Shouder Impingement SyndromeNCT07834151
Additional Effects of Kinetic Chain Training Combined With Standard Shoulder Exercises in Subacromial Pain Syndrome
A study testing Group A (Standard shoulder exercises) and Group B (Kinetic chain training) in people with Shouder Impingement Syndrome, run by Foundation University Islamabad at 1 site in Pakistan.
Trial summary
This randomized controlled trial aims to evaluate the additional effects of kinetic chain training combined with standard shoulder exercises in patients with Subacromial Pain Syndrome (SAPS). Read more about this study
- Who is it for?
- Ages 35 to 60 years
- Conditions the study is for
- Shouder Impingement Syndrome
- What is being tested?
- Group A (Standard shoulder exercises) and Group B (Kinetic chain training)
- Type of treatment
- Surgery or procedure
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 46 participants
- Where
- 1 sitePakistan
- Study dates
- 13 Feb 2026to 18 Jan 2027
- 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 35 to 60 years
- All sexes
- No healthy volunteers
- Adult
Who may be able to join
- Age between 35-60 years
- Both Gender
- Unilateral shoulder pain consistent with SAPS.
- pain during activities with abduction, external rotation and overhead activities
- NPRS score 4-7 at baseline.
- Symptom duration six weeks to 3 months
- Pain reproduced with any two of the following tests Hawkins-Kennedy, painful arc sign, Infraspinatus (External Rotation) Resistance Tests
- Thoracic extension ROM < 20°
Who cannot join
- Age below 35 years or above 60 years
- History or clinical signs of complete supraspinatus or long-head biceps tendon tear
- History of fracture or dislocation of the shoulder, history of surgery around the shoulder with in last year
- Restrictions in passive movements of the GH joint (adhesive capsulitis)
- GH OA, RA, cervical rib
- Diagnosed bursitis, inflammatory arthropathies, active infection or systemic disease affecting shoulder
Show all 13Show fewer
- Suspected cancer or red-flag symptoms.
- Bilateral shoulder pain.
- Sign of nerve root irritation
- Diagnosed with internal shoulder impingement
- History of shoulder pain from traumatic onset
- Positive sulcus sign and apprehension special tests pointing to ligamentous laxity
- Corticosteroid injection was administered to the shoulder within a year before the study
Trial locations and contacts
1 site in 1 country. Contact the study team or a site near you to ask about taking part.
Pakistan1 site, 1 recruiting
- Recruiting
Foundation University College of Physical Therapy
Islamabad, Punjab Province, 44000
Hafiz Ali Bin Asim, MS-SPT, 03135088144, ali.asim@fui.edu.pk
About this study
This randomized controlled trial aims to evaluate the additional effects of kinetic chain training combined with standard shoulder exercises in patients with Subacromial Pain Syndrome (SAPS). SAPS is one of the most common causes of shoulder pain and is associated with altered scapular mechanics, reduced thoracic mobility, and impaired lumbopelvic stability. Conventional rehabilitation primarily targets the shoulder joint and local musculature, often overlooking the contribution of the kinetic chain. This study wil investigate whether integrating kinetic chain training into standard rehabilitation provides superior clinical outcomes.A single-blinded, parallel-group randomized controlled trial will be conducted involving 46 participants aged 35-60 years diagnosed with unilateral SAPS. Participants will be recruited through purposive sampling and randomly allocated into either a control group receiving standard shoulder rehabilitation or an experimental group receiving standard rehabilitation plus kinetic chain training for six weeks. The kinetic chain intervention includes lower trapezius strengthening, thoracic spine and rib mobilization, longissimus and multifidus activation, and gluteus maximus strengthening.
Primary outcomes will include pain intensity, shoulder range of motion, functional disability, scapular dyskinesis, and shoulder muscle strength. These will be assessed using the Numeric Pain Rating Scale (NPRS), Shoulder Pain and Disability Index (SPADI), universal goniometer, bubble inclinometer, and handheld dynamometer before and after the intervention. The findings of this study are expected to determine whether a biomechanically integrated rehabilitation approach offers greater improvements than conventional shoulder-focused exercises alone, thereby providing evidence to guide physiotherapy management of SAPS.
