StrokeNCT06786559
Nurse-led Rehabilitation to Improve Self-care Among Stroke Patients in Bangladesh
A study testing Assistive Device and health Education in people with Stroke and Disability Physical, run by Hiroshima University.
Trial summary
Stroke causes various levels of disability, which decreases physical function for a prolonged period. The purpose of this study is to test the feasibility and efficacy of a nurse-led rehabilitation program focused on improving the activity of daily living (ADL) among post-stroke patients in Bangladesh. Read more about this study
- Who is it for?
- Ages 18 years and older
- Conditions the study is for
- Stroke, Disability Physical
- What is being tested?
- Assistive Device and health Education
- Type of treatment
- Lifestyle or therapy programme
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 64 participants
- Where
- No sites listed yet
- Study dates
- 1 Mar 2025to 30 Aug 2025
- 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
- For Patient
- who is 18 years old and above, both males \& females,
- is irrespective of type of stroke and time of stroke,
- is within 5 days to 2 weeks of onset of the current stroke
- Physician advice rehabilitation, and who needs assistive devices for ADL,
- has family caregivers,
Show all 11Show fewer
- lives in the study area, and
- who will provide written consent \& willing to participate in the study.
- For family care giver
- Primary caregivers irrespective of sex and aged 18 years old and above, living with the patient who take care of an above patient and who meets all the inclusion criteria.
- Who will provide written consent \& willing to participate in the study
Who cannot join
- For patient
- Participation in other clinical trials,
- not having a smartphone at home, For family care giver No exclusion criteria
Trial locations and contacts
No sites are listed yet. Contact the study team or a site near you to ask about taking part.
About this study
Official title: Post Discharge Nurse-led Rehabilitation to Improve Self-care Among Stroke Patients in Bangladesh: A Pilot Randomized Controlled Trial
Stroke causes various levels of disability, which decreases physical function for a prolonged period. The purpose of this study is to test the feasibility and efficacy of a nurse-led rehabilitation program focused on improving the activity of daily living (ADL) among post-stroke patients in Bangladesh. A feasibility study, including descriptive and randomized controlled trial (RCT), will be conducted at the National Institute of Neuroscience \& Hospital (NINS\&H) in Dhaka, Bangladesh, from March 2025 to August 2025. Participants will be the post-stroke patients who got discharged from NINS\&H from 5th days to 2 weeks after the onset of stroke and the family caregivers of the patients and meet the inclusion criteria. The sample size will be calculated based on G-Power analysis with a medium effect size and will be 64. The intervention will be designed to provide the 3-month nurse-led rehabilitation program regarding self-care and the use of assistive devices. Assessment for rehabilitation will be performed by the multidisciplinary team with research nurses (RA nurses), physiotherapists (PT), and occupational therapists (OT). The control group will receive the usual care. The Functional Independence Measure (FIM) measures the primary outcome as improved self-care. The secondary outcomes are self-efficacy and participation in social activities for patients and the care burden of family caregivers. We also qualitatively describe changes and improvements of cognitive, emotional, and behavioral aspects among patients and their families. The endpoints will be compared at baseline and the 3rd month. Rehabilitation with proper assistive devices may improve self-dependence, ADL, and social participation. The caregiver's burden will decrease through the implementation of self-care education and assistive devices for daily life adjustment.
Read the detailed description
Stroke is considered the second most leading cause of death and disability across the globe. According to Bangladesh Sample Vital Statistics 2022, the prevalence of disability is 25.5/1000 population. Almost 70% of strokes occur in lower middle-income countries (LMICs), resulting in increased disease burden than high-income countries. Patients are often the breadwinners, and their families lose their financial footing due to treatment costs and disability, leading to economic deprivation.
Stroke rehabilitation has many barriers, including scarcity of human resources, infrastructure, finances, clinical guidelines, and national policy to support such intervention to reduce the disease burden, which is evident worldwide but much more prominent in low- and middle-income countries (LMCs). According to WHO (2019), < 10/1 million people are skilled in rehabilitation.
The purpose of this study is to test the feasibility and efficacy of nurse-assisted rehabilitation programs focused on improving the activity of daily living among post-stroke patients in Bangladesh. It can be assumed that if the nurse-assisted rehabilitation service is provided within a short time of stroke onset, the prognosis will be better, the patient will be self-dependent, the disease burden will be less, and the patient will be free of complications during post-stroke time.
A pilot randomized control trial (RCT) study will be implemented. The investigators will qualitatively and quantitatively explore the acceptance of home rehabilitation and the use of assistive devices for functional independence among post-stroke patients and their family caregivers. Investigators will also describe cognitive and emotional changes (awareness, motivation, and self-efficacy), behavior, functional changes, and social participation.
