Chronic PainINSPIRENCT06183281
Integrating Nonpharmacologic Strategies for Pain With Inclusion, Respect, and Equity
A study testing CBT, Mindfulness, and Movement in people with Chronic Pain, run by University of California, San Francisco at 2 sites in United States.
Trial summary
INSPIRE creates a trilingual mobile app and telehealth coaching program to promote non-pharmacologic strategies for pain management with Black, Chinese, and Latinx communities in the San Francisco Bay Area. Years 1-2 will develop the app and test it with a brief single arm pilot starting in Nov 2023. Read more about this study
- Who is it for?
- Ages 18 years and older
- Conditions the study is for
- Chronic Pain
- What is being tested?
- CBT, Mindfulness, and Movement
- Type of treatment
- Lifestyle or therapy programme
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 586 participants
- Where
- 2 sitesUnited States
- Study dates
- 28 Apr 2025to 31 Jan 2028
- Phase
- Interventional
- Are there results?
- Not yet: the study is under way
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 18 years and older
- All sexes
- No healthy volunteers
- Adult, Older adult
Who may be able to join
- age 18 or older
- speak English, Spanish, or Cantonese
- have a UCSF Health or SFHN medical provider (any type)
- be willing to use a smartphone (iOS or Android - either their own or one provided by the study)
- have chronic, non-malignant pain for at least 3 months
- be willing to participate in a 12 month patient-centered chronic pain management study where they will be randomized into one of two comparison arms
Who cannot join
- Severe mental illness or other condition preventing informed consent
Trial locations and contacts
2 sites in 1 country. Contact the study team or a site near you to ask about taking part.
United States2 sites, 2 recruiting
- Recruiting
San Francisco General Hospital
San Francisco, California, 94110
Eleanor Schwarz, MD, 415-206-2372, Eleanor.Schwarz@ucsf.edu
Lisa Ochoa-Frongia, MD, 415-476-4082 ext. 411, Lisa.Ochoa-Frongia@ucsf.edu
- Recruiting
UCSF Adult Primary Care Mt. Zion Clinic
San Francisco, California, 94115
Jason Satterfield, PhD, 415-353-2104, Jason.Satterfield@ucsf.edu
Adrian Aguilera, PhD
About this study
Official title: Integrating Nonpharmacologic Strategies for Pain With Inclusion, Respect, and Equity (INSPIRE): Tailored Digital Tools, Telehealth Coaching, and Primary Care Coordination
INSPIRE creates a trilingual mobile app and telehealth coaching program to promote non-pharmacologic strategies for pain management with Black, Chinese, and Latinx communities in the San Francisco Bay Area. Years 1-2 will develop the app and test it with a brief single arm pilot starting in Nov 2023. A full two arm randomized controlled trial (RCT) will being in early 2025 with changes in PEG scores as the primary outcome. Secondary outcomes include Helping to End Addiction Longterm (HEAL) common data elements.
- Conditions
- Chronic Pain
- Being tested
- CBT, Mindfulness, and Movement
- Keywords
- Non-malignant chronic pain, Digital health, Health coaching, Health equity, Cognitive therapy, Mindfulness, Movement
- Medical subject headings
- Chronic Pain
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
CBT, Mindfulness, and MovementBehavioural
Blended CBT, mindfulness, and movement delivered through a mobile app and supported by a weekly telehealth pain management coach.
| Study group | Role | What they receive |
|---|---|---|
| Intervention | Experimental | The INSPIRE chronic pain management system has three primary components: 1) a patient facing smartphone app that collects and interprets a comprehensive intake and patient reported outcomes (PROs), provides health education, and a tailored, modular self-management program that includes cognitive-behavioral therapy (CBT), physical therapy (PT), and mindfulness-based interventions (MBI), 2) a weekly telehealth visit with a pain coach that uses the PRO data and module engagement measures to guide the visit, and 3) enhanced primary care coordination achieved through pain coaching notes and alerts integrated into the electronic health record (EHR). Receives: Behavioral: CBT, Mindfulness, and Movement |
| Control | No intervention | Control participants will receive educational materials about chronic pain and full workbook with non-pharmacologic strategies. |
What is being measured
The primary outcome is the main question the study is designed to answer.