Read the detailed description
Subacromial Pain Syndrome (SAPS) is one of the most prevalent causes of non-traumatic shoulder pain, accounting for approximately 44-65% of shoulder pain cases. It is characterized by pain around the acromion that is aggravated during arm elevation, overhead activities, and lying on the affected side. Although SAPS has traditionally been considered a localized shoulder disorder, current evidence suggests that efficient shoulder function depends on coordinated movement throughout the kinetic chain, including the thoracic spine, trunk, pelvis, and lower extremities. Dysfunction of these proximal segments may alter scapular biomechanics, reduce thoracic mobility, impair muscle activation patterns, and contribute to scapular dyskinesis, ultimately increasing mechanical stress within the subacromial space. Despite this evidence, conventional rehabilitation primarily focuses on local shoulder structures, such as the rotator cuff and scapular muscles, with limited emphasis on restoring kinetic chain function.This study aims to determine whether combining kinetic chain training with standard shoulder exercises produces superior clinical outcomes compared with standard shoulder rehabilitation alone in individuals with SAPS. A single-blinded, parallel-group randomized controlled superiority trial will be conducted over one year. Forty-six participants aged 35-60 years with unilateral SAPS, symptom duration of six weeks to three months, pain intensity of 4-7 on the Numeric Pain Rating Scale (NPRS), thoracic extension range of motion below 20°, and positive clinical impingement tests will be recruited from Fauji Foundation Hospital, Rawalpindi, and Foundation University School of Health Sciences. Participants will be recruited using purposive sampling and randomly allocated into either the control or experimental group using a coin toss method. The outcome assessor will remain blinded to minimize detection bias.
Both groups will receive a standardized six-week shoulder rehabilitation program consisting of patient education, activity modification, pain-free range of motion exercises, rotator cuff \strengthening, stretching of tight musculature, and scapular muscle activation. In addition to this program, the experimental group will receive a structured kinetic chain training protocol comprising progressive lower trapezius strengthening, thoracic spine central posterior-anterior and costotransverse mobilization, activation of the longissimus and multifidus muscles using bird dog exercises, and progressive gluteus maximus strengthening through bridging exercises. All interventions will be performed within a pain-free or minimally painful range and progressed according to the participant's tolerance.
Outcome measures will be assessed at baseline and after completion of the six-week intervention. Pain intensity will be evaluated using the Numeric Pain Rating Scale (NPRS), functional disability using the Shoulder Pain and Disability Index (SPADI), shoulder abduction and external rotation range of motion using a universal goniometer, scapular upward rotation and thoracic extension using a bubble inclinometer, and shoulder and gluteus maximus muscle strength using a handheld dynamometer. Data will be analyzed using SPSS version 21. Depending on data distribution, appropriate parametric or non-parametric statistical tests will be applied for both within-group and between-group comparisons. Ethical approval will be obtained before participant recruitment, written informed consent will be secured from all participants, confidentiality will be maintained, and participants will retain the right to withdraw from the study at any stage. The findings are expected to clarify whether a biomechanically integrated rehabilitation approach incorporating kinetic chain training provides greater improvements in pain, shoulder mobility, muscle strength, scapular function, and disability than conventional shoulder rehabilitation alone, thereby strengthening the evidence for comprehensive physiotherapy management of Subacromial Pain Syndrome.
- Conditions
- Shouder Impingement Syndrome
- Being tested
- Group A (Standard shoulder exercises), Group B (Kinetic chain training)
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Group A (Standard shoulder exercises)Procedure or surgery
Participants in the control group will receive a standardized six-week shoulder rehabilitation program consisting of education and activity modification, pain-free range of motion exercises, isolated rotator cuff strengthening, stretching of tight muscles, and scapular muscle activation. Education will focus on avoiding aggravating overhead activities while encouraging use of the affected arm within pain-free limits. Range of motion exercises will include Codman pendulum exercises and active-assisted shoulder abduction and external rotation. Isometric strengthening will target shoulder external rotation and abduction, with progressive repetitions and hold durations. Stretching will include the pectoralis minor and upper trapezius. Scapular muscle activation will be performed using the Dynamic Hug (Plus) exercise with theraband resistance. Exercise dosage will be progressively increased over the six-week intervention according to participant tolerance and symptom response.
Group B (Kinetic chain training)Procedure or surgery
Participants will receive the same six-week standard shoulder rehabilitation program as the control group, supplemented with kinetic chain training. The kinetic chain protocol will include four components: progressive lower trapezius strengthening, thoracic spine and rib mobilization, longissimus and multifidus activation, and gluteus maximus strengthening. Lower trapezius strengthening will progress from supported scapular depression and retraction to modified and full prone cobra exercises. Thoracic mobilization will include central posterior-anterior mobilization and costotransverse unilateral posterior-anterior glides targeting the upper to mid-thoracic ribs (levels 1-6). Longissimus and multifidus activation will be performed through progressive bird-dog exercises. Gluteus maximus strengthening will involve progressive bilateral and unilateral bridging exercises. All exercises will be progressed over six weeks according to participant tolerance.
| Study group | Role | What they receive |
|---|---|---|
| Group A (Standard shoulder exercises) | Active comparator | Not described Receives: Procedure: Group A (Standard shoulder exercises) |
| Group B (Kinetic chain training) | Experimental | Not described Receives: Procedure: Group B (Kinetic chain training) |
What is being measured
The primary outcome is the main question the study is designed to answer.