The study will be conducted at the National Institute of Neurosciences \& Hospital, Dhaka, Bangladesh (NINS\&H), and patients' homes. The study area is within and near the Dhaka district to reach the study participants and observe them. The study participants will be the post-stroke patients and their caregivers. The written informed consent will be taken from patients and caregivers.
The investigators will use randomized sampling techniques to select the participants. Patients who meet the inclusion criteria will be introduced by the physician at NINS\&H, and research assistant (RA) nurses will contact patients and caregivers to obtain their consent. A total of 64 post-stroke patients, including 10% dropouts, will be enrolled by the researcher.
All quantitative data, including categorical data, will be described/counted/calculated with the mean with standard deviation or median and with quantile, distribution, and range. To compare feasibility and efficacy, data will be analyzed by ANOVA, ANCOVA, regression, and mixed model after checking the normality of data. Statistical significance will be set as <0.05.
The quality of the study will be assured and controlled by the Principal Investigator (PI) and other investigators. Data will be collected by the trained RA nurses.
Through participation in this study, patients and family care providers will develop comprehensive knowledge regarding stroke rehabilitation along with improved capacity of self-care activities with assistive devices. This will improve the quality of life of both stroke-affected individuals and care providers through the reduction of the caregiver's burden. The statistically significant result of this study can be disseminated to the research community of Bangladesh and to the policymakers to improve the rehabilitation facilities for long-term disabled patients with greater effort.
- Conditions
- Stroke, Disability Physical
- Being tested
- Assistive Device and health Education
- Keywords
- Stroke, Disability, Rehabilitation, Assistive device, Self-Care, Care Burden
- Medical subject headings
- Stroke, Caregiver Burden
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Assistive Device and health EducationBehavioural
After discharge they will be assessed and followed by RA nurses through home visit and tele services for 2 months. The nurses will contact the patients periodically over telephone, and follow up their regular self-care activities, adjustment to devices, exercise and adaptive behavior.
| Study group | Role | What they receive |
|---|---|---|
| Assistive Device Intervention | Experimental | Patients and caregivers will be trained in self-care with stroke disabilities (e.g. eating, grooming, bathing, dressing, toileting), physical exercise, lifestyle modification, prevention of complications after stroke through researcher developed "Health booklet". Based on their disabilities some adjustive and exercise devices will be provided to them for improving functional independence. Receives: Behavioral: Assistive Device and health Education |
| Control Group | No intervention | No "Education booklet" or adjustive device are provided to them. The patients with family caregivers in control group will receive the usual care. |
What is being measured
The primary outcome is the main question the study is designed to answer.
Change in the functional independence of activity of daily living
Functional Independence Measurement (FIM) tool will be used. This scale has 18 items from level 1-Total assistance to level 7- Complete independence. The total score is 126, the lowest score is 18. A higher score means improved functional independence level and lower score means less functional independence.
Measured: 3 months
Secondary outcomes (3)
Patient's Self-efficacy
Generalized self-efficacy scale (GSE) will be used to assess the strength of an individual's belief in oneself in difficult situations. The Scale has a total of 10 items with four-point Likert scale range from 1= not at all true to 4= Exactly true. After calculating the sum score, the total score will indicate the efficacy of participants. The lowest score is 10 \& highest score is 40. Higher scores indicate higher self-efficacy.
Measured: 3 months
Patient's Social participation
Social participation scale (short simplified) with 13 items will be used to assess the person's interaction and participation in community life as it measures the severity of social participation restrictions. The scale score ranges from 0-No restriction to 70- Extreme restriction. The higher score indicates more restriction in social participation.
Measured: 3 months
Family Care burden
Zarit Caregiver Burden Assessment (12-items) will be used to reflect how people sometimes feel when taking care of another person. Maximum score-48, minimum score-12, higher score indicates more burden.
Measured: 3 months
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted22 Jan 2025
- Study start1 Mar 2025 (estimated)
- Primary completion30 Aug 2025 (estimated)
- Study completion30 Aug 2025 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (5)Papers the sponsor has linked to this study.
