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Trial registered on ANZCTR
Registration number
ACTRN12625000627459
Ethics application status
Approved
Date submitted
10/04/2025
Date registered
13/06/2025
Date last updated
13/06/2025
Date data sharing statement initially provided
13/06/2025
Type of registration
Retrospectively registered
Titles & IDs
Public title
A feasiblity study evaluating the effect of One to Zero (OTZ) chiropractic technique on brain functionand health in adults with neck dysfunction
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Scientific title
The effect of atlantooccipital joint dysfunction and its treatment on proprioception, motor control and health related quality of life: a repeated measures study in adults with neck dysfunction
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Secondary ID [1]
314180
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Nil
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Universal Trial Number (UTN)
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Trial acronym
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Linked study record
The current study describes feasibility studies that informed record ACTRN12621001191886
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Health condition
Health condition(s) or problem(s) studied:
Autonomic dysfunction
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Impaired head and neck proprioception
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Impaired health and well-being
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Sensorimotor dysfunction
337034
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Impaired mobility
337036
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Neck dysfunction
337033
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Atlantooccipital joint dysfunction
337037
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Condition category
Condition code
Musculoskeletal
333484
333484
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0
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Other muscular and skeletal disorders
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Intervention/exposure
Study type
Interventional
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Description of intervention(s) / exposure
OTZ treatment begins with correction of articular dysfunction between the occiput (C0) and the atlas, first cervical (C1) via a high velocity low amplitude manipulation (HVLA) technique. This technique first addresses decreased functional mobility between the C0-C1 joint, via high velocity, low amplitude manipulative thrusts. Other areas of cervicothoracic joint dysfunction are also treated with a specific HVLA protocol, if clinically indicated. These include the upper thoracic and lumbar spine, if these areas showed clinical evidence of joint dysfunction (e.g. restricted segmental range of motion, local tenderness, etc..). A registered chiropractor with expertise and advanced training in the OTZ technique provided the treatment. The OTZ treatment was personalized to each individual in the treatment arm since this cluster may comprise of acute and/or chronic cases, and different areas of associated joint dysfunction. Individuals in the treatment group received chiropractic care with the OTZ treatment for a total of 4 to 6visits (2 to 3 visits a week for an average of 2 to 3 weeks), dependent on the severity and chronicity of eachparticipant’s joint dysfunction(s). The number of required visits for each participant was decided by thechiropractor providing the treatment, who will use their clinical judgement to make this decision. Each treatment session was approximately 15 minutes in duration with the first session being at least 45 minutes, to acquire details about their medical history and perform a physical examination and assessmentof C0 – C1 joint complex and areas of cervicothoracic spinal dysfunction. The OTZ treatment was performed at the chiropractic clinic where the registered chiropractor administering the treatment practices. In order to monitor adherence to the intervention, the chiropractor provided the researchers with a list of participants and number of treatment sessions that were attended over the intervention period.
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Intervention code [1]
330779
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Rehabilitation
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Intervention code [2]
330780
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Treatment: Other
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Comparator / control treatment
This is a repeated measures design where each participant acted as their own control. They experienced a 2 to 3 week wait period where no new treatments were allowed in the wait period, followed by 2 to 3 weeks of treatment.
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Control group
Active
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Outcomes
Primary outcome [1]
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Neuromuscular function of Neck Muscles
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Assessment method [1]
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Force sensors and surface electromyography will be used to capture the force output and electrical activity during a maximal voluntary contraction of the upper trapezius and sternocleidomastoid muscle, respectively
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Timepoint [1]
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Measure was assessed at baseline and at follow-up (e.g. after the completion of the 2 to 3 week no treatment control period and then after the 2 to 3 weeks of chiropractic care
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Primary outcome [2]
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Physiological outcome measure
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Assessment method [2]
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Surface electromyography electrodes were placed at the mid-clavicular region on the upper aspect of the participant’s chest (right and left side). A ground strap was wrapped around the participant’s left wrist. They were connected to a Powerlab 26T (AD Instruments Inc., Sydney,Australia). This set-up allows for the simultaneous recording of heart rate (beats per a minute) and assessment of heart rate variability (timing between adjacent heart beats).
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Timepoint [2]
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Measure was assessed at baseline, after the no treatment control period (2 to 3 weeks) and completion of either chiropractic care (2 to 3 weeks).
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Primary outcome [3]
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Head repositioning accuracy
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Assessment method [3]
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The ability to accurately reproduce different head positions (i.e. neutral head position and target head position) was measured using a cervical range of motion (C-ROM) device, while participant’s vision was occluded so that the participant has to rely on proprioception.
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Timepoint [3]
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Measure will be assessed at baseline, after the no treatment control period (2 to 3 weeks) and completion of either chiropractic care (2 to 3 weeks).