Shoulder Pain
Measured using Numeric Pain Rating Scale (0-10), Eligibility cut-off of Numeric Pain Rating Scale is 4-7 at baseline.
Measured: before and after 6 weeks
Shoulder abduction range of motion
Active shoulder abduction ROM will be measured in sitting using a universal goniometer
Measured: before and after 6 weeks
Shoulder external rotation range of motion
External rotation ROM will be measured in supine with the shoulder at 90° abduction and elbow at 90° flexion using a universal goniometer.
Measured: before and after 6 weeks
Functional disability
Measured using the Shoulder Pain and Disability Index, consisting of 13 items assessing shoulder pain and functional limitations.
Measured: before and after 6 weeks
Scapular dyskinesis
Scapular upward rotation will be measured using a bubble inclinometer during arm elevation in the scapular plane, with three measurements recorded
Measured: before and after 6 weeks
Thoracic extension
Measured using two bubble inclinometers positioned at T1-T2 and T12-L1; the difference between readings at maximal extension represents thoracic extension ROM. Eligibility cut-off: <20°.
Measured: before and after 6 weeks
Shoulder abduction strength
Measured using a handheld dynamometer during a 6-second maximal isometric shoulder abduction contraction, with three repetitions recorded.
Measured: before and after 6 weeks
Shoulder external rotation strength
Measured using a handheld dynamometer during a 6-second maximal isometric external rotation contraction, with three repetitions recorded.
Measured: before and after 6 weeks
Gluteus maximus strength
Hip extension strength will be measured using a handheld dynamometer in prone with the knee flexed to 90° and hip maintained at 30° extension
Measured: before and after 6 weeks
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted22 Sep 2026
- Study start13 Feb 2026
- Primary completion18 Dec 2026 (estimated)
- Study completion18 Jan 2027 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Other trials for Shouder Impingement SyndromeStudies of the same condition, open and under way.
- More trials run by Foundation University IslamabadThe 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
- Masking
- None (open label)
- Enrolment
- 46 participants (estimated)
Sponsor and investigators
- Lead sponsor
- Foundation University Islamabad
- Sponsor type
- University, hospital or other
- Responsible party
- Sponsor
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT07834151
- Sponsor's protocol ID
- FUI/FUCP/CTR/MSMSK/IqraNaeem
- Status last verified
- Sep 2026
- First submitted
- 16 Sep 2026
- Last updated
- 22 Sep 2026
- Results posted
- No
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
Study at a glance
From the registry record, last updated by the sponsor on 22 Sep 2026. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Additional Effects of Kinetic Chain Training Combined With Standard Shoulder Exercises in Subacromial Pain Syndrome
- ClinicalTrials.gov ID
- NCT07834151
- Acronym / sponsor ID
- FUI/FUCP/CTR/MSMSK/IqraNaeem
- Conditions
- Shouder Impingement Syndrome
- Study type
- Interventional
- Recruitment status
- Recruiting
- Enrolment
- 46 participants (estimated)
- Lead sponsor
- Foundation University IslamabadUniversity, hospital or other
- Study start
- 13 Feb 2026 (actual)
- Primary completion
- 18 Dec 2026 (estimated)
- Study completion
- 18 Jan 2027 (estimated)
- First posted
- 22 Sep 2026 (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.
This randomized controlled trial aims to evaluate the additional effects of kinetic chain training combined with standard shoulder exercises in patients with Subacromial Pain Syndrome (SAPS). SAPS is one of the most common causes of shoulder pain and is associated with altered scapular mechanics, reduced thoracic mobility, and impaired lumbopelvic stability. Conventional rehabilitation primarily targets the shoulder joint and local musculature, often overlooking the contribution of the kinetic chain. This study wil investigate whether integrating kinetic chain training into standard rehabilitation provides superior clinical outcomes.A single-blinded, parallel-group randomized controlled trial will be conducted involving 46 participants aged 35-60 years diagnosed with unilateral SAPS. Participants will be recruited through purposive sampling and randomly allocated into either a control group receiving standard shoulder rehabilitation or an experimental group receiving standard rehabilitation plus kinetic chain training for six weeks. The kinetic chain intervention includes lower trapezius strengthening, thoracic spine and rib mobilization, longissimus and multifidus activation, and gluteus maximus strengthening.