- Other trials for StrokeStudies 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
- Supportive care
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- None (open label)
- Enrolment
- 64 participants (estimated)
Sponsor and investigators
- Lead sponsor
- Hiroshima University
- Sponsor type
- University, hospital or other
- Responsible party
- Principal investigator, Salma Akhter, Hiroshima University
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT06786559
- Sponsor's protocol ID
- 392
- Status last verified
- Jan 2025
- First submitted
- 6 Jan 2025
- Last updated
- 22 Jan 2025
- Results posted
- No
- Data monitoring committee
- Yes
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- No
Publications
Laver KE, Adey-Wakeling Z, Crotty M, Lannin NA, George S, Sherrington C. Telerehabilitation services for stroke. Cochrane Database Syst Rev. 2020 Jan 31;1(1):CD010255. doi: 10.1002/14651858.CD010255.pub3.
PubMed 32002991Prvu Bettger J, Liu C, Gandhi DBC, Sylaja PN, Jayaram N, Pandian JD. Emerging Areas of Stroke Rehabilitation Research in Low- and Middle-Income Countries: A Scoping Review. Stroke. 2019 Nov;50(11):3307-3313. doi: 10.1161/STROKEAHA.119.023565. Epub 2019 Oct 17. No abstract available.
PubMed 31619149Rahman S, Sarker S, Haque AKMN, Uttsha MM, Islam MF, Deb S. AI-Driven Stroke Rehabilitation Systems and Assessment: A Systematic Review. IEEE Trans Neural Syst Rehabil Eng. 2023;31:192-207. doi: 10.1109/TNSRE.2022.3219085. Epub 2023 Jan 30.
PubMed 36327176Kim DY, Ryu B, Oh BM, Kim DY, Kim DS, Kim DY, Kim DK, Kim EJ, Lee HY, Choi H, Kim HS, Lee HH, Kim HJ, Oh HM, Seok H, Park J, Park J, Park JG, Kim JM, Lee J, Shin JH, Lee JK, Oh JS, Park KD, Kim KT, Chang MC, Chun MH, Kim MW, Kang MG, Song MK, Choi M, Ko MH, Kim NY, Paik NJ, Jung SH, Yoon SY, Lim SH, Lee SJ, Yoo SD, Lee SH, Yang SN, Park SW, Lee SY, Han SJ, Lee SJ, Bok SK, Ohn SH, Im S, Pyun SB, Hyun SE, Kim SH, Ko SH, Jee S, Kwon S, Kim TW, Chang WH, Chang WK, Yoo WK, Kim YH, Yoo YJ, Kim YW, Shin YI, Park YG, Choi YH, Kim Y; KSNR Stroke CPG Writing Group. Clinical Practice Guideline for Stroke Rehabilitation in Korea-Part 1: Rehabilitation for Motor Function (2022). Brain Neurorehabil. 2023 Jul 17;16(2):e18. doi: 10.12786/bn.2023.16.e18. eCollection 2023 Jul.
PubMed 37554256Akhter S, Huq KE, Date S, Islam M, Chhobi FK, Sayeed SKJB, Islam MM, Afrin M, Kazawa K, Moriyama M. Introduction of Nurse-Led Rehabilitation Services for Patients With Stroke After Discharge to Improve Self-Care Management in Bangladesh: Pilot Randomized Controlled Trial. JMIR Rehabil Assist Technol. 2026 Jul 17;13:e88808. doi: 10.2196/88808.
PubMed 42470187
Study at a glance
From the registry record, last updated by the sponsor on 22 Jan 2025. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Post Discharge Nurse-led Rehabilitation to Improve Self-care Among Stroke Patients in Bangladesh: A Pilot Randomized Controlled Trial
- ClinicalTrials.gov ID
- NCT06786559
- Acronym / sponsor ID
- 392
- Conditions
- Stroke, Disability Physical
- Keywords
- Stroke, Disability, Rehabilitation, Assistive device, Self-Care, Care Burden
- Study type
- Interventional
- Recruitment status
- Not yet recruiting
- Enrolment
- 64 participants (estimated)
- Lead sponsor
- Hiroshima UniversityUniversity, hospital or other
- Study start
- 1 Mar 2025 (estimated)
- Primary completion
- 30 Aug 2025 (estimated)
- Study completion
- 30 Aug 2025 (estimated)
- First posted
- 22 Jan 2025 (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.
