervention | 
| Pain related medication | NSAIDS, Narcotics | 12 weeks post intervention | 
| Knee injections | HA and CS injections | 12 weeks post intervention | 
| Physical therapy | Utilization of physical therapy | 12 weeks post intervention | 
| Ambulation assist devices | Utilization of ambulation assist devices | 12 weeks post intervention | 
| Plan for TKA surgery | Plan for TKA surgery | 12 weeks post intervention | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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NMES, arthritis, knee pain, osteoarthritis, electrical stimulation therapy