Low Back PainNCT01796496
Manipulative Therapy Techniques to Treat Chronic Low Back Pain
A study testing Manipulative Therapy Techniques and Functional Technique in people with Low Back Pain and Chronic Disease, run by Universidad de Almeria at 1 site in Spain.
Trial summary
The purpose of this study is to analyze the effectiveness of a three manipulative therapy techniques in People with Chronic Low Back Pain. Read more about this study
- Who is it for?
- Ages 25 to 55 years
- Conditions the study is for
- Low Back Pain, Chronic Disease
- What is being tested?
- Manipulative Therapy Techniques and Functional Technique
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 62 participants
- Where
- 1 siteSpain
- Study dates
- Mar 2013to Nov 2013
- Phase
- Interventional
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 25 to 55 years
- All sexes
- No healthy volunteers
- Adult
Who may be able to join
- Low back pain for ≥ 3 months.
- Score ≥4 on the Roland Morris disability questionnaire.
- No undergoing another physical therapy treatment.
- Inability to achieve lumbar muscle flexion-relaxation in trunk flexion
Who cannot join
- Clinical signs of radiculopathy.
- Presence of lumbar stenosis.
- Fibromyalgia.
- Spondylolisthesis.
- History of spinal surgery.
- Treatment with corticosteroids in the past two weeks.
- Disease of the central or peripheral nervous system.
Trial locations and contacts
1 site in 1 country.
About this study
Official title: Short-term Effect of Manipulative Therapy Techniques in People With Chronic Low Back Pain: A Randomized Controlled Trial.
The purpose of this study is to analyze the effectiveness of a three manipulative therapy techniques in People with Chronic Low Back Pain.
Read the detailed description
Objective: To analyze the effectiveness of a three manipulative therapy techniques in individuals with chronic non-specific low back pain of mechanical etiology.
Design: Randomized clinical trial. Setting: Almeria, South Spain. Participants: Sixty two with chronic non-specific low back pain will be randomly assigned to an experimental or control group.
Intervention: For 3-week, the experimental group will undergo treatment comprising 3 sessions (1/week) of manipulative therapy techniques in the lumbar and sacral areas, and the control group will receive a functional technique in the lumbar area.
Main Outcome Measures: Oswestry disability index, pain visual analogue scale, Tampa scale for kinesiophobia, Roland-Morris disability questionnaire, McQuade test, quality of life scores and the range of trunk anteflexion motion, which were all assessed before the treatment and immediately after the last treatment session.
The primary outcome measure is the change in the RMDQ score at the end of the 3 weeks study period. A difference of 2.5 point is considered to be the minimum clinically important difference in the RMDQ score. A sample size of 62 patients (31 per group) would enable detection of a 2.5 point difference between groups given 80-90% power, a 5% (two-tailed) significance level, and a conservative standard derivation of 5 points. Key baseline demographic variables and clinical measure scores will be compared between groups by using independent Student t tests for continuous data and chi-square tests for categorical data. Separate 2x2 mixed model ANOVA with repeated measurements for the time factor need to be conducted in order to test between-groups differences in visual analogue scale, McQuade test, range of trunk anteflexion motion, Oswestry disability index, Roland Morris disability questionnaire, Tampa scale for kinesiophobia, and quality of life as the dependent variables, with group (functional technique or three manipulative therapy techniques) as the between subjects variable and time (baseline, post-treatment). A paired t-test will perform to test within-group differences in score changes from pre- to post-treatment. Effect size will test using Cohen's d. p = 0.05 will be considered significant in all tests.
- Conditions
- Low Back Pain, Chronic Disease
- Being tested
- Manipulative Therapy Techniques, Functional Technique
- Keywords
- Low back pain., Manipulative therapy techniques., Randomized controlled trial., Chronic pain.
- Medical subject headings
- Low Back Pain, Chronic Disease, Chronic Pain
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Manipulative Therapy TechniquesOther
- Global Technical bilateral pelvis: The technique involves inserting a small spine rotation and make a slack in three stages.
- Indirect technique of lumbar roll in rotation for bilateral L3: to reduce the slack and make the body drop simultaneously, together with a high speed contraction pectoral muscles and triceps, iliac crest leading caudad which produces a rotation of the vertebra underlying joint space opening.
- Dog-technic on D12: this technique reduces the slack in the abdomen toward the hand in contact with D12. Next, the therapist conducted a thrust in the direction of the reduction.
