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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 endorsed by the ANZCTR. Before participating in a study, talk to your health care provider and refer to this
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Trial registered on ANZCTR
Registration number
ACTRN12622000628741
Ethics application status
Approved
Date submitted
11/08/2021
Date registered
28/04/2022
Date last updated
28/04/2022
Date data sharing statement initially provided
28/04/2022
Date results provided
28/04/2022
Type of registration
Retrospectively registered
Titles & IDs
Public title
Can a community based supervised exercise programme on hospice patients with end stage Chronic Obstructive Pulmonary Disease improve physical performance, quality of life and physical activity? A pilot study
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Scientific title
The impact of a community-based supervised exercise programme on hospice patients with end stage Chronic Obstructive Pulmonary Disease on physical performance, quality of life and physical activity; a pilot study
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Secondary ID [1]
305018
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None
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Universal Trial Number (UTN)
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Trial acronym
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Linked study record
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Health condition
Health condition(s) or problem(s) studied:
end stage chronic obstructive pulmonary disease
323189
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palliative care
323190
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Condition category
Condition code
Respiratory
320772
320772
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0
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Chronic obstructive pulmonary disease
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Physical Medicine / Rehabilitation
320773
320773
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0
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Physiotherapy
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Intervention/exposure
Study type
Observational
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Patient registry
False
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Target follow-up duration
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Target follow-up type
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Description of intervention(s) / exposure
Study participants are recruited from Assisi Hospice Day Care Centre. A routine activity at the Day Care Centre daily is an individualised exercise session. Study participants will have received exercise sessions regardless of their participation in the study. The additional activities imposed by the study and outside of routine care are a 6-minute walk test, a 5-times Sit-to-Stand Test, a St.George's Respiratory questionnaire and collection of physical activity and sitting time data through a physical activity monitor, ActivPal. These tests will take 1 hour at every observation session and performed at recruitment, and 1,3 and 6 months post-recruitment. Assisi Hospice physiotherapist (who is part of the research team) and other research team members will perform these physical tests, questionnaire and ActivPal application on the participants.
The individualised exercises are prescribed and supervised by the physiotherapists and conducted by therapy assistants face-to-face at Assisi Hospice Day Care Centre. These exercise sessions run in tandem with other activities at the day care centre. Participants can attend the day care centre for up to five days based on their attendance at the day care. The exercise session is performed only once daily and the time of exercise is dependent of every patient's day care routine. The duration of each exercise session is between 45-60 minutes with rest breaks in between modalities. Exercise intensity is tailored to each participant’s tolerance at moderate intensity level equivalent to a Borg dyspnoea scale of 3-4/10 and comprise primarily of strengthening and cardiovascular exercises. Exercise prescribed can include pneumatic weights strength training, upper limb, lower limb ergometry or lower limb stepper exercises and group exercises using resistance bands or free weights. The exercises are delivered in a group setting of 4 patients.
Whilst in the study, their participation rate of exercise session at day care center is measured monthly by audit of session attendance. Adverse events will be defined as counts of hospitalisation or death as a result of exercise and severe acute desaturation requiring high level of oxygenation to reverse the hypoxia. Medical follow up with the covering daycare physician will also be arranged if patient is still unwell despite initial measures and falls during exercise.
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Intervention code [1]
321422
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Diagnosis / Prognosis
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Comparator / control treatment
No control group
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Control group
Uncontrolled
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Outcomes
Primary outcome [1]
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Time taken to complete 5-times Sit-to-Stand using a stopwatch
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Assessment method [1]
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Timepoint [1]
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Baseline (0 month) at recruitment, 1 month, 3 month, 6 month post-recruitment
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Primary outcome [2]
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1) Distance walked measured by laps around a 25-metre circular track
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Assessment method [2]
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Timepoint [2]
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Baseline (0 month) at recruitment, 1 month, 3 month, 6 month post-recruitment
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Primary outcome [3]
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Quality of life measured by St.George's Respiratory Questionnaire
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Assessment method [3]
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Timepoint [3]
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Baseline (0 month) at recruitment, 1 month, 3 month, 6 month post-recruitment
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Secondary outcome [1]
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Physical activity levels - daily step count measured using ActivPal activity monitor
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Assessment method [1]
399563
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Timepoint [1]
399563
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Baseline (0 month) at recruitment, 3 month, 6 month post-recruitment
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Secondary outcome [2]
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Physical activity levels - number of postural changes from sit to stand, measured using ActivPal activity monitor
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Assessment method [2]
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Timepoint [2]
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Baseline (0 month) at recruitment, 3 month, 6 month post-recruitment
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Secondary outcome [3]
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Number of adverse events Composite outcomes: Advers events due to hospitalisations caused by exercise and/or physical tests, or severe acute desaturation requiring high level of oxygenation to reverse the hypoxia, Hospitalisations due to adverse events are measured by the number of admissions from the outpatient daycare centre into inpatient hospice or by accessing patient electronic medical record.
