We're building a better ClinicalTrials.gov. Check it out and tell us what you think!
Try the New Site
We're building a modernized ClinicalTrials.gov! Visit Beta.ClinicalTrials.gov to try the new functionality.
ClinicalTrials.gov Menu

Validation of Early Prognostic Data for Recovery Outcome After Stroke for Future, Higher Yield Trials (VERIFY)

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Know the risks and potential benefits of clinical studies and talk to your health care provider before participating. Read our disclaimer for details.
ClinicalTrials.gov Identifier: NCT05338697
Recruitment Status : Recruiting
First Posted : April 21, 2022
Last Update Posted : August 30, 2022
University of California, Los Angeles
University of Auckland, New Zealand
Medical University of South Carolina
Information provided by (Responsible Party):
Pooja Khatri, University of Cincinnati

Brief Summary:
VERIFY will validate biomarkers of upper extremity (UE) motor outcome in the acute ischemic stroke window for immediate use in clinical trials, and explore these biomarkers in acute intracerebral hemorrhage. VERIFY will create the first multicenter, large-scale, prospective dataset of clinical, transmagnetic stimulation (TMS), and MRI measures in the acute stroke time window.

Condition or disease Intervention/treatment
Stroke Stroke, Acute Stroke, Ischemic Stroke Hemorrhagic Diagnostic Test: Transcranial Magnetic Stimulation (TMS)

Detailed Description:

Currently, 7 million US stroke survivors have significant disability, more than half with residual motor deficits. Motor function, particularly of the upper extremity (UE), is critical for regaining independence after stroke. UE function largely depends on integrity of motor cortex and its descending fibers, collectively termed the corticomotor system (CMS). Validated, clinically relevant biomarkers that identify biologically distinct patient subgroups are critically needed, particularly for the often affected and functionally important CMS. Their absence is a major obstacle to developing and personalizing new recovery therapies, especially in the early days poststroke.

Presence or absence of motor evoked potential (MEP) responses to TMS and extent of MRI-measured acute lesion load involving corticospinal tract (CST) are ready for formal validation. Also, the Predict Recovery Potential (PREP)-2 prediction tool, which sequentially combines acute clinical information and MEP status, is primed for multi-site validation.

The central objective is to validate the most biologically relevant and primed biomarkers of 90-day UE motor outcomes after ischemic stroke in the first large-scale, prospective, acute dataset of clinical, TMS, and MRI measures. The central hypothesis is that patients have different UE outcomes depending on CMS function measured with TMS, and on CST injury measured with MRI.

The specific aims are:

  1. to externally validate the relationships that TMS and MRI biomarkers of CMS integrity have with 90-day UE motor impairment outcome and
  2. to externally validate the PREP2 prediction tool to predict 90- day UE functional outcome. The study will also explore these biomarkers in acute intracerebral hemorrhage.

The study will comprehensively measure UE outcomes 90 days post-stroke in three domains of motor performance -impairment, function, and use - identified by the World Health Organization International Classification of Functioning, Disability and Health.

By establishing biomarkers for use in the acute stroke period to identify patient subgroups with distinct 90-day outcomes, the study will improve the efficiency of stroke recovery trials and inform rehabilitation decision-making.

Sample Size: 657 participants: 557 with ischemic stroke and 100 with intracerebral hemorrhage (exploratory cohort) enrolled at up to 35 sites.

Trial Status: VERIFY received formal FDA IDE approval in November 2020 and received NIH funding in September 2021. Participating sites from the United States have been identified, and the study is now enrolling eligible participants.

Layout table for study information
Study Type : Observational
Estimated Enrollment : 657 participants
Observational Model: Cohort
Time Perspective: Prospective
Official Title: Validation of Early Prognostic Data for Recovery Outcome After Stroke for Future, Higher Yield Trials
Actual Study Start Date : June 18, 2022
Estimated Primary Completion Date : July 2026
Estimated Study Completion Date : July 2026

Resource links provided by the National Library of Medicine

Group/Cohort Intervention/treatment
Ischemic & Hemorrhagic stroke patients
557 ischemic stroke patients and 100 hemorrhagic stroke patients
Diagnostic Test: Transcranial Magnetic Stimulation (TMS)
No intervention used. This study is using TMS to obtain motor evoked potential (MEP), a prognostic biomarker. The TMS procedure is being conducted during the first week of hospitalization, which required registration under an IDE. Only TMS devices that have received 510(k) clearance from the FDA are used in this study, consisting of MEGA-TMS and MagStim 200-2.