Functional TechniqueOther
The therapist presses the two anterior superior iliac spines to open the back of the pelvis, this maintained throughout the technique. Then patient is asked to breathe deeply and exhale, sacrum makes a flexion-extension respectively. These movements should be symmetrical and of equal duration in time.
| Study group | Role | What they receive |
|---|---|---|
| Manipulative Therapy Techniques | Experimental | Manipulative Therapy Techniques involve three techniques on lumbar and sacral areas. This protocol will be administered one a week for 3 weeks. Receives: Other: Manipulative Therapy Techniques |
| Functional Technique | Active comparator | Manipulative Therapy Technique involves one technique on lumbar area. This protocol will be administered one a week for 3 weeks. Receives: Other: Functional Technique |
What is being measured
The primary outcome is the main question the study is designed to answer.
Roland Morris Disability Questionnaire (RMDQ)
The Roland Morris disability questionnaire is a self-administered disability measurement scored on a 24-point scale from 0 = no disability to 24 = severe disability.
Measured: At baseline, 3 weeks and 7 weeks
Secondary outcomes (6)
Oswestry Disability Index (ODI)
The Oswestry disability index evaluates daily life activity limitations in 10 dimensions, each scored on a 6-point scale (0-5 points); the total points scored are expressed as a percentage, used to classify individuals as minimally disabled (0-10%), moderately disabled (20-40%), severely disabled (40-60%), crippled (60-80%), or bedbound (80-100%).
Measured: At baseline, 3 weeks and 7 weeks
Visual Analogue Scale (VAS)
The visual analogue scale for pain intensity ranged from 0 = no pain to 10 = worst imaginable pain.
Measured: At baseline, 3 weeks and 7 weeks
Tampa Scale for Kinesiophobia (TSK)
The Tampa Scale for Kinesiophobia comprises 17 items on the fear of movement or recurrent lesion, each scored on a 4-point Likert scale from "completely disagree" to "completely agree".
Measured: At baseline, 3 weeks and 7 weeks
Quality of Life
SF-36 Health Questionnaire scores range from 0 to 100% and indicate the self-perceived health-related quality of life.
Measured: At baseline, 3 weeks and 7 weeks
Isometric Resistance of Abdominal Muscles
The McQuade test measures the isometric resistance of abdominal muscles in seconds.
Measured: At baseline, 3 weeks and 7 weeks
Lumbar Mobility in Flexion
Lumbar mobility in flexion was determined by measuring the distance from the tip of the third finger to the floor with a tape measure.
Measured: At baseline, 3 weeks and 7 weeks
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted21 Feb 2013 (estimated)
- Study startMar 2013
- Primary completionOct 2013
- Study completionNov 2013
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (26)Papers the sponsor has linked to this study.
- Other trials for Low Back PainStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Single group
- Masking
- Double blind
- Who is masked
- Participant, Investigator
- Enrolment
- 62 participants (actual)
Sponsor and investigators
- Lead sponsor
- Universidad de Almeria
- Sponsor type
- University, hospital or other
- Collaborators
- Universidad de Granada, Universidad Rey Juan Carlos
- Responsible party
- Principal investigator, Adelaida María Castro-Sánchez, Universidad de Almeria
- Investigators
- Adelaida M Castro-Sánchez, PhD, Study director, Universidad de Almeria
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT01796496
- Sponsor's protocol ID
- UAL-1
- Status last verified
- Nov 2013
- First submitted
- 20 Feb 2013
- Last updated
- 6 Oct 2015
- Results posted
- No
- Data monitoring committee
- No
Publications
Schafer A, Gartner-Tschacher N, Schottker-Koniger T. [Subgroup-specific therapy of low back pain: description and validity of two classification systems]. Orthopade. 2013 Feb;42(2):90-9. doi: 10.1007/s00132-012-2041-5. German.
PubMed 23370728Rodeghero JR, Denninger TR, Ross MD. Abdominal pain in physical therapy practice: 3 patient cases. J Orthop Sports Phys Ther. 2013 Feb;43(2):44-53. doi: 10.2519/jospt.2013.4408. Epub 2013 Jan 14.
PubMed 23322025Muir JM. Partial lumbosacral transitional vertebrae: 2 cases of unilateral sacralization. J Chiropr Med. 2012 Jun;11(2):77-83. doi: 10.1016/j.jcm.2011.12.002.
PubMed 23204950Shum GL, Tsung BY, Lee RY. The immediate effect of posteroanterior mobilization on reducing back pain and the stiffness of the lumbar spine. Arch Phys Med Rehabil. 2013 Apr;94(4):673-9. doi: 10.1016/j.apmr.2012.11.020. Epub 2012 Nov 23.