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Assessment method [3]
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Timepoint [3]
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Monitored continuously from time of enrolment to 6 months of post-enrolment.
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Secondary outcome [4]
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Participation rate in the exercise program measured by audit of session attendance
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Assessment method [4]
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Timepoint [4]
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Monitored monthly from time of enrolment to 6 months post-enrolment
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Secondary outcome [5]
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Physical activity levels - composite measure: time spent in active movements and time spent sitting, measured using ActivPal activity monitor
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Assessment method [5]
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Timepoint [5]
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Baseline (0 month) at recruitment, 3 month, 6 month post-recruitment
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Secondary outcome [6]
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Time walked before the first rest, time taken to reach nadir saturation, and time taken for vitals to recover from the Six-minute walk test, using a stopwatch
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Assessment method [6]
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Timepoint [6]
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Baseline (0 month) at recruitment, 1 month, 3 month, 6 month post-recruitment
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Eligibility
Key inclusion criteria
1. Stage 3 and 4, Group D patients with chronic obstructive pulmonary disease (COPD)
2. Currently undergoing supervised exercise program in the center
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Minimum age
55
Years
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Maximum age
No limit
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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
1. Cognitively impaired (Abbreviated Mental Test less than 7/10)
2. Orthopedic condition that does not allow exercise testing
3. Any absolute contraindications to exercise testing
4. Cannot comprehend English/Mandarin
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Study design
Purpose
Natural history
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Duration
Longitudinal
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Selection
Defined population
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Timing
Prospective
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Statistical methods / analysis
A repeated measures ANOVA (if data is normally distributed) or a Friedman test (if data is non-parametric) will be used to measure changes in STS, 6MWT and SGRQ between multiple time-points (baseline, 1-month, 3-month and 6-month) and changes in sitting time, time spent in active movement and step counts between baseline, 3-month and 6-month timepoints. Pearson’s correlation will be used to measure relationships between outcomes. Level of significance is set at p<0.05.
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Recruitment
Recruitment status
Stopped early
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Data analysis
Data collected is being analysed
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Reason for early stopping/withdrawal
Lack of funding/staff/facilities
Participant recruitment difficulties
Other reasons/comments
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Other reasons
Surge in Omicron-variant covid cases have limited new referrals into hospice day care. Ethics is due in April 2022 and the recruitment site is not keen to continue as referral of patient population to be studied since September 2021 was zero.