Primary Outcome Measures :
  1. Upper Extremity-Fugl Meyer (UE-FM) for AIM 1 [ Time Frame: 90 days post-stroke ]
    UE-FM score, as a continuous scale, adjusted for baseline score in analysis

  2. Action Research Arm Test (ARAT) for AIM 2 [ Time Frame: 90 days post-stroke ]
    ARAT categorized as 'excellent', 'good', 'limited', or 'poor'

Other Outcome Measures:
  1. Motor Activity Log (MAL) [ Time Frame: 90 days post-stroke ]
    MAL categorized as 0 to 3 versus >/=3 to 5.

  2. modified Rankin Score (mRS) [ Time Frame: 90 days post-stroke ]
    mRS level (0-6)

Information from the National Library of Medicine

Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below. For general information, Learn About Clinical Studies.

Layout table for eligibility information
Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   Yes
Sampling Method:   Non-Probability Sample
Study Population
Patients with ischemic or intracerebral hemorrhage consented within 48-96 hours of stroke onset in the acute hospitalization setting

Inclusion Criteria:

  • Age 18 years or older
  • Unilateral stroke due to ischemia or intracerebral hemorrhage
  • Motor deficits in the acutely affected UE, defined as a Shoulder Abduction and Finger Extension (SAFE) score ≤ 8 out of 10 points (i.e., excluding full or nearly full motor strength in both shoulder abduction and finger extension) within 48 to 96 hours of stroke onset (or time last known well).
  • Provision of signed and dated informed consent form within 48 to 96 hours of stroke onset (or time last known well).
  • Stated willingness to comply with all study procedures and availability for the duration of the study
  • Fluent in English or Spanish

Exclusion Criteria:

  • UE injury or conditions on paretic side that limited use prior to the stroke.
  • Legally blind.
  • Dense sensory loss indicated by a score of 2 on NIHSS sensory item
  • Unable to abduct the shoulder or extend the fingers of the non-paretic arm/hand/wrist on verbal command
  • Isolated cerebellar stroke
  • Bilateral hemisphere acute strokes
  • Co-enrollment in a trial of an intervention targeting the incident stroke (acute treatment or rehabilitation/recovery intervention) after baseline assessments for VERIFY are initiated
  • Known or expected inability to maintain follow-up with study procedures through 90 days
  • Cognitive or communication impairment precluding informed consent by the participant.
  • Major medical, neurological, or psychiatric condition that would substantially affect functional status
  • Non-cerebrovascular diagnosis associated with unlikely survival at 90 days
  • Pregnancy
  • Contraindication to noncontrast MRI (i.e., certain metallic implants, metallic foreign bodies or severe claustrophobia)
  • Contraindication to TMS (i.e., cardiac pacemaker or other electronic devices in the body at or above the level of the seventh cervical vertebra, such as cochlear implant, cortical stimulator, deep brain stimulator, vagus nerve stimulator, cervical spine epidural stimulator, or ventriculoperitoneal shunt; Skull defect related to current stroke; Seizure after onset of current stroke; Seizure within the last 12 months while taking anti-epileptic medications; Previous serious adverse reaction to TMS)
  • Unable to perform behavioral assessments within 48-120 hours of symptom onset
  • Unable to receive TMS or get MRI within 72-168 hours of symptom onset
  • Anticipated inability to perform study procedures within 168 hours of symptom onset.

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT05338697

Layout table for location contacts
Contact: Pooja Khatri, MD 513-558-5478 pooja.khatri@uc.edu
Contact: Lisa Mundo, MA 513-558-0125 mundokl@ucmail.uc.edu

Show Show 24 study locations
Sponsors and Collaborators
University of Cincinnati
University of California, Los Angeles
University of Auckland, New Zealand
Medical University of South Carolina
Layout table for investigator information
Principal Investigator: Pooja Khatri, MD University of Cincinnati
Principal Investigator: Steve Cramer, MD University of California, Los Angeles
Principal Investigator: Cathy Stinear, PhD University of Auckland, New Zealand
Principal Investigator: Achala Vagal, MD University of Cincinnati
Layout table for additonal information
Responsible Party: Pooja Khatri, Professor, University of Cincinnati
ClinicalTrials.gov Identifier: NCT05338697    
Other Study ID Numbers: G200291
First Posted: April 21, 2022    Key Record Dates
Last Update Posted: August 30, 2022
Last Verified: August 2022

Layout table for additional information
Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: Yes
Additional relevant MeSH terms:
Layout table for MeSH terms
Ischemic Stroke
Hemorrhagic Stroke
Cerebrovascular Disorders
Brain Diseases
Central Nervous System Diseases
Nervous System Diseases
Vascular Diseases
Cardiovascular Diseases