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Multiple SclerosisPhase 1RAPPER IVNCT06429085

Rex Robot Assisted Rehabilitation to Enhance Balance and Mobility for People With Multiple Sclerosis, Clinical and Biomarker Study - RAPPER IV

A Phase 1 study testing Rex robotic assisted balance exercises in people with Multiple Sclerosis, run by East Kent Hospitals University NHS Foundation Trust at 1 site in United Kingdom.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

Multiple Sclerosis (MS) poses challenges to balance and mobility, impacting the daily lives of affected individuals. The RAPPER IV study is a clinical trial to evaluate a balance and mobility training intervention supported by a powered Rex robotic exoskeleton for people living with MS. Read more about this study

Who is it for?
Ages 18 to 79 years
Conditions the study is for
Multiple Sclerosis
What is being tested?
Rex robotic assisted balance exercises
Type of treatment
Medical device
Could I receive a placebo?
No, everyone receives an active treatment
How many people
20 participants
Where
1 siteUnited Kingdom
Study dates
18 Dec 2018to 31 Mar 2020
Phase
Phase 1
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 18 to 79 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • • Are aged greater than 18 years and less than 80 years
  • Have a confirmed diagnosis of MS by a Consultant Neurologist as per McDonald Criteria.
  • Have moderate mobility restriction as defined by an Extended Disability Status Scale (EDSS) score of between 4 to 6.5
  • Ten participants to be recruited from EDSS 4 to 5.5
  • Ten participants to be recruited from EDSS 5.5 to 6.5
  • Within the anthropometric requirements of the REX device (See 'RAPPER III- MS 014 TF-04 v 3.0 REX Clinical Assessment Guide A4' for details of weight, height, size and range of motion requirements)
  • Offer written informed consent to take part in the study

Who cannot join

  • a history of osteoporosis or osteoporosis related bone fractures.
  • skin integrity issues that could be adversely affected by the REX device
  • severe hypertonia (spasticity) as indicated by a score equal to or greater than 4 on the modified Ashworth scale for any muscle in their lower limbs.
  • a behavioural, cognitive or communication impairment which could interfere with the ability to participate in a rehabilitation program, as noted during screening (e.g., agitation, inability to follow two step commands)
  • are unable or unwilling to provide informed consent
  • are considered medically unsuitable for rehabilitation in the opinion of the screening medical specialist
Show all 9Show fewer
  • a known allergy (skin contact) to materials used in Rex
  • are pregnant
  • taking part in any other medical research trial at the same time

Trial locations and contacts

1 site in 1 country.

United Kingdom1 site
  • East Kent Hospitals University NHS Trust

    Canterbury, Kent

Other trials in United Kingdom

About this study

Multiple Sclerosis (MS) poses challenges to balance and mobility, impacting the daily lives of affected individuals. The RAPPER IV study is a clinical trial to evaluate a balance and mobility training intervention supported by a powered Rex robotic exoskeleton for people living with MS.

Aims and objectives:

Read more

This study aims to gain an insight into the potential health benefits of using a Rex robot to assist in a neuro-rehabilitation intervention program focused on improving balance and functional mobility with supervision from a specialist clinician.

Objectives

  • to evaluate the feasibility of using the Rex robotic walking device for rehabilitation with people who have mobility restrictions due to Multiple Sclerosis (MS)
  • to assess and evaluate the clinical effectiveness of a 5-week robotic assisted exercise program focused on core stability exercises, balance and walking using patient related outcome measures
  • to gain an insight into the experiences of participants and their spouses of using the robotic walking device for rehabilitation and how this has impacted on their lives

A single cohort group of 20 people who were living with MS who met trial eligibility criteria were recruited. A variety of clinical outcome measurements were taken pre, during and post trial and results were analysed by a statistician.

Read the detailed description

The key research questions:

  • Is it feasible for a person with balance and mobility impairment caused by MS to use a robotic walking device to exercise in standing and walking with supervision safely?
  • What are the key outcome measures most sensitive to measurable change in this study population sample, which may reflect potential improvement during the trial period? (Clinical outcome scales and self-reported questionnaires)
  • Is this robotic assisted balance and mobility training program feasible, safe and effective?
  • Does the completion of this balance and mobility exercise treatment intervention result in measurable improvements in balance, mobility, spasticity, lower limb joint range of movement and achievable individual patient goals?