Primary outcomes will include pain intensity, shoulder range of motion, functional disability, scapular dyskinesis, and shoulder muscle strength. These will be assessed using the Numeric Pain Rating Scale (NPRS), Shoulder Pain and Disability Index (SPADI), universal goniometer, bubble inclinometer, and handheld dynamometer before and after the intervention. The findings of this study are expected to determine whether a biomechanically integrated rehabilitation approach offers greater improvements than conventional shoulder-focused exercises alone, thereby providing evidence to guide physiotherapy management of SAPS.
Detailed description
Subacromial Pain Syndrome (SAPS) is one of the most prevalent causes of non-traumatic shoulder pain, accounting for approximately 44-65% of shoulder pain cases. It is characterized by pain around the acromion that is aggravated during arm elevation, overhead activities, and lying on the affected side. Although SAPS has traditionally been considered a localized shoulder disorder, current evidence suggests that efficient shoulder function depends on coordinated movement throughout the kinetic chain, including the thoracic spine, trunk, pelvis, and lower extremities. Dysfunction of these proximal segments may alter scapular biomechanics, reduce thoracic mobility, impair muscle activation patterns, and contribute to scapular dyskinesis, ultimately increasing mechanical stress within the subacromial space. Despite this evidence, conventional rehabilitation primarily focuses on local shoulder structures, such as the rotator cuff and scapular muscles, with limited emphasis on restoring kinetic chain function.This study aims to determine whether combining kinetic chain training with standard shoulder exercises produces superior clinical outcomes compared with standard shoulder rehabilitation alone in individuals with SAPS. A single-blinded, parallel-group randomized controlled superiority trial will be conducted over one year. Forty-six participants aged 35-60 years with unilateral SAPS, symptom duration of six weeks to three months, pain intensity of 4-7 on the Numeric Pain Rating Scale (NPRS), thoracic extension range of motion below 20°, and positive clinical impingement tests will be recruited from Fauji Foundation Hospital, Rawalpindi, and Foundation University School of Health Sciences. Participants will be recruited using purposive sampling and randomly allocated into either the control or experimental group using a coin toss method. The outcome assessor will remain blinded to minimize detection bias.
Both groups will receive a standardized six-week shoulder rehabilitation program consisting of patient education, activity modification, pain-free range of motion exercises, rotator cuff \strengthening, stretching of tight musculature, and scapular muscle activation. In addition to this program, the experimental group will receive a structured kinetic chain training protocol comprising progressive lower trapezius strengthening, thoracic spine central posterior-anterior and costotransverse mobilization, activation of the longissimus and multifidus muscles using bird dog exercises, and progressive gluteus maximus strengthening through bridging exercises. All interventions will be performed within a pain-free or minimally painful range and progressed according to the participant's tolerance.
Outcome measures will be assessed at baseline and after completion of the six-week intervention. Pain intensity will be evaluated using the Numeric Pain Rating Scale (NPRS), functional disability using the Shoulder Pain and Disability Index (SPADI), shoulder abduction and external rotation range of motion using a universal goniometer, scapular upward rotation and thoracic extension using a bubble inclinometer, and shoulder and gluteus maximus muscle strength using a handheld dynamometer. Data will be analyzed using SPSS version 21. Depending on data distribution, appropriate parametric or non-parametric statistical tests will be applied for both within-group and between-group comparisons. Ethical approval will be obtained before participant recruitment, written informed consent will be secured from all participants, confidentiality will be maintained, and participants will retain the right to withdraw from the study at any stage. The findings are expected to clarify whether a biomechanically integrated rehabilitation approach incorporating kinetic chain training provides greater improvements in pain, shoulder mobility, muscle strength, scapular function, and disability than conventional shoulder rehabilitation alone, thereby strengthening the evidence for comprehensive physiotherapy management of Subacromial Pain Syndrome.
Study design
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- None (open label)
- Number of arms
- 2
| Arm | Type | Receives |
|---|---|---|
| Group A (Standard shoulder exercises) | Active comparator | Procedure: Group A (Standard shoulder exercises) |
| Group B (Kinetic chain training) | Experimental | Procedure: Group B (Kinetic chain training) |
Who may qualify
- Ages
- 35 to 60 years
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult
Key inclusion criteria (8 listed)
- Age between 35-60 years
- Both Gender
- Unilateral shoulder pain consistent with SAPS.
