Meek, Christopher
(2020)
Acceptance based telephone support around the time of transition to secondary progressive multiple sclerosis: a feasibility randomised controlled trial.
DClinPsy thesis, University of Nottingham.
Abstract
Introduction: Multiple Sclerosis (MS) is the most common neurological disease in young adults, and it contains different stages. Transitioning to Secondary Progressive Multiple Sclerosis (SPMS) is a difficult time for patients, fraught with psychological uncertainty and an increase in physical disability. In parallel, healthcare appointments become less frequent, disease modifying treatments are withdrawn, and social contacts typically become more difficult to maintain. The aim of this study was to assess whether providing a brief, Acceptance and Commitment Therapy (ACT) based telephone supported bibliotherapy intervention during transition to SPMS is feasible, effective and valued by participants. A separate questionnaire study was conducted as an adjunct to the project to determine the strength of relationship between psychological flexibility and distress in SPMS.
Method: A single centre, mixed-methods, two-arm feasibility randomised controlled trial (RCT), comparing (i) Acceptance Based Support + treatment as usual (TAU) to (ii) TAU for those who had transitioned to SPMS was conducted. Feasibility, signal of efficacy and acceptability were assessed in both groups by self-report measures at 3 timepoints (Baseline, 8 weeks, 12 weeks), and feedback interviews analysed using framework analysis following the completion of the study. The questionnaire study recruited participants through the MS Register, a large existing database of MS patients. Those with SPMS were invited to complete a single psychological flexibility questionnaire, which was paired with a previously completed anxiety/depression questionnaire to observe correlation direction and strength.
Results: The recruitment strategy was not feasible: 14 of 40 were recruited (35%) during the four-month time period. Mean sample age of 53, ten women. The data collection procedures and trial processes were feasible and acceptable to participants, reflected through all measures being completed, no attrition, and positive participant interview feedback. The intervention did not demonstrate efficacy, with no practically important differences between baseline and 8-week or 12-week follow up for anxiety (d = 0.00 [-1.60, 1.60]), depression (d = 0.00 [-1.60, 1.60]), or psychological flexibility (d = 0.42 [-1.20, 2.04]). The control group showed a significant reduction in anxiety at 12-week (d = 1.91, [-0.03, 3.83], p = .04), but not at 8-week but was due to one outlier. Comparisons between control and intervention groups showed no significant difference in anxiety (F = 3.21, p = .10), depression (F = 0.12, p = .89) or psychological flexibility (F = 0.36, p = .56) scores. Positive interview feedback suggested potential impact not being captured through self-report measures. The questionnaire study (n = 688) found psychological flexibility was negatively correlated with distress (r = -0.65), anxiety (r = -0.58) and depression (r = -0.56).
Discussion: A future trial with those transitioning to SPMS using a similar ACT-based telephone supported bibliotherapy intervention and this methodology is not feasible, due to an unsuccessful recruitment strategy and a lack of evidence of efficacy. A more efficient recruitment strategy, or longer recruitment period is needed to recruit a large enough sample. Adapting the ACT intervention is also needed to ensure that it targets psychological flexibility, which could include changing the workbook or session delivery. The questionnaire study finding that psychological flexibility is negatively correlated with distress provides justification for using a psychological flexibility focussed intervention, such as ACT in SPMS.
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