To answer these questions, we invited 20 people diagnosed with MS (as defined by "McDonald" criteria, Polman et al, 2011) to undertake a 5-week balance exercise intervention program supported by the use of the Rex robotic walking device, designed to strengthen their postural body and leg muscles and improve their balance.

Participants were monitored and progressed on an individual basis throughout the treatment program as appropriate and a range of standardised assessments, questionnaires and relevant clinical outcome scales were used to capture and measure change related to this trial.

Prospective, open label, single arm, non-randomized, non-comparative feasibility study of Rex robot assisted training to improve balance, mobility and cardiovascular fitness for people living with MS.

A purposive sample of 20 adults, who have a primary diagnosis of MS, aged between 18 and 80 years old, with an Expanded Disability Status Scale (EDSS) as defined by Kurtzke (1983), with scores between 4 and 6.5 were recruited into this study.

Being tested
Rex robotic assisted balance exercises
Keywords
Balance, Core stability, Mobility, Powered exoskeleton, Neuro-rehabilitation
Medical subject headings
Multiple Sclerosis

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Rex robotic assisted balance exercisesDevice

    Individual is supported by a Rex robotic exoskeleton which enables assisted and supervised practise of balance exercises. This intervention took place as a supported and supervised series of 5 sessions over 5 weeks as an Out-patient.

Study groups in NCT06429085
Study groupRoleWhat they receive
People diagnosed with Multiple SclerosisExperimentalUse of powered Rex robotic exoskeleton to enable the practice of core stability balance exercises
Receives: Device: Rex robotic assisted balance exercises

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Timed transfer into the Rex device

    Timed transfer into the Rex device with appropriate level of assistance

    Measured: Time point 1 - Week 1

  2. Completion of sit to stand and stand to sit within the Rex device

    Completion of sit to stand and stand to sit within the Rex device with hands on assistance from trial therapist

    Measured: Time point 1 - Week 1

  3. Completion of 1 Rex robotic assisted balance rehabilitation exercise session

    Completion of 1 Rex robotic assisted balance rehabilitation exercise session with hands on assistance from trial therapist

    Measured: Time point 1 - Week 1

  4. Screening loss analysis

    Number of individuals screened and those eligible who entered the trial and those who completed the trial

    Measured: End of recruitment period - Week 30

Secondary outcomes (11)
  1. Timed up and Go

    Timed up and Go

    Measured: Time point 1 - Week 1

  2. Berg Balance Scale

    Berg Balance Scale

    Measured: Measured at 3 time points: Weeks 1, 6 and 10

  3. Visual Analog Scale (Pain)

    Visual Analog Scale (Pain)

    Measured: Measured at 2 time points: Weeks 1 and 6

  4. Modified Falls Efficacy Scale

    Balance and falls risk

    Measured: Measured at 2 time points: Weeks 1 and 6

  5. Activities-specific Balance Confidence scale

    Balance and confidence in balance

    Measured: Measured at 2 time points: Weeks 1 and 6

  6. Spasticity Impact Scale

    Perception of impact of spasticity on life

    Measured: Measured at 2 time points: Weeks 1 and 6

  7. EQ-5D-5L

    Perceived Health Related Quality of Life

    Measured: Measured at 2 time points: Weeks 1 and 6

  8. MSIS-29

    Perceived impact of MS on life

    Measured: Measured at 2 time points: Weeks 1 and 6

  9. Joint range of movement

    Joint range of movement

    Measured: Measured at 2 time points: Weeks 1 and 6

  10. Goal Attainment Scale

    Goal Attainment Scale

    Measured: Set at Week 1 and measured and reviewed at Week 25

  11. Modified Ashworth Scale

    Modified Ashworth Scale for muscle spasticity

    Measured: Measured at 2 time points: Weeks 1 and 6

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted24 May 2024
  2. Study start18 Dec 2018
  3. Primary completion31 Mar 2020
  4. Study completion31 Mar 2020

Resources

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 1
Primary purpose
Treatment
Allocation
Not applicable
Intervention model
Single group
Model description
Prospective, open label, single arm, non-randomized, non-comparative feasibility study of Rex robot assisted training to improve balance and mobility for people living with MS.
Masking
None (open label)
Enrolment
20 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT06429085
Sponsor's protocol ID
Protocol Version 2.0
Acronym
RAPPER IV
Status last verified
May 2024
First submitted
13 May 2024
Last updated
24 May 2024
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Publications

  • Zajicek J, Fox P, Sanders H, Wright D, Vickery J, Nunn A, Thompson A; UK MS Research Group. Cannabinoids for treatment of spasticity and other symptoms related to multiple sclerosis (CAMS study): multicentre randomised placebo-controlled trial. Lancet. 2003 Nov 8;362(9395):1517-26. doi: 10.1016/S0140-6736(03)14738-1.

