A feasibility randomised control trial of acceptance and commitment therapy for spinal cord stimulation surgery patients

Akiens, Samantha (2016) A feasibility randomised control trial of acceptance and commitment therapy for spinal cord stimulation surgery patients. DClinPsy thesis, University of Nottingham.

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Introduction: This thesis explored the feasibility of conducting a randomised control trial (RCT) of Acceptance and Commitment Therapy (ACT) within patient’s Spinal Cord Stimulation (SCS) treatment pathway. Previous ACT literature has reported that this is an effective intervention with persons with chronic pain, even when in a self-help format. Whilst this growing body of ACT literature is promising, chronic pain is a broad term used for a number and varying levels of disability. Chronic neuropathic pain (CNP) is usually more complex and resistant to treatment. According to NICE guidelines SCS should be the last treatment option for CNP sufferers. However, there is currently a dearth of literature exploring the effectiveness of the addition of a psychological interventions with the SCS population.

Objectives: The aim of this thesis was to explore the parameters of interest in ACT with SCS patient population including recruitment, acceptability of intervention and treatment signals.

Design: A mixed between-within group design with repeated measures. There were three conditions in the study.

Methods: Ethical and NHS trust approval was obtained. SCS participants were recruited from one Neuromodulation clinic during their routine appointment. Fourteen SCS patients that consented to the study were randomised to either SCS combined with an ACT self-help intervention (SCS-ACT) or SCS and treatment as usual (SCS-TAU). A third arm of the study was included to gain additional information on the ACT self-help intervention. This arm had been assessed for SCS surgery at the same neuromodulation clinic but deemed to be not suitable for the surgery. They were invited to the study via a letter from the clinic. All participants completed outcome measures pre and post-intervention.

The participants in the two ACT arms (SCS-ACT and ACT-only) were given an ACT self-help manual and received telephone support sessions over six consecutive weeks. These participants also completed an interview at the end of the intervention.

Results: Recruitment to the study was lower than expected and the majority of the participants in the ACT conditions (77%) did not complete the self-help manual. All the participants in the SCS-ACT condition had reliable improvement on at least two outcome domains, however, due to the small sample size it was not possible to assess whether these improvements were due to the SCS surgery or the ACT intervention. The interviews identified a number of barriers that prevented participants completing the manual.

Discussion: The study demonstrated that a number of amendments need to be made to the study design and the self-help manual before a full-scale RCT is justified. Therefore it is recommended that a number of alterations are implemented in another feasibility study to assess whether this improves recruitment, retention and outcomes.

Item Type: Thesis (University of Nottingham only) (DClinPsy)
Supervisors: das Nair, Roshan
Moghaddam, Nima
Basu, S.
Keywords: Spinal cord stimulation, Acceptance and commitment therapy, Chronic neuropathic pain, Feasibility study
Subjects: W Medicine and related subjects (NLM Classification) > WM Psychiatry
Faculties/Schools: UK Campuses > Faculty of Medicine and Health Sciences > School of Medicine
Item ID: 33681
Depositing User: Akiens, Samantha
Date Deposited: 02 Feb 2017 14:49
Last Modified: 21 Dec 2017 01:54
URI: https://eprints.nottingham.ac.uk/id/eprint/33681

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