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Trial registered on ANZCTR
Registration number
ACTRN12621001025820
Ethics application status
Approved
Date submitted
25/06/2021
Date registered
5/08/2021
Date last updated
15/02/2022
Date data sharing statement initially provided
5/08/2021
Date results provided
15/02/2022
Type of registration
Prospectively registered
Titles & IDs
Public title
Effects of Therapeutic Ultrasound on Breastmilk Composition
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Scientific title
Effects of therapeutic ultrasound on breastmilk composition of mothers who are 1-6 months post partum and exclusively breastfeeding
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Secondary ID [1]
304628
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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:
Inflammatory conditions of the lactating breast
322560
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Condition category
Condition code
Reproductive Health and Childbirth
320180
320180
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0
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Breast feeding
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Inflammatory and Immune System
320447
320447
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0
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Other inflammatory or immune system disorders
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Intervention/exposure
Study type
Interventional
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Description of intervention(s) / exposure
Therapeutic ultrasound:
Therapeutic ultrasound (Chattanooga, model: Intelect Advanced 2772MC, Austin, Texas, USA) will delivered by one of the researchers using a 5cm2 soundhead, with consistent, light pressured, overlapping and linear strokes for 10 minutes. It will be delivered closely adjacent to the nipple from a superolateral to inferomedial direction. Continuous ultrasound at 1MHz will be utilised and the median of the clinically used intensity within Australia of 1.8Wcm2 will be tested. The frequency of ultrasound therapy will be a single session only. The intervention session will be of approximately 30 minutes duration, consisting of the provision of 2 milk samples (pre and post ultrasound therapy) and a singular, 10 minute session of therapeutic ultrasound. Monitoring of adherence will not be required, as it is single session only.
Mothers interested in participating in the study will be screened for eligibility via a Qualtrics survey sent by email which will contain a link to the participation information document detailing the research and their potential role and informed consent will be gained. Data collection will occur in an enclosed room within a church building in Kewdale, Western Australia (WA).
A qualified physiotherapist, who has undergone undergraduate training in this modality and has had many hours of clinical experience using therapeutic ultrasound as a treatment modality, will deliver it to all participants.
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Intervention code [1]
320979
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Treatment: Other
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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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Protein concentration in breastmilk (g/L)
Instrument: Bradford protein assay
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Assessment method [1]
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Timepoint [1]
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Immediately pre intervention and immediately post intervention
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Secondary outcome [1]
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Fat concentration was calculated in %
Instrument: The creamotocrit method
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Assessment method [1]
397404
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Timepoint [1]
397404
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Immediately pre intervention and immediately post intervention.
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Secondary outcome [2]
397405
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Lactose concentration in breastmilk (g/L)
Instrument: enzymatic lactose assay
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Assessment method [2]
397405
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Timepoint [2]
397405
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Immediately pre intervention and immediately post intervention.
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Eligibility
Key inclusion criteria
English-speaking mothers aged over 18 whose infants are aged between 1-6 months, who are fully breastfeeding (i.e. not pumping more than twice a day).
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Minimum age
18
Years
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Maximum age
No limit
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Sex
Females
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Can healthy volunteers participate?
No
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Key exclusion criteria
Mothers who are mixed feeding (i.e. with formula or solids) or have a history and/or current inflammatory condition of the lactating breast will be excluded. Women who have a current pregnancy; known or suspected cancer; circulation problems; bleeding disorders; acute infection; disease of the nervous system; heart condition or cardiac pacemaker and any other electronic, metallic or breast implants will be excluded as they will be ineligible to receive therapeutic ultrasound.
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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
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Who is / are masked / blinded?
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Intervention assignment
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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
Power calculations were based on the primary outcome measure of breast milk protein concentration. Additionally, in comparison to lactose or fat, protein is more likely to be impacted by TUS due to denaturing of proteins. For a within factors repeated measures ANOVA, n=22 was required to detect an effect size f=0.35 (equivalent to a partial eta-squared of 0.11, based on a 10% change in protein from a mean of 12.6g/L with pooled SD = 1.8) within a single group over 2 timepoints (pre-post), with alpha=0.025 as per a non-inferiority study. Based on a 10% contingency, a sample of n=25 was estimated.