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Secondary outcome [1]
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Self-reported current neck pain
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Assessment method [1]
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Participants were asked to complete the Neck disability Index questionnaire to determine their neck pain-related disability, at the moment of administration.
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Timepoint [1]
446004
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Measure was assessed at baseline, after the no treatment control period (2 to 3 weeks) and completion of either chiropractic care (2 to 3 weeks).
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Secondary outcome [2]
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Neck Range of Motion (ROM)
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Assessment method [2]
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A cervical range of motion device was used to measure the degrees of neck movement inthe three planes – Sagittal (front, back), Coronal (left and right lateral flexion) and transverse (right and left rotation). This is a primary outcome, which seeks to examine improvements in neck mobility.
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Timepoint [2]
446000
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Measure was assessed at baseline, after the no treatment control period (2 to 3 weeks) and completion of chiropractic care (2 to 3 weeks).
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Secondary outcome [3]
446003
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Lower Limb Strength
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Assessment method [3]
446003
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Quadriceps strength was measured via a portable force transducer, by instructing participants to extend their leg against the force transducer.
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Timepoint [3]
446003
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Measure was assessed at baseline, after the no treatment control period (2 to 3 weeks) and completion of chiropractic care (2 to 3 weeks).
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Secondary outcome [4]
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Self-reported Anxiety
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Assessment method [4]
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Participants will be asked to complete the beck anxiety inventory questionnaire,which will provide information on their current anxiety levels, if any.
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Timepoint [4]
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Measure will be assessed at baseline, after the no treatment control period (2 to 3 weeks) and completion of either chiropractic care (2 to 3 weeks).
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Secondary outcome [5]
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Self-reported Upper limb Pain and Dysfunction
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Assessment method [5]
446006
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Participants were asked to complete the disabilities of the arm, shoulder and hand (DASH) questionnaire, which provides information on their upper limb pain andupper limb pain-related disability, if any.
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Timepoint [5]
446006
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Measure was assessed at baseline, after the no treatment control period (2 to 3 weeks) and completion of chiropractic care (2 to 3 weeks).
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Secondary outcome [6]
446005
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Self-reported Current Neck Pain – Visual Analog Scale
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Assessment method [6]
446005
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Participants were asked to complete the neck pain visual analog scale questionnaire, to determine their level of neck pain, at the moment of administration, in the past week and in the past 3 to 6 months.
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Timepoint [6]
446005
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Measure was assessed at baseline, after the no treatment control period (2 to 3 weeks) and completion of chiropractic care (2 to 3 weeks).
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Secondary outcome [7]
446002
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Grip Strength
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Assessment method [7]
446002
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Hand grip strength will be measured via a portable force transducer, by squeezing a hand dynamometer (portable force transducer) as hard as they can. This is a primary outcome measure, to assess changes in the upper limb following treatment.
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Timepoint [7]
446002
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Measure was assessed at baseline, after the no treatment control period (2 to 3 weeks) and completion of chiropractic care (2 to 3 weeks).
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Secondary outcome [8]
446001
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Shoulder ROM
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Assessment method [8]
446001
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This was a primary outcome, to examine any change in mobility of the shoulder.
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Timepoint [8]
446001
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Measure was assessed at baseline, after the no treatment control period (2 to 3 weeks) and completion of chiropractic care (2 to 3 weeks).
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Secondary outcome [9]
446015
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Self-reported Sleep Quality
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Assessment method [9]
446015
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Participants were asked to complete the Insomnia Severity Index, which assessed the nature, severity, and impact of insomnia.
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Timepoint [9]
446015
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Measure will be assessed at baseline, after the no treatment control period (2 to 3 weeks) and completion of either chiropractic care (2 to 3 weeks).
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Secondary outcome [10]
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Self-reported Health Status
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Assessment method [10]
446016
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Participants will be asked to complete the 36-Item Short Form Health Survey(SF-36), which will provide information regarding their health.
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Timepoint [10]
446016
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Measure will be assessed at baseline, after the no treatment control period (2 to 3 weeks) and completion of either chiropractic care (2 to 3 weeks).
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Secondary outcome [11]
446019
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Adverse events in response to the OTZ treatment:
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Assessment method [11]
446019
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A report would be given to the researchers by the chiropractor, which will contain information on the number of participant(s) and what the adverse event(s) was/were.
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Timepoint [11]
446019
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Measure assessed following the completion of chiropractic care for the treatment group.