Change from Baseline in Pain Intensity and Interference on the 11-point Pain, Enjoyment of Life, and General Activity Scale (PEG)
The PEG Pain Screening Tool is a validated, self-reported 3-question survey assessing pain severity, the extent to which pain interferes with enjoyment of life, and the extent to which pain interferes with general activity. Possible scores for each question range from 0 (no pain, no interference) to 10 (worst possible pain, worst possible interference). The average of scores from the three questions yields the PEG score. Change = (PEG score at time point - PEG score at baseline)
Measured: Baseline, 3mo, 6mo, 12mo
Secondary outcomes (14)
Change from Baseline in Physical Functioning on the 5-point PROMIS Physical Function Short Form 6b
The PROMIS Physical Function Short Form 6b is a validated, self-reported 6-question survey assessing someone's ability to do household chores, to go up and down stairs at a normal pace, to go for a 15-minute walk, to run errands or shop, to do more than two hours of physical labor, and to do moderate work around the house. Possible scores for each question range from 1 (unable to do) to 5 (able to do without difficulty). Lower scores are indicative of lower levels of physical functioning. Change = (score at time point - score at baseline)
Measured: Baseline, 3mo, 6mo, 12mo
Change from Baseline in Sleep Disturbance and Sleep Duration on the 5-point PROMIS Sleep Disturbance Short Form 6a
The PROMIS Sleep Disturbance Short Form 6a is a validated, self-reported 6-question survey assessing quality of sleep. Possible scores for each question range from 1 (very good) to 5 (very poor). A higher score indicates greater sleep disturbance. Change = (score at time point - score at baseline)
Measured: Baseline, 3mo, 6mo, 12mo
Change from Baseline in Fear and Anxiety about Pain on the 5-point Pain Catastrophizing Scale Short Form 6
The Pain Catastrophizing Scale Short Form 6 is a validated, self-reported 6-question survey assessing thoughts and feelings that someone may have about their pain. Possible scores for each question range from 0 (not at all, no catastrophizing thoughts and feelings) to 4 (all the time, constant catastrophizing thoughts and feelings). Change = (score at time point - score at baseline)
Measured: Baseline, 3mo, 6mo, 12mo
Change from Baseline in Self-reported Depressive Symptoms on the 4-point Patient Health Questionnaire - 9 (PHQ-9)
The PHQ-9 is a validated, self-reported 9-question survey assessing common symptoms of depression. Possible scores for each question range from 0 (not at all) to 3 (nearly every day). A higher score indicates a higher likelihood of depression. Change = (score at time point - score at baseline)
Measured: Baseline, 3mo, 6mo, 12mo
Change from Baseline in Self-reported Anxiety Symptoms on the 4-point General Anxiety Scale (GAD-7)
The GAD-7 is a validated, self-reported 7-question survey assessing common symptoms of anxiety. Possible scores for each question range from 0 (not at all) to 3 (nearly every day). A higher score indicates a higher likelihood of general anxiety. Change = (score at time point - score at baseline)
Measured: Baseline, 3mo, 6mo, 12mo
Change from Baseline in Overall Satisfaction with Treatment on the 7-point Patient Global Impression of Change (PGIC)
The Patient Global Impression of Change (PGIC) is a validated, self-reported 1-question survey assessing how much a patient's pain has improved since the start of treatment. Possible scores range from 0 (very much improved) to 6 (very much worse). Change = (score at time point - score at baseline)
Measured: Baseline, 3mo, 6mo, 12mo
Change from Baseline in Self-reported Alcohol Use Disorder Symptoms on the 5-point Alcohol Use Disorder Identification Test (AUDIT)
The Alcohol Use Disorder Identification Test (AUDIT) is a validated, self-reported 10-question survey assessing common symptoms of alcohol use disorder. Possible scores for each question range from 0 (never) to 4 (4 or more times per week). Scores for each question are added up. A score of 8 or higher is considered to indicate hazardous or harmful alcohol use. Change = (score at time point - score at baseline)
Measured: Baseline, 3mo, 6mo, 12mo
Change from Baseline in Drug Abuse Screening Test (DAST) Score
The Drug Abuse Screening Test (DAST) is a validated, self-reported 10-question survey assessing risk of drug abuse. Each question is answered with a "yes" or a "no". Answers that indicate possible risk of drug abuse are given a score of 1, while answers that do not indicate possible risk of drug abuse are given a score of 0. The scores for each question are then added together. Change = (score at time point - score at baseline)
Measured: Baseline, 3mo, 6mo, 12mo
Change from Baseline in Internalized Stigma of Mental Illness on the 4-point Internalized Stigma of Mental Illness Inventory (ISMI)
The Internalized Stigma of Mental Illness Inventory (ISMI) is a validated, self-reported 29-question survey assessing a patient's attitude, beliefs, and behaviors relating to their mental illness. Possible scores range from 1 (strongly disagree) to 4 (strongly agree). The scores for each question are added together. A higher score indicates greater internalized stigma of mental illness. Change = (score at time point - score at baseline)
Measured: Baseline, 3mo, 6mo, 12mo
Change from Baseline in Self-reported Social Isolation on the 5-point PROMIS Social Isolation Short Form 8a
The PROMIS Social Isolation Short Form 8a is a validated, self-reported 8-question survey assessing a the extent to which someone feels isolated socially. Possible scores range from 1 (never) to 5 (always). The scores for each question are added together. A higher score indicates more severe isolation. Change = (score at time point - score at baseline)
Measured: Baseline, 3mo, 6mo, 12mo
Change from Baseline in Clinician Self-reported Attitudes, Beliefs, and Perspectives about Mental Illness on the 5-point Opening Minds Survey for Health Care Providers
The Opening Minds Survey for Health Care Providers is a validated, self-reported 20-question survey assessing health care providers' attitudes, beliefs, and perspectives about mental illness. Possible responses to each question are "Strongly Disagree", "Disagree", "Neither Agree nor Disagree", "Agree", and "Strongly Agree". No numeric scores are assigned to responses. Changes in responses between each time point and baseline will be evaluated qualitatively.