Generalised linear mixed models were used to analyse pre-post differences in breastmilk composition, after adjusting for lactation stage as determined by age of the baby and time since last feed from the right breast in minutes. Results were summarised using marginal means and 95% confidence intervals. Statistical analysis was completed using Stata I/C v16.0 (StataCorp, College Station, TX).
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Recruitment
Recruitment status
Completed
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Date of first participant enrolment
Anticipated
9/08/2021
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Actual
11/08/2021
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Date of last participant enrolment
Anticipated
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Actual
25/10/2021
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Date of last data collection
Anticipated
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Actual
28/10/2021
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Sample size
Target
25
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Accrual to date
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Final
26
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Recruitment in Australia
Recruitment state(s)
WA
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Funding & Sponsors
Funding source category [1]
308989
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University
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Name [1]
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Curtin University
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Address [1]
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Kent Street, Bentley, WA, 6102
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Country [1]
308989
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Australia
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Primary sponsor type
University
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Name
Curtin University
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Address
Curtin University. Kent Street, Bentley, WA, 6102
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Country
Australia
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Secondary sponsor category [1]
309926
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None
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Name [1]
309926
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Address [1]
309926
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Country [1]
309926
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Ethics approval
Ethics application status
Approved
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Ethics committee name [1]
308882
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Curtin University Human Research Ethics Committee
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Ethics committee address [1]
308882
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Curtin University. Kent Street, Bentley, WA, 6102
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Ethics committee country [1]
308882
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Australia
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Date submitted for ethics approval [1]
308882
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24/06/2021
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Approval date [1]
308882
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10/08/2021
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Ethics approval number [1]
308882
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HRE2021-0469
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Summary
Brief summary
Inflammatory conditions of the lactating breast (ICLB) can affect up to 33% of breastfeeding mothers in the early post-partum period and are associated with pain, redness, flu-like symptoms, and fever. Physiotherapy intervention has an important role in the treatment of ICLB, which most commonly includes therapeutic ultrasound (TUS). TUS can produce heat and other non-thermal effects through sound wave energy which may assist in resolution of ICLB by reducing inflammation, accelerating tissue healing, clearing blocked ducts and other antimicrobial properties. Breastmilk contains numerous important components that combine to create the optimal nutritional source for infants. The most abundant of these components include water (87%), lactose (7%), fat (4%) and protein (1%). As TUS generates heat in the lactating breast, there is concern from Physiotherapists providing TUS and the mothers receiving it, that breastmilk composition may be affected. This is a quasi-experimental study with pre-post measures taken in a single session. Mothers will provide hand expressed breast milk samples pre and post application of continuous therapeutic ultrasound at 1MHz and at the highest clinically used intensity within Australia of 2.2Wcm2. Protein (g/L), lactose (g/L) and fat (g/L) concentrations will be analysed from the milk samples collected before and after TUS. The primary hypothesis of this study is that protein, lactose and fat concentrations within breastmilk will not change significantly before and after the application of TUS to the breast.
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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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Dr Leanda McKenna
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Address
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Curtin University. Kent street, Bentley, WA, 6102
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Country
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Australia
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Phone
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+61 8 92663660
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Fax
112202
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Email
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[email protected]
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Contact person for public queries
Name
112203
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Leanda McKenna
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Address
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Curtin University. Kent street, Bentley, WA, 6102
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Country
112203
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Australia
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Phone
112203
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+61 8 92663660
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Fax
112203
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Email
112203
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[email protected]
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Contact person for scientific queries
Name
112204
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Leanda McKenna
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Address
112204
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Curtin University. Kent street, Bentley, WA, 6102
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Country
112204
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Australia
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Phone
112204
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+61 8 92663660
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Fax
112204
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Email
112204
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[email protected]
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Data sharing statement
Will individual participant data (IPD) for this trial be available (including data dictionaries)?
No
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No/undecided IPD sharing reason/comment
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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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