Trial Review

Technical difficulties have been reported by some users of the search function and is being investigated by technical staff. Thank you for your patience and apologies for any inconvenience caused.

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 information for consumers
Trial registered on ANZCTR


Registration number
ACTRN12623000775617p
Ethics application status
Not yet submitted
Date submitted
16/05/2023
Date registered
17/07/2023
Date last updated
17/07/2023
Date data sharing statement initially provided
17/07/2023
Type of registration
Prospectively registered

Titles & IDs
Public title
Changing Outcomes After Low Anterior resection (COALA) : Prehabilitative Pelvic Floor Muscle Training to reduce incidence of Low Anterior Resection Syndrome
Scientific title
COALA Trial: Changing Outcomes After Low Anterior resection in colorectal cancer by anal sphincter prehabilitation prior to reversal of ileostomy (COALA-1)
Secondary ID [1] 309668 0
Nil
Universal Trial Number (UTN)
Trial acronym
COALA-1
Linked study record

Health condition
Health condition(s) or problem(s) studied:
Rectal Cancer 330016 0
Low anterior Resection Syndrome 330017 0
Condition category
Condition code
Cancer 326926 326926 0 0
Bowel - Back passage (rectum) or large bowel (colon)
Physical Medicine / Rehabilitation 327538 327538 0 0
Physiotherapy

Intervention/exposure
Study type
Interventional
Description of intervention(s) / exposure
Pelvic floor muscle training will be delivered via 6 fortnightly, 1 hour, face to face one on one physiotherapy appointments over 12 weeks (at least 4 weeks before and at least 6 weeks after ileostomy closure following low anterior resection) using a standardised approach to each appointment to deliver an individualised treatment plan for each patient. Each session will consist of a targeted history to determine symptoms, education about lifestyle modifications, assessment of Pelvic floor muscles via anal palpation with/ or Transabdominal ultrasound (where available), education and review of exercises.
Patients will then be asked to perform exercises daily for 3 times per day and this will be logged in an exercise diary. The exercises and emphasis will be tailored to a patient's symptoms and ability.

An example of the exercises prescribed in would be as follows:
These exercises are a set prescription of repetitions
Initially, muscle identification exercises
- Position: Sitting forward in a chair, with knees and legs apart
- Exercise: Squeeze pelvic floor and identify pelvic floor lift
Rest 4 seconds, then repeat 3-4 times
This will be repeated 3 times/day

Then, an ongoing regime of this exercise will be prescribed as follows:
Exercise 1- Hold 5-10sec, rest5-10sec ( pending on patient's ability)/5reps increase to 10 reps/3xday
Exercise 2- Hold/Rest/ 10reps increase to 20 reps/3xday
Follow exercise 3, 4 and daily application as above

The duration of these exercises is variable as this depends on the repetitions rather than a specific time.
Intervention code [1] 326104 0
Treatment: Other
Intervention code [2] 326105 0
Rehabilitation
Comparator / control treatment
The control group will receive standard treatment following closure of loop ileostomy, which can include medical treatments, but must exclude the use of pelvic floor muscle training.
Control group
Active

Outcomes
Primary outcome [1] 334758 0
Incidence of low anterior resection syndrome via validated Low Anterior Resection Score (LARS) developed and validated by Emmertson et al in 2012

Emmertsen KJ, Laurberg S. Low anterior resection syndrome score: development and validation of a symptom-based scoring system for bowel dysfunction after low anterior resection for rectal cancer. Ann Surg. 2012 May;255(5):922-8. doi: 10.1097/SLA.0b013e31824f1c21. PMID: 22504191.
Timepoint [1] 334758 0
1, 6 and 12 months after closure of loop ileostomy
Secondary outcome [1] 421989 0
Quality of life via eQ5D score
Timepoint [1] 421989 0
1, 6 and 12 months after closure of loop ileostomy
Secondary outcome [2] 421990 0
Compliance with pelvic floor muscle training - assessed using exercise diary
Timepoint [2] 421990 0
1, 6 and 12 months after closure of loop ileostomy

Eligibility
Key inclusion criteria
The inclusion criteria for this study are:
Adults aged 18 years and older, AND
Have undergone a low anterior resection and received a diverting ileostomy, AND
Who will have their ileostomies reversed in 4-8 weeks' time, AND
High risk of major LARS as defined by POLARS score
Minimum age
18 Years
Maximum age
No limit
Sex
Both males and females
Can healthy volunteers participate?
No
Key exclusion criteria
Are unable to provide informed consent, OR
Are unable to perform the pelvic floor rehabilitation program

Study design
Purpose of the study
Prevention
Allocation to intervention
Randomised controlled trial
Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
POLARS score will be used to identify patients at risk of major LARS. From here, the investigator will input the patient into REDCap and obtain the allocation, subsequently informing the physiotherapist. The physiotherapist will then perform a baseline assessment using the modified Oxford scale, then determine the appropriate intervention and document this as an isolated note on the EMR.