Measured: Baseline, 3mo, 6mo, 12mo
Change from Baseline in Patient Self-reported Trust of their Healthcare Provider(s) on the 5-point PROMIS Healthcare Relationship Trust (HCR) Scale
The Healthcare Relationship Trust Scale is a validated, self-reported 13-question survey assessing how a patient feels about their health care provider. Possible scores range from 0 (none of the time) to 4 (all of the time). The scores for each question are added together. A higher score indicates greater trust of the patient's health care provider. Change = (score at time point - score at baseline)
Measured: Baseline, 3mo, 6mo, 12mo
Change from Baseline in Self-reported Pain Self-Efficacy on the 7-point Pain Self-Efficacy Questionnaire - Two Item Short Form (PSEQ-2)
The Pain Self-Efficacy Questionnaire Two Item Short Form (PSEQ-2) is a validated, self-reported 2-question survey assessing a patient's ability to live and work despite their pain. Possible scores range from 0 (not at all confident) to 6 (completely confident). The scores for each question are added together. A higher score indicates greater self-efficacy. Change = (score at time point - score at baseline)
Measured: Baseline, 3mo, 6mo, 12mo
Change from Baseline in Self-reported Psychological Inflexibility on the 7-point Psychological Inflexibility in Pain Scale
The Psychological Inflexibility in Pain Scale is a validated, self-reported 12-question survey assessing how a patient accepts and adapts to a life with chronic pain. Possible scores range from 1 (never true) to 7 (always true). The scores for each question are added together. A higher score indicates greater psychological inflexibility in pain. Change = (score at time point - score at baseline)
Measured: Baseline, 3mo, 6mo, 12mo
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted27 Dec 2023
- Study start28 Apr 2025
- Primary completion31 Jan 2028 (estimated)
- Study completion31 Jan 2028 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (1)Papers the sponsor has linked to this study.
- Other trials for Chronic PainStudies of the same condition, open and under way.
- More trials run by University of California, San FranciscoThe sponsor's other registered studies.
- 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
- Parallel groups
- Model description
- Subjects will be randomized into intervention or enhanced usual care conditions
- Masking
- Single blind
- Who is masked
- Outcomes assessor
- Enrolment
- 586 participants (estimated)
Sponsor and investigators
- Lead sponsor
- University of California, San Francisco
- Sponsor type
- University, hospital or other
- Collaborators
- University of California, Berkeley, National Institute of Neurological Disorders and Stroke (NINDS)
- Responsible party
- Sponsor
- Investigators
- Jason Satterfield, PhD, Principal investigator, University of California, San Francisco
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT06183281
- Sponsor's protocol ID
- R33NS129050
- Other IDs
- R61NS129050, R33NS129050
- Acronym
- INSPIRE
- Status last verified
- Jul 2026
- First submitted
- 13 Aug 2023
- Last updated
- 27 Jul 2026
- Results posted
- No
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- No: This project is part of the Helping to End Addiction Longterm (HEAL) initiative and will use the data sharing platform required for that consortia.
Publications
Ristau J, Okobi A, Miller MJ, Cheng J, Deviren S, Schwarz EB, Fairchild T, Tsoh JY, Aguilera A, Zheng-Huang CJ, Satterfield JM. Integrating nonpharmacologic strategies for pain with Inclusion, Respect, and Equity (INSPIRE): a digital health study protocol for a pragmatic multisite randomized controlled trial. Trials. 2026 Jan 8;27(1):109. doi: 10.1186/s13063-025-09402-8.