Stroke causes various levels of disability, which decreases physical function for a prolonged period. The purpose of this study is to test the feasibility and efficacy of a nurse-led rehabilitation program focused on improving the activity of daily living (ADL) among post-stroke patients in Bangladesh. A feasibility study, including descriptive and randomized controlled trial (RCT), will be conducted at the National Institute of Neuroscience \& Hospital (NINS\&H) in Dhaka, Bangladesh, from March 2025 to August 2025. Participants will be the post-stroke patients who got discharged from NINS\&H from 5th days to 2 weeks after the onset of stroke and the family caregivers of the patients and meet the inclusion criteria. The sample size will be calculated based on G-Power analysis with a medium effect size and will be 64. The intervention will be designed to provide the 3-month nurse-led rehabilitation program regarding self-care and the use of assistive devices. Assessment for rehabilitation will be performed by the multidisciplinary team with research nurses (RA nurses), physiotherapists (PT), and occupational therapists (OT). The control group will receive the usual care. The Functional Independence Measure (FIM) measures the primary outcome as improved self-care. The secondary outcomes are self-efficacy and participation in social activities for patients and the care burden of family caregivers. We also qualitatively describe changes and improvements of cognitive, emotional, and behavioral aspects among patients and their families. The endpoints will be compared at baseline and the 3rd month. Rehabilitation with proper assistive devices may improve self-dependence, ADL, and social participation. The caregiver's burden will decrease through the implementation of self-care education and assistive devices for daily life adjustment.
Detailed description
Stroke is considered the second most leading cause of death and disability across the globe. According to Bangladesh Sample Vital Statistics 2022, the prevalence of disability is 25.5/1000 population. Almost 70% of strokes occur in lower middle-income countries (LMICs), resulting in increased disease burden than high-income countries. Patients are often the breadwinners, and their families lose their financial footing due to treatment costs and disability, leading to economic deprivation.
Stroke rehabilitation has many barriers, including scarcity of human resources, infrastructure, finances, clinical guidelines, and national policy to support such intervention to reduce the disease burden, which is evident worldwide but much more prominent in low- and middle-income countries (LMCs). According to WHO (2019), < 10/1 million people are skilled in rehabilitation.
The purpose of this study is to test the feasibility and efficacy of nurse-assisted rehabilitation programs focused on improving the activity of daily living among post-stroke patients in Bangladesh. It can be assumed that if the nurse-assisted rehabilitation service is provided within a short time of stroke onset, the prognosis will be better, the patient will be self-dependent, the disease burden will be less, and the patient will be free of complications during post-stroke time.
A pilot randomized control trial (RCT) study will be implemented. The investigators will qualitatively and quantitatively explore the acceptance of home rehabilitation and the use of assistive devices for functional independence among post-stroke patients and their family caregivers. Investigators will also describe cognitive and emotional changes (awareness, motivation, and self-efficacy), behavior, functional changes, and social participation.
The study will be conducted at the National Institute of Neurosciences \& Hospital, Dhaka, Bangladesh (NINS\&H), and patients' homes. The study area is within and near the Dhaka district to reach the study participants and observe them. The study participants will be the post-stroke patients and their caregivers. The written informed consent will be taken from patients and caregivers.
The investigators will use randomized sampling techniques to select the participants. Patients who meet the inclusion criteria will be introduced by the physician at NINS\&H, and research assistant (RA) nurses will contact patients and caregivers to obtain their consent. A total of 64 post-stroke patients, including 10% dropouts, will be enrolled by the researcher.
All quantitative data, including categorical data, will be described/counted/calculated with the mean with standard deviation or median and with quantile, distribution, and range. To compare feasibility and efficacy, data will be analyzed by ANOVA, ANCOVA, regression, and mixed model after checking the normality of data. Statistical significance will be set as <0.05.
The quality of the study will be assured and controlled by the Principal Investigator (PI) and other investigators. Data will be collected by the trained RA nurses.
Through participation in this study, patients and family care providers will develop comprehensive knowledge regarding stroke rehabilitation along with improved capacity of self-care activities with assistive devices. This will improve the quality of life of both stroke-affected individuals and care providers through the reduction of the caregiver's burden. The statistically significant result of this study can be disseminated to the research community of Bangladesh and to the policymakers to improve the rehabilitation facilities for long-term disabled patients with greater effort.
Study design
- Primary purpose
- Supportive care
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- None (open label)
- Number of arms
- 2
| Arm | Type | Receives |
|---|---|---|
| Assistive Device Intervention | Experimental | Behavioral: Assistive Device and health EducationPatients and caregivers will be trained in self-care with stroke disabilities (e.g. eating, grooming, bathing, dressing, toileting), physical exercise, lifestyle modification, prevention of complications after stroke through researcher developed "Health booklet". Based on their disabilities some adjustive and exercise devices will be provided to them for improving functional independence. |
| Control Group | No intervention | –No "Education booklet" or adjustive device are provided to them. The patients with family caregivers in control group will receive the usual care. |
Who may qualify
- Ages
- 18 years and older
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (11 listed)
- For Patient
- For family care giver
- Primary caregivers irrespective of sex and aged 18 years old and above, living with the patient who take care of an above patient and who meets all the inclusion criteria.