Methods used to generate the sequence in which subjects will be randomised (sequence generation)
POLARS score will be used to identify patients at risk of major LARS.
Randomisation by minimisation will be performed using REDCap. Participants will be allocated with a 1:1 ratio to intervention and control groups. Participants will be stratified by: (i) country (Australia/UK), gender (male/female) and (iii) neoadjuvant chemoradiotherapy (yes/no).


POLARS score is a nomogram designed to predict post operative LARS score by Battersby et al in 2018.

Battersby NJ, Bouliotis G, Emmertsen KJ, Juul T, Glynne-Jones R, Branagan G, Christensen P, Laurberg S, Moran BJ; UK and Danish LARS Study Groups. Development and external validation of a nomogram and online tool to predict bowel dysfunction following restorative rectal cancer resection: the POLARS score. Gut. 2018 Apr;67(4):688-696. doi: 10.1136/gutjnl-2016-312695. Epub 2017 Jan 23. PMID: 28115491.
Masking / blinding
Blinded (masking used)
Who is / are masked / blinded?


The people assessing the outcomes
The people analysing the results/data
Intervention assignment
Parallel
Other design features
Phase
Not Applicable
Type of endpoint/s
Efficacy
Statistical methods / analysis
Categorical data will be expressed as frequency (percentage). Univariate and multivariate categorical variables will be compared using the Chi-square test and logistic regression, respectively. Continuous variables will be expressed as mean (standard deviation) and median (interquartile range) depending on the normality. Normality will be assessed using the D’Agostino-Pearson test. Parametric and non-parametric continuous variables will be compared using the Student’s T-test and Mann-Whitney U-test, respectively. Participants will be compared over time using the Paired Student’s T-test for parametric data and the Wilcoxon Signed Rank test for non-parametric data. Subgroup analyses will be performed for risk groups, gender, neoadjuvant therapy and country of recruitment. P-values <0.05 are considered statistically significant. Statistical analysis will be performed using GraphPad Prism v9.0 (GraphPad Software Inc., San Diego, CA, USA) and StataBE v17.0 (StataCorp, College Station, TX, USA).
Missing data (provided data are ‘missing completely at random’), will be addressed by performing primary analysis with only observed outcomes (complete case analysis). Loss to follow-up will be addressed by intention-to-treat analysis with simple mean/median imputation.
The free-text responses in the acceptability intervention survey will be thematically analysed using NVivo V.10. Data will be presented as a combination of themes and direct quotations (of non-identifying data) only.

Recruitment
Recruitment status
Not yet recruiting
Date of first participant enrolment
Anticipated
28/08/2023
Actual
Date of last participant enrolment
Anticipated
25/11/2024
Actual
Date of last data collection
Anticipated
25/11/2025
Actual
Sample size
Target
554
Accrual to date
Final
Recruitment in Australia
Recruitment state(s)
ACT,NSW,NT,QLD,SA,TAS,WA,VIC
Recruitment hospital [1] 24740 0
Austin Health - Austin Hospital - Heidelberg
Recruitment hospital [2] 24741 0
Austin Health - Heidelberg Repatriation Hospital - Heidelberg West
Recruitment hospital [3] 24742 0
Warringal Private Hospital - Heidelberg
Recruitment hospital [4] 24743 0
The Alfred - Melbourne
Recruitment hospital [5] 24744 0
Eastern Health - Box Hill
Recruitment hospital [6] 24745 0
Epworth Cliveden - Melbourne East
Recruitment hospital [7] 24746 0
Peter MacCallum Cancer Centre - Melbourne
Recruitment hospital [8] 24747 0
Melbourne Private Hospital - Parkville
Recruitment hospital [9] 24748 0
Royal Melbourne Hospital - City campus - Parkville
Recruitment hospital [10] 24749 0
Royal Hobart Hospital - Hobart
Recruitment hospital [11] 24750 0
The Royal Adelaide Hospital - Adelaide
Recruitment hospital [12] 24751 0
Knox Private Hospital - Wantirna
Recruitment hospital [13] 24752 0
The Northern Hospital - Epping
Recruitment hospital [14] 24753 0
Sir Charles Gairdner Hospital - Nedlands
Recruitment hospital [15] 24754 0
St George's Health Service - Kew
Recruitment hospital [16] 24755 0
Royal North Shore Hospital - St Leonards
Recruitment postcode(s) [1] 40382 0
2065 - St Leonards
Recruitment postcode(s) [2] 40374 0
3002 - Melbourne East
Recruitment postcode(s) [3] 40372 0
3004 - Melbourne
Recruitment postcode(s) [4] 40375 0
3052 - Parkville
Recruitment postcode(s) [5] 40379 0
3076 - Epping
Recruitment postcode(s) [6] 40371 0
3081 - Heidelberg West
Recruitment postcode(s) [7] 40370 0
3084 - Heidelberg
Recruitment postcode(s) [8] 40381 0
3101 - Kew
Recruitment postcode(s) [9] 40373 0
3128 - Box Hill
Recruitment postcode(s) [10] 40378 0
3152 - Wantirna
Recruitment postcode(s) [11] 40377 0
5000 - Adelaide
Recruitment postcode(s) [12] 40380 0
6009 - Nedlands
Recruitment postcode(s) [13] 40376 0
7000 - Hobart
Recruitment outside Australia
Country [1] 25537 0
United Kingdom
State/province [1] 25537 0
London