PubMed 23178541Falco FJ, Manchikanti L, Datta S, Sehgal N, Geffert S, Onyewu O, Zhu J, Coubarous S, Hameed M, Ward SP, Sharma M, Hameed H, Singh V, Boswell MV. An update of the effectiveness of therapeutic lumbar facet joint interventions. Pain Physician. 2012 Nov-Dec;15(6):E909-53.
PubMed 23159980Williams JM, Haq I, Lee RY. The effect of pain relief on dynamic changes in lumbar curvature. Man Ther. 2013 Apr;18(2):149-54. doi: 10.1016/j.math.2012.09.004. Epub 2012 Oct 9.
PubMed 23058448Williams JM, Haq I, Lee RY. A novel approach to the clinical evaluation of differential kinematics of the lumbar spine. Man Ther. 2013 Apr;18(2):130-5. doi: 10.1016/j.math.2012.08.003. Epub 2012 Oct 6.
PubMed 23047044Hendrick P, Mani R, Bishop A, Milosavljevic S, Schneiders AG. Therapist knowledge, adherence and use of low back pain guidelines to inform clinical decisions--a national survey of manipulative and sports physiotherapists in New Zealand. Man Ther. 2013 Apr;18(2):136-42. doi: 10.1016/j.math.2012.09.002. Epub 2012 Oct 6.
PubMed 23047043Cook C, Learman K, Showalter C, Kabbaz V, O'Halloran B. Early use of thrust manipulation versus non-thrust manipulation: a randomized clinical trial. Man Ther. 2013 Jun;18(3):191-8. doi: 10.1016/j.math.2012.08.005. Epub 2012 Oct 2.
PubMed 23040656Carlsson H, Rasmussen-Barr E. Clinical screening tests for assessing movement control in non-specific low-back pain. A systematic review of intra- and inter-observer reliability studies. Man Ther. 2013 Apr;18(2):103-10. doi: 10.1016/j.math.2012.08.004. Epub 2012 Sep 25.
PubMed 23018080Rubinstein SM, Terwee CB, Assendelft WJ, de Boer MR, van Tulder MW. Spinal manipulative therapy for acute low-back pain. Cochrane Database Syst Rev. 2012 Sep 12;2012(9):CD008880. doi: 10.1002/14651858.CD008880.pub2.
PubMed 22972127Marlowe D. Complementary and alternative medicine treatments for low back pain. Prim Care. 2012 Sep;39(3):533-46. doi: 10.1016/j.pop.2012.06.008. Epub 2012 Jul 30.
PubMed 22958563Guild DG. Mechanical therapy for low back pain. Prim Care. 2012 Sep;39(3):511-6. doi: 10.1016/j.pop.2012.06.006.
PubMed 22958560Balthazard P, de Goumoens P, Rivier G, Demeulenaere P, Ballabeni P, Deriaz O. Manual therapy followed by specific active exercises versus a placebo followed by specific active exercises on the improvement of functional disability in patients with chronic non specific low back pain: a randomized controlled trial. BMC Musculoskelet Disord. 2012 Aug 28;13:162. doi: 10.1186/1471-2474-13-162.
PubMed 22925609Tufo A, Desai GJ, Cox WJ. Psoas syndrome: a frequently missed diagnosis. J Am Osteopath Assoc. 2012 Aug;112(8):522-8. doi: 10.7556/jaoa.2012.112.8.522.
PubMed 22904251
Study at a glance
From the registry record, last updated by the sponsor on 6 Oct 2015. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Short-term Effect of Manipulative Therapy Techniques in People With Chronic Low Back Pain: A Randomized Controlled Trial.
- ClinicalTrials.gov ID
- NCT01796496
- Acronym / sponsor ID
- UAL-1
- Conditions
- Low Back Pain, Chronic Disease
- Keywords
- Low back pain., Manipulative therapy techniques., Randomized controlled trial., Chronic pain.
- Study type
- Interventional
- Recruitment status
- Completed
- Enrolment
- 62 participants (actual)
- Lead sponsor
- Universidad de AlmeriaUniversity, hospital or other
- Collaborators
- Universidad de Granada, Universidad Rey Juan Carlos
- Study start
- Mar 2013
- Primary completion
- Oct 2013 (actual)
- Study completion
- Nov 2013 (actual)
- First posted
- 21 Feb 2013 (estimated)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
The purpose of this study is to analyze the effectiveness of a three manipulative therapy techniques in People with Chronic Low Back Pain.