- Who will provide written consent \& willing to participate in the study
Key exclusion criteria (3 listed)
- For patient
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 |
|---|---|---|
| Assistive Device and health EducationAfter discharge they will be assessed and followed by RA nurses through home visit and tele services for 2 months. The nurses will contact the patients periodically over telephone, and follow up their regular self-care activities, adjustment to devices, exercise and adaptive behavior. | Behavioural | Assistive Device Intervention |
Primary outcome
Change in the functional independence of activity of daily living
Time frame: 3 months
Functional Independence Measurement (FIM) tool will be used. This scale has 18 items from level 1-Total assistance to level 7- Complete independence. The total score is 126, the lowest score is 18. A higher score means improved functional independence level and lower score means less functional independence.
3 secondary outcomes
Patient's Self-efficacy
Time frame: 3 months
Patient's Social participation
Time frame: 3 months
Family Care burden
Time frame: 3 months
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 22 Jan 2025.
- Background: PubMed 32002991Laver KE, Adey-Wakeling Z, Crotty M, Lannin NA, George S, Sherrington C. Telerehabilitation services for stroke. Cochrane Database Syst Rev. 2020 Jan 31;1(1):CD010255. doi: 10.1002/14651858.CD010255.pub3.
- Background: PubMed 31619149Prvu Bettger J, Liu C, Gandhi DBC, Sylaja PN, Jayaram N, Pandian JD. Emerging Areas of Stroke Rehabilitation Research in Low- and Middle-Income Countries: A Scoping Review. Stroke. 2019 Nov;50(11):3307-3313. doi: 10.1161/STROKEAHA.119.023565. Epub 2019 Oct 17. No abstract available.
- Background: PubMed 36327176Rahman S, Sarker S, Haque AKMN, Uttsha MM, Islam MF, Deb S. AI-Driven Stroke Rehabilitation Systems and Assessment: A Systematic Review. IEEE Trans Neural Syst Rehabil Eng. 2023;31:192-207. doi: 10.1109/TNSRE.2022.3219085. Epub 2023 Jan 30.
- Background: PubMed 37554256Kim DY, Ryu B, Oh BM, Kim DY, Kim DS, Kim DY, Kim DK, Kim EJ, Lee HY, Choi H, Kim HS, Lee HH, Kim HJ, Oh HM, Seok H, Park J, Park J, Park JG, Kim JM, Lee J, Shin JH, Lee JK, Oh JS, Park KD, Kim KT, Chang MC, Chun MH, Kim MW, Kang MG, Song MK, Choi M, Ko MH, Kim NY, Paik NJ, Jung SH, Yoon SY, Lim SH, Lee SJ, Yoo SD, Lee SH, Yang SN, Park SW, Lee SY, Han SJ, Lee SJ, Bok SK, Ohn SH, Im S, Pyun SB, Hyun SE, Kim SH, Ko SH, Jee S, Kwon S, Kim TW, Chang WH, Chang WK, Yoo WK, Kim YH, Yoo YJ, Kim YW, Shin YI, Park YG, Choi YH, Kim Y; KSNR Stroke CPG Writing Group. Clinical Practice Guideline for Stroke Rehabilitation in Korea-Part 1: Rehabilitation for Motor Function (2022). Brain Neurorehabil. 2023 Jul 17;16(2):e18. doi: 10.12786/bn.2023.16.e18. eCollection 2023 Jul.
- Derived from this study: PubMed 42470187Akhter S, Huq KE, Date S, Islam M, Chhobi FK, Sayeed SKJB, Islam MM, Afrin M, Kazawa K, Moriyama M. Introduction of Nurse-Led Rehabilitation Services for Patients With Stroke After Discharge to Improve Self-Care Management in Bangladesh: Pilot Randomized Controlled Trial. JMIR Rehabil Assist Technol. 2026 Jul 17;13:e88808. doi: 10.2196/88808.
- Individual participant dataSharing planned: No
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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.
Questions about this trial
What is this clinical trial studying?
A study testing Assistive Device and health Education in people with Stroke and Disability Physical, run by Hiroshima University.
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 11 inclusion and 3 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: opening soon, as of the sponsor's last update on 22 Jan 2025. Status can change between updates, so confirm with the study contact before making plans.
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 Salma Akhter, PhD (07037923841, dncsalma@gmail.com), or a site near the patient. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Change in the functional independence of activity of daily living (time frame: 3 months). 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 NCT06786559, which also lists 5 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 22 Jan 2025.