Effectiveness of STIL Orthosis in PD

Phase

N/A

Condition

Essential Tremor

Dystonia

Treatment

Sham

STIL Orthosis

Clinical Study ID

NCT06886178

NL86972.091.24

Ages > 18
All Genders

Study Summary

Parkinson's disease is a neurodegenerative condition that leads to uncontrollable shaking (tremor), which can substantially impair everyday activities. The goal of this clinical trial is to learn if the STIL Orthosis works as a treatment option for tremor in people with Parkinson's disease. The main questions it aims to answer are:

Does the STIL Orthosis reduce tremor?
Are users satisfied with the usability and comfort of the STIL Orthosis?
Does the STIL Orthosis have any adverse effects?

Participants' tremor will be measured during three conditions:

While wearing the STIL Orthosis
While wearing an orthosis without dampening (sham)
While wearing no orthosis (baseline)

Researchers will compare the severity of tremor while wearing the STIL Orthosis against tremor during sham and baseline.

Eligibility Criteria

Inclusion

Inclusion Criteria:

Participant is at least 18 years of age.
Willing to sign the informed consent.
Diagnosed with Parkinson's disease by a neurologist or movement disordersspecialist.
Action tremor in one or two arms (clinical severity score of at least 2 on theirdominant side, on MDS-UPDRS items 3.15 or 3.16).
At least experiencing wrist flexion/extension or forearm pronation/supinationtremor.

Exclusion

Exclusion Criteria:

Diagnosed with any other neurological disorder, such as epilepsy, Essential tremor,functional tremor, physiologic tremor, cerebellar tremor, MS, spasticity, ataxia,dystonia, Alzheimer's disease or dementia, atypical parkinsonism, peripheralneuropathy affecting the arms (e.g., carpal tunnel syndrome).
Disease duration of >= 7 years.
Using a high dose of dopamine agonists, i.e., a levodopa equivalent dose (LED) of >150 mg for agonists, equivalent to approximately 1.5 mg pramipexole and 5 mgrotigotine). This is done, because dopamine agonists can have longer-lasting effectsbeyond 12 hours after the last dose (which is our criterion for OFF, to ensurefeasibility for participants). If patients take higher doses of dopamine agonists,they may still be ON at the time of study.
Experiencing severe bradykinesia/rigidity, to such an extent that the participant isunable to perform the ADL tasks (drinking, eating, pouring water).
Limited movement or muscle function in the arm/hand (for contractures or musclediseases), or loss of muscle function in one arm (e.g., due to paralysis, oramputation).
Swollen, infected, inflamed areas, or skin eruptions, open wounds, or cancerouslesions of skin on the forearm or hand that would wear the orthosis during theclinical investigation.
Consuming excessive alcohol (more than 21 glasses per week for men and 14 glassesper week for women), as defined in the GGZ guidelines on alcohol use.
Having received a botulinum toxin injection to suppress hand tremor in the past sixmonths, or planned in the coming 60 days.
Previous or planned Deep Brain Stimulation (DBS) at time of study enrollment thatinterferes with testing.
Change in any tremor medication in the past 30 days or planned during the period oftesting.
A hand circumference smaller than 170 mm, or larger than 250 mm.
An upper arm circumference smaller than 180 mm, or larger than 350 mm.
Patch/band-aid allergies.
Participant is unable to communicate with the investigator and staff due to: (1) notmastering the Dutch and English language, (2) blindness, (3) deafness, (4)illiteracy.
Pregnancy or anticipated pregnancy at time of study enrollment.
Any health condition that in the neurologist's opinion should preclude participationin this study.

Study Design

Sham

November 19, 2024

June 01, 2025

Study Description

Background: Tremor is a common symptom in people with Parkinson's disease (PD), affecting 75% of patients. While PD tremor usually occurs at rest, 46-93% of patients also have action tremor. Action tremor often does not respond to dopaminergic medication, and stereotactic surgery is invasive and unsuitable for many patients. By interfering with daily activities, action tremor can reduce independence and quality of life, necessitating new treatments.
STIL Orthosis: The STIL Orthosis, a CE-certified device, aims to reduce tremor by dampening wrist flexion-extension and forearm pronation-supination. It features dampeners that limit high-frequency movements, such as tremor, while maintaining voluntary movements. In patients with essential tremor (n=24), the STIL Orthosis reduced action tremor severity during daily activities by 65-87% compared to baseline. This suggests that it could be a promising treatment for PD action tremors.
Design: In this study, 25 PD patients will be recruited to test whether the STIL Orthosis can be used to treat PD-related action tremor. Action tremor will be measured under three conditions: while wearing the STIL Orthosis (intervention), while wearing an orthosis without dampening (sham), and while wearing no orthosis (baseline). Severity of action tremor in all conditions will be assessed using the TETRAS scale.
Primary outcome: The primary outcome of this study is action tremor severity, measured using the TETRAS scale. The main study endpoint is the difference in TETRAS scores between two conditions (intervention vs. sham and intervention vs. baseline).
Secondary outcomes: As secondary outcomes, we will measure tremor severity using the MDS-UPDRS part III scale, focusing on items related to postural, kinetic, and rest tremor (3.15, 3.16, 3.17). We will also measure tremor power using surface electromyography (sEMG) and accelerometry. Furthermore, we will assess perceived change in tremor using the PGC-I, user satisfaction on relevant items from the D-QUEST, and product safety using an adverse events report form.
Sample size calculation: The sample size calculation is based on a pilot study with 8 Parkinson's disease patients experiencing action tremor in the forearm, which showed an effect size of 1.24 1.86 for MDS-UPDRS part 3 (tremor items 3.15, 3.16, and 3.17) and 2.21 for TETRAS. Given that patients only benefit from a device that has a large effect on their tremor, an effect size Cohen's d=0.8 was chosen, which is also common practice in the medical literature. In total, two main comparisons will be done on the primary outcome (TETRAS score): intervention vs. sham, intervention vs. baseline. To adjust for multiple statistical tests, a Bonferroni correction of alpha = 0.05/2 = 0.025 is used. To achieve 80% power in a two-sided paired t-test, a minimum of 18 patients needs to be included. In order to compensate for possible drop-outs, 25 patients will be included for this clinical investigation.
Statistical analysis: All analyses will follow the intention-to-treat principle. Paired-samples t-test will be used to test for intervention-related effects on action tremor severity. In the event that tremor severity scores are not normally distributed, Wilcoxon signed rank tests will be used instead.

Connect with a study center

Donders Institute for Brain, Cognition and Behaviour
Nijmegen, Gelderland 6511EN
Netherlands
Active - Recruiting

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