Funding & Sponsors
Funding source category [1] 313861 0
Other
Name [1] 313861 0
Austin Health
Country [1] 313861 0
Australia
Primary sponsor type
Hospital
Name
Austin Health
Address
145 Studley Road
3084 Heidelberg
Melbourne, Victoria
Australia
Country
Australia
Secondary sponsor category [1] 315699 0
None
Name [1] 315699 0
Address [1] 315699 0
Country [1] 315699 0

Ethics approval
Ethics application status
Not yet submitted
Ethics committee name [1] 313008 0
Austin Health Human Research Ethics Committee
Ethics committee address [1] 313008 0
145 Studley Road
3084 Heidelberg
Melbourne, Victoria
Ethics committee country [1] 313008 0
Australia
Date submitted for ethics approval [1] 313008 0
21/08/2023
Approval date [1] 313008 0
Ethics approval number [1] 313008 0

Summary
Brief summary
Colorectal cancer is the third most common cancer globally, with rectal cancer accounting for over a third of colorectal cancer diagnoses and deaths. A common treatment for rectal cancer is surgery.
While many patients who have undergone a low anterior resection report good outcomes, patients often experience a variety of disruptive bowel symptoms and poor bowel control following surgery. These symptoms can include painful bowel motions, diarrhoea and involuntary loss of stool and is collectively termed low anterior resection syndrome. One treatment for this condition is pelvic floor muscle training. This involves patients doing pelvic floor exercises aimed at improving the function of the pelvic floor and therefore reducing the symptoms of the condition. While this has proven to improve symptoms, there is limited research into the preventative role of pelvic floor muscle training on low anterior resection syndrome. Therefore, we aim to assess if pelvic floor muscle training can be used to prevent low anterior resection syndrome and improve quality of life.
This study aims to assess if pelvic floor muscle training can be used to prevent low anterior resection syndrome following surgical treatment of colorectal cancer, and improve quality of life for patients.

Who is it for?
You may be eligible for this study if you are an adult colorectal cancer patient who has undergone a low anterior resection and received a diverting ileostomy, and are now waiting for an ileostomy reversal.

Study details
Participants located at centres that have resources to provide a physiotherapy-based intervention will be randomly assigned to one of two groups: pelvic floor muscle training or standard care. Participants in the pelvic floor muscle training group will perform pelvic floor exercises until six weeks after their ileostomy reversal. Standard care will not involve any pelvic floor muscle training.

All participants will be asked to complete questionnaires at several timepoints following their ileostomy reversal regarding bowel function and quality of life.

Information from this study will help inform clinical practice regarding optimisation of surgical treatment for colorectal cancer patients.
Trial website
Trial related presentations / publications
Public notes

Contacts
Principal investigator
Name 126666 0
Dr Helen Mohan
Address 126666 0
Austin Health
145 Studley Road
3084 Heidelberg
Melbourne, Victoria
Country 126666 0
Australia
Phone 126666 0
+61411101743
Fax 126666 0
Email 126666 0
helen.mohan@austin.org.au
Contact person for public queries
Name 126667 0
Dr Hwa Ian Ong
Address 126667 0
Austin Health
145 Studley Road
3084 Heidelberg
Melbourne, Victoria
Country 126667 0
Australia
Phone 126667 0
+61 394965000
Fax 126667 0
Email 126667 0
ian.ong@austin.org.au
Contact person for scientific queries
Name 126668 0
Dr Hwa Ian Ong
Address 126668 0
Austin Health
145 Studley Road
3084 Heidelberg
Melbourne, Victoria
Country 126668 0
Australia
Phone 126668 0
+61 394965000
Fax 126668 0
Email 126668 0
ian.ong@austin.org.au

Data sharing statement
Will individual participant data (IPD) for this trial be available (including data dictionaries)?
Yes
What data in particular will be shared?
Deidentified patient data will be shared, including baseline characteristics and outcome scores
When will data be available (start and end dates)?
Data will be available upon completion of the study, anticipated Nov 2025 and it will be available for 5 years after publication.
Available to whom?
This will be assessed on a case by case basis with advice from the local Ethics committee
Available for what types of analyses?
Meta-analyses and systematic reviews
How or where can data be obtained?
Access will be subject to approval by principal investigator, who can be contacted through email address helen.mohan@austin.org.au


What supporting documents are/will be available?

Doc. No.TypeCitationLinkEmailOther DetailsAttachment
19175Study protocol    To be published
19176Informed consent form    Will be uploaded once it has been approved through... [More Details]
19177Clinical study report    To be published
19178Ethical approval    Will be uploaded once obtained



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.