PubMed 41507957
Study at a glance
From the registry record, last updated by the sponsor on 27 Jul 2026. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Integrating Nonpharmacologic Strategies for Pain With Inclusion, Respect, and Equity (INSPIRE): Tailored Digital Tools, Telehealth Coaching, and Primary Care Coordination
- ClinicalTrials.gov ID
- NCT06183281
- Acronym / sponsor ID
- INSPIRE / R33NS129050
- Conditions
- Chronic Pain
- Keywords
- Non-malignant chronic pain, Digital health, Health coaching, Health equity, Cognitive therapy, Mindfulness, Movement
- Study type
- Interventional
- Recruitment status
- Recruiting
- Enrolment
- 586 participants (estimated)
- Lead sponsor
- University of California, San FranciscoUniversity, hospital or other
- Collaborators
- University of California, Berkeley, National Institute of Neurological Disorders and Stroke (NINDS)
- Study start
- 28 Apr 2025 (actual)
- Primary completion
- 31 Jan 2028 (estimated)
- Study completion
- 31 Jan 2028 (estimated)
- First posted
- 27 Dec 2023 (actual)
- 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.
INSPIRE creates a trilingual mobile app and telehealth coaching program to promote non-pharmacologic strategies for pain management with Black, Chinese, and Latinx communities in the San Francisco Bay Area. Years 1-2 will develop the app and test it with a brief single arm pilot starting in Nov 2023. A full two arm randomized controlled trial (RCT) will being in early 2025 with changes in PEG scores as the primary outcome. Secondary outcomes include Helping to End Addiction Longterm (HEAL) common data elements.
Study design
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Single blind (outcomes assessor)
- Number of arms
- 2
- Model description
- Subjects will be randomized into intervention or enhanced usual care conditions
| Arm | Type | Receives |
|---|---|---|
| Intervention | Experimental | Behavioral: CBT, Mindfulness, and MovementThe INSPIRE chronic pain management system has three primary components: 1) a patient facing smartphone app that collects and interprets a comprehensive intake and patient reported outcomes (PROs), provides health education, and a tailored, modular self-management program that includes cognitive-behavioral therapy (CBT), physical therapy (PT), and mindfulness-based interventions (MBI), 2) a weekly telehealth visit with a pain coach that uses the PRO data and module engagement measures to guide the visit, and 3) enhanced primary care coordination achieved through pain coaching notes and alerts integrated into the electronic health record (EHR). |
| Control | No intervention | –Control participants will receive educational materials about chronic pain and full workbook with non-pharmacologic strategies. |
Who may qualify
- Ages
- 18 years and older
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (6 listed)
- age 18 or older
- speak English, Spanish, or Cantonese
- have a UCSF Health or SFHN medical provider (any type)
- be willing to use a smartphone (iOS or Android - either their own or one provided by the study)
- have chronic, non-malignant pain for at least 3 months
Key exclusion criteria (1 listed)
- Severe mental illness or other condition preventing informed consent
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 |
|---|---|---|
| CBT, Mindfulness, and MovementBlended CBT, mindfulness, and movement delivered through a mobile app and supported by a weekly telehealth pain management coach. | Behavioural | Intervention |
Primary outcome
Change from Baseline in Pain Intensity and Interference on the 11-point Pain, Enjoyment of Life, and General Activity Scale (PEG)
Time frame: Baseline, 3mo, 6mo, 12mo
The PEG Pain Screening Tool is a validated, self-reported 3-question survey assessing pain severity, the extent to which pain interferes with enjoyment of life, and the extent to which pain interferes with general activity. Possible scores for each question range from 0 (no pain, no interference) to 10 (worst possible pain, worst possible interference). The average of scores from the three questions yields the PEG score. Change = (PEG score at time point - PEG score at baseline)
14 secondary outcomes
Change from Baseline in Physical Functioning on the 5-point PROMIS Physical Function Short Form 6b
Time frame: Baseline, 3mo, 6mo, 12mo
Change from Baseline in Sleep Disturbance and Sleep Duration on the 5-point PROMIS Sleep Disturbance Short Form 6a
Time frame: Baseline, 3mo, 6mo, 12mo
Change from Baseline in Fear and Anxiety about Pain on the 5-point Pain Catastrophizing Scale Short Form 6
Time frame: Baseline, 3mo, 6mo, 12mo