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Eligibility
Key inclusion criteria
Males and females aged 18 – 65 who experience any of the following symptoms and/or problems: recurrent neck problems; decreased shoulder range of motion; difficulty maintaining good posture, especially while sitting; unexplained whole-body stiffness that doesn’t benefi t from stretching. To be eligible for the study, participants are to have had these issues for at least 3 months and not started anytreatments in the past three weeks. These individuals were screened for the articular dysfunction at the C0-C1 joint complex by the treating chiropractor as this joint dysfunction is the inclusion criterion for theOTZ treatment.
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Minimum age
18
Years
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Maximum age
65
Years
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Sex
Both males and females
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Can healthy volunteers participate?
No
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Key exclusion criteria
Individuals with contraindications to chiropractic care such as fractures, tumors, infections,or recent head trauma will be excluded.
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Study design
Purpose of the study
Treatment
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Allocation to intervention
Non-randomised trial
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Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
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Methods used to generate the sequence in which subjects will be randomised (sequence generation)
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Masking / blinding
Open (masking not used)
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Who is / are masked / blinded?
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Intervention assignment
Single group
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Other design features
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Phase
Not Applicable
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Type of endpoint/s
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Statistical methods / analysis
Repeated measures ANOVA with partial eta squared to determine effect size for future RCTs.
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Recruitment
Recruitment status
Completed
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Date of first participant enrolment
Anticipated
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Actual
11/06/2018
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Date of last participant enrolment
Anticipated
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Actual
1/04/2019
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Date of last data collection
Anticipated
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Actual
27/05/2019
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Sample size
Target
22
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Accrual to date
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Final
22
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Recruitment outside Australia
Country [1]
26959
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Canada
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State/province [1]
26959
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Ontario
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Funding & Sponsors
Funding source category [1]
318696
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Government body
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Name [1]
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Mathematics of Information Technology and Complex Systems (MITACS)
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Address [1]
318696
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Country [1]
318696
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Canada
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Primary sponsor type
Individual
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Name
Bernadette Murphy-Ontario Tech University
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Address
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Country
Canada
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Secondary sponsor category [1]
321125
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Individual
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Name [1]
321125
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Paul Yielder-Ontario Tech University
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Address [1]
321125
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Country [1]
321125
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Canada
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Secondary sponsor category [2]
321126
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Individual
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Name [2]
321126
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Heidi Haavik-New Zealand College of Chiropractic
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Address [2]
321126
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Country [2]
321126
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Canada
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Ethics approval
Ethics application status
Approved
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Ethics committee name [1]
317305
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Ontario Tech University Research Ethics Board
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Ethics committee address [1]
317305
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Ontario Tech Research Ethics Board, 2000 Simcoe St North, Oshawa, Ontario, Canada L1G 0C5email
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Ethics committee country [1]
317305
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Canada
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Date submitted for ethics approval [1]
317305
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04/04/2018
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Approval date [1]
317305
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07/06/2018
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Ethics approval number [1]
317305
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14817
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Summary
Brief summary
The One-to-Zero (OTZ) System is a chiropractic technique which corrects problems with the upper neck joints located at the base of the skull. Originally OTZ was used to improve function and decrease pain in patients with a condition known as a frozen shoulder. As chiropractors trained in the OTZ technique have continued to use the technique, patients have reported improvements in many other areas of health and performance, including chronic pain, headaches, insomnia, balance, agility, hand-eye-coordination, anxiety, etc. The goal of this repeated measures work if to provide objective measures of motor control, proprioception and self-reported health outcome measures to determine effect sizes for future RCTs.
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Trial website
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Trial related presentations / publications
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Public notes
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Contacts
Principal investigator
Name
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Prof Bernadette Murphy
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Address
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Faculty of Health Sciences Ontario Tech University 2000 Simcoe St North, Oshawa, Ontario, L1G 0C5Canada
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Country
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Canada
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Phone
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+1 905 7218668
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Fax
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Email
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[email protected]
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Contact person for public queries
Name
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Bernadette Murphy
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Address
140635
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Faculty of Health Sciences Ontario Tech University 2000 Simcoe St North, Oshawa, Ontario, L1G 0C5Canada
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Country
140635
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Canada
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Phone
140635
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+1 905 7218668
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Fax
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Email
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[email protected]
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Contact person for scientific queries
Name
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Bernadette Murphy
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Address
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Faculty of Health Sciences Ontario Tech University 2000 Simcoe St North, Oshawa, Ontario, L1G 0C5Canada
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Country
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Canada
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Phone
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+1 905 7218668
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Fax
140636
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Email
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[email protected]
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Data sharing statement
Will the study consider sharing individual participant data?
No
No IPD sharing reason/comment:
as this was a feasibility study, we did not request permssion for this at the time of the original ethics application.
What supporting documents are/will be available?
No Supporting Document Provided
Results publications and other study-related documents
Documents added manually
No documents have been uploaded by study researchers.
Documents added automatically
No additional documents have been identified.
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