- pain during activities with abduction, external rotation and overhead activities
- NPRS score 4-7 at baseline.
Key exclusion criteria (13 listed)
- Age below 35 years or above 60 years
- History or clinical signs of complete supraspinatus or long-head biceps tendon tear
- History of fracture or dislocation of the shoulder, history of surgery around the shoulder with in last year
- Restrictions in passive movements of the GH joint (adhesive capsulitis)
- GH OA, RA, cervical rib
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 |
|---|---|---|
| Group A (Standard shoulder exercises)Participants in the control group will receive a standardized six-week shoulder rehabilitation program consisting of education and activity modification, pain-free range of motion exercises, isolated rotator cuff strengthening, stretching of tight muscles, and scapular muscle activation. Education will focus on avoiding aggravating overhead activities while encouraging use of the affected arm within pain-free limits. Range of motion exercises will include Codman pendulum exercises and active-assisted shoulder abduction and external rotation. Isometric strengthening will target shoulder external rotation and abduction, with progressive repetitions and hold durations. Stretching will include the pectoralis minor and upper trapezius. Scapular muscle activation will be performed using the Dynamic Hug (Plus) exercise with theraband resistance. Exercise dosage will be progressively increased over the six-week intervention according to participant tolerance and symptom response. | Procedure or surgery | Group A (Standard shoulder exercises) |
| Group B (Kinetic chain training)Participants will receive the same six-week standard shoulder rehabilitation program as the control group, supplemented with kinetic chain training. The kinetic chain protocol will include four components: progressive lower trapezius strengthening, thoracic spine and rib mobilization, longissimus and multifidus activation, and gluteus maximus strengthening. Lower trapezius strengthening will progress from supported scapular depression and retraction to modified and full prone cobra exercises. Thoracic mobilization will include central posterior-anterior mobilization and costotransverse unilateral posterior-anterior glides targeting the upper to mid-thoracic ribs (levels 1-6). Longissimus and multifidus activation will be performed through progressive bird-dog exercises. Gluteus maximus strengthening will involve progressive bilateral and unilateral bridging exercises. All exercises will be progressed over six weeks according to participant tolerance. | Procedure or surgery | Group B (Kinetic chain training) |
Primary outcome
Shoulder Pain
Time frame: before and after 6 weeks
Measured using Numeric Pain Rating Scale (0-10), Eligibility cut-off of Numeric Pain Rating Scale is 4-7 at baseline.
Shoulder abduction range of motion
Time frame: before and after 6 weeks
Active shoulder abduction ROM will be measured in sitting using a universal goniometer
Shoulder external rotation range of motion
Time frame: before and after 6 weeks
External rotation ROM will be measured in supine with the shoulder at 90° abduction and elbow at 90° flexion using a universal goniometer.
Functional disability
Time frame: before and after 6 weeks
Measured using the Shoulder Pain and Disability Index, consisting of 13 items assessing shoulder pain and functional limitations.
Scapular dyskinesis
Time frame: before and after 6 weeks
Scapular upward rotation will be measured using a bubble inclinometer during arm elevation in the scapular plane, with three measurements recorded
Thoracic extension
Time frame: before and after 6 weeks
Measured using two bubble inclinometers positioned at T1-T2 and T12-L1; the difference between readings at maximal extension represents thoracic extension ROM. Eligibility cut-off: <20°.
Shoulder abduction strength
Time frame: before and after 6 weeks
Measured using a handheld dynamometer during a 6-second maximal isometric shoulder abduction contraction, with three repetitions recorded.
Shoulder external rotation strength
Time frame: before and after 6 weeks
Measured using a handheld dynamometer during a 6-second maximal isometric external rotation contraction, with three repetitions recorded.
Gluteus maximus strength
Time frame: before and after 6 weeks
Hip extension strength will be measured using a handheld dynamometer in prone with the knee flexed to 90° and hip maintained at 30° extension
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 Sep 2026.
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.
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Group A (Standard shoulder exercises) and Group B (Kinetic chain training) in people with Shouder Impingement Syndrome, run by Foundation University Islamabad at 1 site in Pakistan.
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 8 inclusion and 13 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 22 Sep 2026. 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 Pakistan. 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 Iqra Naeem, DPT (+92 3200514211, driqranaeempt@gmail.com), or a site near the patient. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Shoulder Pain (time frame: before and after 6 weeks). The study lists 9 primary outcomes in all. It is what the study was designed to measure, not a finding.
Where can I read the original study information?
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 Sep 2026.