Detailed description
Objective: To analyze the effectiveness of a three manipulative therapy techniques in individuals with chronic non-specific low back pain of mechanical etiology.
Design: Randomized clinical trial. Setting: Almeria, South Spain. Participants: Sixty two with chronic non-specific low back pain will be randomly assigned to an experimental or control group.
Intervention: For 3-week, the experimental group will undergo treatment comprising 3 sessions (1/week) of manipulative therapy techniques in the lumbar and sacral areas, and the control group will receive a functional technique in the lumbar area.
Main Outcome Measures: Oswestry disability index, pain visual analogue scale, Tampa scale for kinesiophobia, Roland-Morris disability questionnaire, McQuade test, quality of life scores and the range of trunk anteflexion motion, which were all assessed before the treatment and immediately after the last treatment session.
The primary outcome measure is the change in the RMDQ score at the end of the 3 weeks study period. A difference of 2.5 point is considered to be the minimum clinically important difference in the RMDQ score. A sample size of 62 patients (31 per group) would enable detection of a 2.5 point difference between groups given 80-90% power, a 5% (two-tailed) significance level, and a conservative standard derivation of 5 points. Key baseline demographic variables and clinical measure scores will be compared between groups by using independent Student t tests for continuous data and chi-square tests for categorical data. Separate 2x2 mixed model ANOVA with repeated measurements for the time factor need to be conducted in order to test between-groups differences in visual analogue scale, McQuade test, range of trunk anteflexion motion, Oswestry disability index, Roland Morris disability questionnaire, Tampa scale for kinesiophobia, and quality of life as the dependent variables, with group (functional technique or three manipulative therapy techniques) as the between subjects variable and time (baseline, post-treatment). A paired t-test will perform to test within-group differences in score changes from pre- to post-treatment. Effect size will test using Cohen's d. p = 0.05 will be considered significant in all tests.
Study design
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Single group
- Masking
- Double blind (participant, investigator)
- Number of arms
- 2
| Arm | Type | Receives |
|---|---|---|
| Manipulative Therapy Techniques | Experimental | Other: Manipulative Therapy TechniquesManipulative Therapy Techniques involve three techniques on lumbar and sacral areas. This protocol will be administered one a week for 3 weeks. |
| Functional Technique | Active comparator | Other: Functional TechniqueManipulative Therapy Technique involves one technique on lumbar area. This protocol will be administered one a week for 3 weeks. |
Who may qualify
- Ages
- 25 to 55 years
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult
Key inclusion criteria (4 listed)
- Low back pain for ≥ 3 months.
- Score ≥4 on the Roland Morris disability questionnaire.
- No undergoing another physical therapy treatment.
- Inability to achieve lumbar muscle flexion-relaxation in trunk flexion
Key exclusion criteria (7 listed)
- Clinical signs of radiculopathy.
- Presence of lumbar stenosis.
- Fibromyalgia.
- Spondylolisthesis.
- History of spinal surgery.
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Manipulative Therapy Techniques* Global Technical bilateral pelvis: The technique involves inserting a small spine rotation and make a slack in three stages. * Indirect technique of lumbar roll in rotation for bilateral L3: to reduce the slack and make the body drop simultaneously, together with a high speed contraction pectoral muscles and triceps, iliac crest leading caudad which produces a rotation of the vertebra underlying joint space opening. * Dog-technic on D12: this technique reduces the slack in the abdomen toward the hand in contact with D12. Next, the therapist conducted a thrust in the direction of the reduction. | Other | Manipulative Therapy Techniques |
| Functional TechniqueThe therapist presses the two anterior superior iliac spines to open the back of the pelvis, this maintained throughout the technique. Then patient is asked to breathe deeply and exhale, sacrum makes a flexion-extension respectively. These movements should be symmetrical and of equal duration in time. | Other | Functional Technique |
Primary outcome
Roland Morris Disability Questionnaire (RMDQ)
Time frame: At baseline, 3 weeks and 7 weeks
The Roland Morris disability questionnaire is a self-administered disability measurement scored on a 24-point scale from 0 = no disability to 24 = severe disability.
6 secondary outcomes
Oswestry Disability Index (ODI)
Time frame: At baseline, 3 weeks and 7 weeks
Visual Analogue Scale (VAS)
Time frame: At baseline, 3 weeks and 7 weeks
Tampa Scale for Kinesiophobia (TSK)
Time frame: At baseline, 3 weeks and 7 weeks
Quality of Life
Time frame: At baseline, 3 weeks and 7 weeks
Isometric Resistance of Abdominal Muscles
Time frame: At baseline, 3 weeks and 7 weeks
Lumbar Mobility in Flexion
Time frame: At baseline, 3 weeks and 7 weeks
Results and safety
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 6 Oct 2015.