Change from Baseline in Self-reported Depressive Symptoms on the 4-point Patient Health Questionnaire - 9 (PHQ-9)
Time frame: Baseline, 3mo, 6mo, 12mo
Change from Baseline in Self-reported Anxiety Symptoms on the 4-point General Anxiety Scale (GAD-7)
Time frame: Baseline, 3mo, 6mo, 12mo
Change from Baseline in Overall Satisfaction with Treatment on the 7-point Patient Global Impression of Change (PGIC)
Time frame: Baseline, 3mo, 6mo, 12mo
Change from Baseline in Self-reported Alcohol Use Disorder Symptoms on the 5-point Alcohol Use Disorder Identification Test (AUDIT)
Time frame: Baseline, 3mo, 6mo, 12mo
Change from Baseline in Drug Abuse Screening Test (DAST) Score
Time frame: Baseline, 3mo, 6mo, 12mo
Change from Baseline in Internalized Stigma of Mental Illness on the 4-point Internalized Stigma of Mental Illness Inventory (ISMI)
Time frame: Baseline, 3mo, 6mo, 12mo
Change from Baseline in Self-reported Social Isolation on the 5-point PROMIS Social Isolation Short Form 8a
Time frame: Baseline, 3mo, 6mo, 12mo
Change from Baseline in Clinician Self-reported Attitudes, Beliefs, and Perspectives about Mental Illness on the 5-point Opening Minds Survey for Health Care Providers
Time frame: Baseline, 3mo, 6mo, 12mo
Change from Baseline in Patient Self-reported Trust of their Healthcare Provider(s) on the 5-point PROMIS Healthcare Relationship Trust (HCR) Scale
Time frame: Baseline, 3mo, 6mo, 12mo
Change from Baseline in Self-reported Pain Self-Efficacy on the 7-point Pain Self-Efficacy Questionnaire - Two Item Short Form (PSEQ-2)
Time frame: Baseline, 3mo, 6mo, 12mo
Change from Baseline in Self-reported Psychological Inflexibility on the 7-point Psychological Inflexibility in Pain Scale
Time frame: Baseline, 3mo, 6mo, 12mo
Results and safety
This study is still under way. Results are not available in the source record yet.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 27 Jul 2026.
- Derived from this study: PubMed 41507957Ristau J, Okobi A, Miller MJ, Cheng J, Deviren S, Schwarz EB, Fairchild T, Tsoh JY, Aguilera A, Zheng-Huang CJ, Satterfield JM. Integrating nonpharmacologic strategies for pain with Inclusion, Respect, and Equity (INSPIRE): a digital health study protocol for a pragmatic multisite randomized controlled trial. Trials. 2026 Jan 8;27(1):109. doi: 10.1186/s13063-025-09402-8.
- Individual participant dataSharing planned: No. This project is part of the Helping to End Addiction Longterm (HEAL) initiative and will use the data sharing platform required for that consortia.
Related trials for Chronic Pain
Recruiting
Empowered Relief® for Cancer Survivors With Chronic Pain
Chronic Pain Due to Cancer, Pain Catastrophizing
RecruitingObservational study
Pain Phenotypes in Individuals With Multiple Sclerosis
Multiple Sclerosis, Chronic Pain
Not yet recruiting
Effect of Lumbar Stabilization Exercises With and Without YTWL (Scapular Stabilization Exercises) on Reducing Chronic Low Back Pain and Related Disability. A Randomized Clinical Trial,
Chronic Non Specific Mechanical Low Back Pain
Not yet recruiting
Comparing Non-Medicine Strategies for Improving Low Back Pain
Chronic Low-back Pain (cLBP), High-Impact Chronic Pain (HICP)
Not yet recruiting
Effect of Pectoral Nerve Block (PECS) Using Magnesium Sulfate Added to Dexamethasone on Quality of Recovery and Chronic Post-Mastectomy Pain
Breast Cancer, Postoperative Pain
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.
Jason Satterfield, PhD principal investigator
University of California, San Francisco
2 sites in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing CBT, Mindfulness, and Movement in people with Chronic Pain, run by University of California, San Francisco at 2 sites in United States.
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 6 inclusion and 1 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: looking for participants now, as of the sponsor's last update on 27 Jul 2026. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 2 sites in United States. 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?
This study is still under way. Results are not available in the source record yet.
How can a doctor refer a patient or contact the research team?
Contact Jason Satterfield, PhD (415-353-2104, Jason.Satterfield@ucsf.edu), or a site near the patient. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Change from Baseline in Pain Intensity and Interference on the 11-point Pain, Enjoyment of Life, and General Activity Scale (PEG) (time frame: Baseline, 3mo, 6mo, 12mo). 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 NCT06183281, which also lists 1 linked publication.
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 27 Jul 2026.