Acceptance-based telephone support around the time of transition to secondary progressive multiple sclerosis: A feasibility randomised controlled trial

Meek, Christopher; Moghaddam, Nima G.; Evangelou, Nikos; Oates, Lloyd L.; Topcu, Gogem; Allen, Christopher; das Nair, Roshan

Abstract

Introduction
Transitioning to secondary progressive multiple sclerosis (SPMS) is a difficult time for people, fraught with psychological uncertainty and an increase in physical disability. In parallel, healthcare appointments become less frequent, most disease modifying treatments are withdrawn, and social contacts typically become more difficult to maintain.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 support intervention during transition to SPMS is feasible, effective and valued by participants.

Method
A single centre, mixed-methods, two-arm feasibility randomised controlled trial (RCT), comparing (i) ACT-based support + treatment as usual to (ii) treatment as usual only was conducted for those who had transitioned to SPMS. 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.

Results
The recruitment strategy was not feasible: 14 of 40 were recruited (35%) during the four-month time period (Mage = 53, 10 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 a signal of efficacy between baseline and 8-week or 12-week follow up on measures, but wide confidence intervals preclude drawing strong conclusions. Positive interview feedback suggested outcomes not being captured through self-report measures.

Discussion
Due to an unsuccessful recruitment strategy and mixed evidence of efficacy, certain adjustments should be made to the intervention and methodology before progressing to a definitive trial. A more efficient recruitment strategy, or longer recruitment period is needed to recruit a large enough sample. Adapting the ACT intervention may be needed to ensure that it targets psychological flexibility, which could include changing the workbook or session delivery based on interview feedback, however the small sample size means we should interpret the efficacy findings with caution.

Citation

Meek, C., Moghaddam, N. G., Evangelou, N., Oates, L. L., Topcu, G., Allen, C., & das Nair, R. (2021). Acceptance-based telephone support around the time of transition to secondary progressive multiple sclerosis: A feasibility randomised controlled trial. Journal of Contextual Behavioral Science, 21, 158-170. https://doi.org/10.1016/j.jcbs.2021.07.001

• Journal Article Type: Article
• Acceptance Date: Jul 12, 2021
• Online Publication Date: Jul 15, 2021
• Publication Date: 2021-07
• Deposit Date: Jul 16, 2021
• Publicly Available Date: Jul 16, 2022
• Journal: Journal of Contextual Behavioral Science
• Print ISSN: 2212-1447
• Publisher: Elsevier
• Peer Reviewed: Peer Reviewed
• Volume: 21
• Pages: 158-170
• DOI: https://doi.org/10.1016/j.jcbs.2021.07.001
• Keywords: Behavioral Neuroscience; Organizational Behavior and Human Resource Management; Applied Psychology; Ecology, Evolution, Behavior and Systematics; Health(social science)
• Public URL: https://nottingham-repository.worktribe.com/output/5787259
• Publisher URL: https://www.sciencedirect.com/science/article/abs/pii/S221214472100065X