- Background: PubMed 23370728Schafer A, Gartner-Tschacher N, Schottker-Koniger T. [Subgroup-specific therapy of low back pain: description and validity of two classification systems]. Orthopade. 2013 Feb;42(2):90-9. doi: 10.1007/s00132-012-2041-5. German.
- Background: PubMed 23322025Rodeghero JR, Denninger TR, Ross MD. Abdominal pain in physical therapy practice: 3 patient cases. J Orthop Sports Phys Ther. 2013 Feb;43(2):44-53. doi: 10.2519/jospt.2013.4408. Epub 2013 Jan 14.
- Background: PubMed 23204950Muir JM. Partial lumbosacral transitional vertebrae: 2 cases of unilateral sacralization. J Chiropr Med. 2012 Jun;11(2):77-83. doi: 10.1016/j.jcm.2011.12.002.
- Background: PubMed 23178541Shum GL, Tsung BY, Lee RY. The immediate effect of posteroanterior mobilization on reducing back pain and the stiffness of the lumbar spine. Arch Phys Med Rehabil. 2013 Apr;94(4):673-9. doi: 10.1016/j.apmr.2012.11.020. Epub 2012 Nov 23.
- Background: PubMed 23159980Falco FJ, Manchikanti L, Datta S, Sehgal N, Geffert S, Onyewu O, Zhu J, Coubarous S, Hameed M, Ward SP, Sharma M, Hameed H, Singh V, Boswell MV. An update of the effectiveness of therapeutic lumbar facet joint interventions. Pain Physician. 2012 Nov-Dec;15(6):E909-53.
- Background: PubMed 23058448Williams JM, Haq I, Lee RY. The effect of pain relief on dynamic changes in lumbar curvature. Man Ther. 2013 Apr;18(2):149-54. doi: 10.1016/j.math.2012.09.004. Epub 2012 Oct 9.
- Background: PubMed 23047044Williams JM, Haq I, Lee RY. A novel approach to the clinical evaluation of differential kinematics of the lumbar spine. Man Ther. 2013 Apr;18(2):130-5. doi: 10.1016/j.math.2012.08.003. Epub 2012 Oct 6.
- Background: PubMed 23047043Hendrick P, Mani R, Bishop A, Milosavljevic S, Schneiders AG. Therapist knowledge, adherence and use of low back pain guidelines to inform clinical decisions--a national survey of manipulative and sports physiotherapists in New Zealand. Man Ther. 2013 Apr;18(2):136-42. doi: 10.1016/j.math.2012.09.002. Epub 2012 Oct 6.
- Background: PubMed 23040656Cook C, Learman K, Showalter C, Kabbaz V, O'Halloran B. Early use of thrust manipulation versus non-thrust manipulation: a randomized clinical trial. Man Ther. 2013 Jun;18(3):191-8. doi: 10.1016/j.math.2012.08.005. Epub 2012 Oct 2.
- Background: PubMed 23018080Carlsson H, Rasmussen-Barr E. Clinical screening tests for assessing movement control in non-specific low-back pain. A systematic review of intra- and inter-observer reliability studies. Man Ther. 2013 Apr;18(2):103-10. doi: 10.1016/j.math.2012.08.004. Epub 2012 Sep 25.
- Background: PubMed 22972127Rubinstein SM, Terwee CB, Assendelft WJ, de Boer MR, van Tulder MW. Spinal manipulative therapy for acute low-back pain. Cochrane Database Syst Rev. 2012 Sep 12;2012(9):CD008880. doi: 10.1002/14651858.CD008880.pub2.
- Background: PubMed 22958563Marlowe D. Complementary and alternative medicine treatments for low back pain. Prim Care. 2012 Sep;39(3):533-46. doi: 10.1016/j.pop.2012.06.008. Epub 2012 Jul 30.
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Adelaida M Castro-Sánchez, PhD study director
Universidad de Almeria
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Manipulative Therapy Techniques and Functional Technique in people with Low Back Pain and Chronic Disease, run by Universidad de Almeria at 1 site in Spain.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 4 inclusion and 7 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: finished, as of the sponsor's last update on 6 Oct 2015. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in Spain. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Roland Morris Disability Questionnaire (RMDQ) (time frame: At baseline, 3 weeks and 7 weeks). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT01796496, which also lists 26 linked publications.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 6 Oct 2015.