    PubMed 14615106
  • Straudi S, Fanciullacci C, Martinuzzi C, Pavarelli C, Rossi B, Chisari C, Basaglia N. The effects of robot-assisted gait training in progressive multiple sclerosis: A randomized controlled trial. Mult Scler. 2016 Mar;22(3):373-84. doi: 10.1177/1352458515620933. Epub 2015 Dec 10.

    PubMed 26658817
  • Bethoux F, Bennett S. Introduction: enhancing mobility in multiple sclerosis. Int J MS Care. 2011 Spring;13(1):1-3. doi: 10.7224/1537-2073-13.1.1. No abstract available.

    PubMed 24453699
  • Latimer-Cheung AE, Pilutti LA, Hicks AL, Martin Ginis KA, Fenuta AM, MacKibbon KA, Motl RW. Effects of exercise training on fitness, mobility, fatigue, and health-related quality of life among adults with multiple sclerosis: a systematic review to inform guideline development. Arch Phys Med Rehabil. 2013 Sep;94(9):1800-1828.e3. doi: 10.1016/j.apmr.2013.04.020. Epub 2013 May 10.

    PubMed 23669008
  • Donze C. Update on rehabilitation in multiple sclerosis. Presse Med. 2015 Apr;44(4 Pt 2):e169-76. doi: 10.1016/j.lpm.2014.10.019. Epub 2015 Mar 4.

    PubMed 25746432
  • Wiles CM, Newcombe RG, Fuller KJ, Shaw S, Furnival-Doran J, Pickersgill TP, Morgan A. Controlled randomised crossover trial of the effects of physiotherapy on mobility in chronic multiple sclerosis. J Neurol Neurosurg Psychiatry. 2001 Feb;70(2):174-9. doi: 10.1136/jnnp.70.2.174.

    PubMed 11160464
  • Cattaneo D, Jonsdottir J, Zocchi M, Regola A. Effects of balance exercises on people with multiple sclerosis: a pilot study. Clin Rehabil. 2007 Sep;21(9):771-81. doi: 10.1177/0269215507077602.

    PubMed 17875557
  • Birch N, Graham J, Priestley T, Heywood C, Sakel M, Gall A, Nunn A, Signal N. Results of the first interim analysis of the RAPPER II trial in patients with spinal cord injury: ambulation and functional exercise programs in the REX powered walking aid. J Neuroeng Rehabil. 2017 Jun 19;14(1):60. doi: 10.1186/s12984-017-0274-6.

    PubMed 28629390
  • Kurtzke JF. Rating neurologic impairment in multiple sclerosis: an expanded disability status scale (EDSS). Neurology. 1983 Nov;33(11):1444-52. doi: 10.1212/wnl.33.11.1444.

    PubMed 6685237
  • Sakel M, Saunders K, Hodgson P, Stephensen D, Phadke CP, Bassett PA, Wilkinson D. Feasibility and Safety of a Powered Exoskeleton for Balance Training for People Living with Multiple Sclerosis: A Single-Group Preliminary Study (Rapper III). J Rehabil Med. 2022 Dec 9;54:jrm00357. doi: 10.2340/jrm.v54.4544.

    PubMed 36484722

Questions about this trial

What is this clinical trial studying?

A Phase 1 study testing Rex robotic assisted balance exercises in people with Multiple Sclerosis, run by East Kent Hospitals University NHS Foundation Trust at 1 site in United Kingdom.

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 7 inclusion and 9 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 24 May 2024. 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 United Kingdom. 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.

What does this phase mean?

Phase 1 studies test a treatment in a small group of people for the first time or in a new way, mainly to check safety and find the right dose.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

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?

Timed transfer into the Rex device (time frame: Time point 1 - Week 1). The study lists 4 primary outcomes in all. 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 NCT06429085, which also lists 10 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 24 May 2024; AzTrials last refreshed its copy on 7 Nov 2026.

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