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Date of first participant enrolment
Anticipated
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Actual
26/07/2021
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Date of last participant enrolment
Anticipated
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Actual
2/08/2021
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Date of last data collection
Anticipated
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Actual
22/02/2022
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Sample size
Target
10
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Accrual to date
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Final
6
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Recruitment outside Australia
Country [1]
24038
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Singapore
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State/province [1]
24038
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Funding & Sponsors
Funding source category [1]
309414
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Self funded/Unfunded
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Name [1]
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NA
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Address [1]
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NA
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Country [1]
309414
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Primary sponsor type
University
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Name
Singapore Institute of Technology
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Address
10 Dover Road, S138683
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Country
Singapore
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Secondary sponsor category [1]
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None
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Name [1]
312182
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Address [1]
312182
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Country [1]
312182
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Ethics approval
Ethics application status
Approved
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Ethics committee name [1]
309212
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Agency of Integrated Care (AIC) Institutional Review Board
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Ethics committee address [1]
309212
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5 Maxwell Road, #10-00 Tower Block MND Complex, S069110, Singapore
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Ethics committee country [1]
309212
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Singapore
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Date submitted for ethics approval [1]
309212
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Approval date [1]
309212
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14/04/2021
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Ethics approval number [1]
309212
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2020-010
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Ethics committee name [2]
309217
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Singapore Institute of Technology (SIT) Institutional Review Board
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Ethics committee address [2]
309217
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10 Dover Road, Singapore 138683
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Ethics committee country [2]
309217
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Singapore
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Date submitted for ethics approval [2]
309217
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Approval date [2]
309217
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28/04/2021
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Ethics approval number [2]
309217
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2021097
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Summary
Brief summary
Patients with end stage pulmonary disease experience a prolonged functional decline associated with a heavy symptom load, emotional distress and social isolation prior to their death. Community palliative care has been evolving to meet the needs of these patients and is a nascent approach in the care spectrum in Singapore. This study aims to understand the impact of a community based supervised exercise programme on the exercise capacity, physical activity levels as well as patient reported quality of life of palliative patients with end stage Chronic Obstructive Pulmonary Disease (COPD) within a 6-month period. Current Assisi Hospice day care patients who have been diagnosed with Stage 3 or 4, GOLD D COPD and currently undergoing a supervised exercise programme prescribed by a physiotherapist will be recruited into this study. The 5-time sit to stand (STS) , 6-minute walk test (6MWT) and St George Respiratory Questionnaire (SGRQ) will be measured at the start of the study and at the timepoints of 1 month, 3 months and 6 months to evaluate changes in lower limb muscle strength, exercise capacity and self-reported quality of life for each participant, respectively. The participant’s physical activity levels (PAL) based on their active/sedentary times and number of steps taken per day will also be measured at the start of the study, and then remeasured again at 3 months and 6 months to understand the participant’s activity levels as a result of the supervised exercise programme. PAL are measured by the activity monitor, ActivPal, placed on the front of the right thigh. As there is a possibility of a floor effect in these patients, other parameters during the 5 time STS and 6MWT will be also be collected. This includes the time walked to first stop/termination of test, time taken to reach nadir saturation, as well as the time required for the patient’s vital signs to recover will also be recorded. Adverse events and participation rate in exercise programmes will also be tracked. We hypothesise that there is no significant nor clinical important change in 6MWT distance, but significant improvements in time to first rest, time taken to reach nadir saturation and time required for vitals recovery will be observed at 3-month and 6-month timepoints. Significant improvements may be seen in quality of life and sit-to-stand time at 6-month. There will be significant reductions in sitting time at 6-month.
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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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A/Prof Rahizan Zainuldin
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Address
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Health and Social Sciences Cluster Singapore Institution of Technology 10 Dover Road Singapore 138683
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Country
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Singapore
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Phone
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+65 65924603
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Fax
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Email
113362
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[email protected]
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Contact person for public queries
Name
113363
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Rahizan Zainuldin
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Address
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Health and Social Sciences Cluster Singapore Institution of Technology 10 Dover Road Singapore 138683
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Country
113363
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Singapore
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Phone
113363
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+65 65924603
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Fax
113363
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Email
113363
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[email protected]
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Contact person for scientific queries
Name
113364
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Rahizan Zainuldin
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Address
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Health and Social Sciences Cluster Singapore Institution of Technology 10 Dover Road Singapore 138683
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Country
113364
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Singapore
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Phone
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+65 65924603
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Fax
113364
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Email
113364
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[email protected]
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Data sharing statement
Will the study consider sharing individual participant data?
Yes
Will there be any conditions when requesting access to individual participant data?
Persons/groups eligible to request access:
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Only researchers on a reasonable request and on case-by-case basis by Principal Investigator
Conditions for requesting access:
•
-
What individual participant data might be shared?
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Individual participant data underlying published results only
What types of analyses could be done with individual participant data?
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For IPD meta-analyses and for achieving the aims of the proposal at request
When can requests for individual participant data be made (start and end dates)?
From:
Immediately after publication and ending 3 years after publication.
To:
-
Where can requests to access individual participant data be made, or data be obtained directly?
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Access subject to approval by Principal Investigator, Rahizan Zainuldin through
[email protected]
Are there extra considerations when requesting access to individual participant data?
No
What supporting documents are/will be available?
No Supporting Document Provided
Results publications and other study-related documents
Documents added manually
Type
Is Peer Reviewed?
DOI
Citations or Other Details
Attachment
Basic results
No
Basic results summary.docx
Documents added automatically
No additional documents have been identified.
Download to PDF