Acceptance and Commitment Therapy for Muscle Disease (ACTMuS)

• ClinicalTrials.gov Identifier: NCT02810028
• Recruitment Status: Completed
• First Posted: June 22, 2016
• Last Update Posted: August 22, 2019
• Sponsor: King's College Hospital NHS Trust
• Collaborators: King's College London; Barts & The London NHS Trust; Muscular Dystrophy Association; University Hospital Southampton NHS Foundation Trust
• Information provided by (Responsible Party): King's College Hospital NHS Trust

Study Description

Brief Summary:

In adults, muscle diseases are usually chronic long-term conditions that do not have a definitive cure. Supportive care has been shown to reduce complications from muscle disease and improved survival in some cases. However, there has been limited research to evaluate interventions that may improve quality of life (QoL) with this patient group. The QoL of those with MD is not just affected by the severity of their MD but also a variety of psychological variables. Based upon the knowledge of these psychological variables the investigators feel that a particular type of psychological intervention known as "acceptance and commitment therapy" (ACT) could potentially improve QoL in those with MD. The investigators therefore propose to test whether ACT does in fact improve QoL in those with MD by randomising 154 patients to receive either standard medical care plus a guided self-help ACT programme, or standard medical care only.

Condition or disease	Intervention/treatment	Phase
Muscle Diseases	Behavioral: Acceptance and Commitment Therapy (ACT)	Not Applicable

Detailed Description:

Previous research has shown that while QoL is determined by the severity of the MD, this does not explain all aspects of the reduced QoL of those with MD. Previous research suggested that a cognitive behavioural approach using Acceptance and Commitment Therapy (ACT) would best suit those with MD. A pilot study of this approach in seven participants with MD was promising, and has led to this definitive trial of ACT. The aim of this study is to determine the efficacy of an ACT intervention to improve the QoL of individuals with MD.

Patients with one of the following muscle diseases will be recruited: limb girdle muscular dystrophy, dystrophinopathies resulting in a Becker' muscular dystrophy phenotype, facioscapulohumeral muscular dystrophy and inclusion body myositis. Patients will be recruited primarily through muscle clinics at King's College Hospital (KCH) and The Royal London Hospital (RLH) but also via Muscular Dystrophy UK (MDUK) and UK registries of patients with these muscle diseases.

Study Design

• Study Type: Interventional (Clinical Trial)
• Actual Enrollment: 155 participants
• Allocation: Randomized
• Intervention Model: Parallel Assignment
• Masking: Single (Outcomes Assessor)
• Primary Purpose: Treatment
• Official Title: Acceptance and Commitment Therapy for Muscle Disease
• Study Start Date: July 2016
• Actual Primary Completion Date: April 2018
• Actual Study Completion Date: January 2019

Arms and Interventions

Arm	Intervention/treatment
Experimental: ACT + Standard Medical Care (SMC); This consists of 4 self-guided psycho-education modules supported by weekly telephone contact with a health professional trained in Acceptance and Commitment Therapy (ACT). Standard medical care will be provided as usual.	Behavioral: Acceptance and Commitment Therapy (ACT); Acceptance and Commitment Therapy (ACT) is a form of cognitive behavioural therapy focused explicitly on promoting psychological flexibility. An ACT programme suits the aims of the study because it targets avoidance of distress, promotes acceptance of illness through motivating meaningful activity outside of illness, improves the processes that underlie beliefs rather than by directly challenging beliefs, thus reducing possible trivialisation of the understandable distress caused by living with MD.
No Intervention: Standard Medical Care (SMC); All participants will receive SMC. As such, they will receive all the treatment and support they would otherwise receive outside of a research trial including a personalised assessment from the physiotherapist.

Outcome Measures

Primary Outcome Measures :

1. Individualised Neuromuscular Quality of Life Questionnaire (INQoL) - Life areas [ Time Frame: 9 weeks post randomisation ]
   Measures impact of MD on life areas: activities, independence, social functioning, emotional functioning and body image.

Secondary Outcome Measures :

1. Individualised Neuromuscular Quality of Life Questionnaire (INQoL) - Symptom impact domains [ Time Frame: 9 weeks post randomisation ]
   Measures the impact of key muscle disease symptoms: weakness, fatigue and pain.
2. Work and Social Adjustment Scale (WSAS) [ Time Frame: 9 weeks post randomisation ]
   Assesses how much symptoms interfere with participation in life i.e. work, home management, social, private and relationships.
3. Hospital Anxiety and Depression Scale (HADS) [ Time Frame: 9 weeks post randomisation ]
   Measures mood.
4. Stanford Health Assessment Questionnaire Disability Index (HAQ-DI) [ Time Frame: 9 weeks post randomisation ]
   Measures functional impairment.
5. Acceptance and Action Questionnaire (AAQ-II) [ Time Frame: 9 weeks post randomisation ]
   Measures psychological flexibility.
6. Mindfulness Attention Awareness Scale (MAAS) [ Time Frame: 9 weeks post randomisation ]
   Measures dispositional open awareness of and attention to the present moment.
7. Committed Action Scale (CAS) [ Time Frame: 9 weeks post randomisation ]
   Measures commitment towards goals.
8. IBM Functional Rating Scale [ Time Frame: 9 weeks post randomisation ]
   Assesses function in people with Inclusion Body Myositis.
9. Patient Global Impression of Change scale (PGIC) [ Time Frame: 9 weeks post randomisation ]
   Assesses patient's own impression of change during the course of the study.
10. Patient rating of treatment satisfaction [ Time Frame: 9 weeks post randomisation ]
    Measures patient's satisfaction with the treatment they have received.

Other Outcome Measures:

1. 6-minute timed walk test [ Time Frame: Baseline only ]
   Measures mobility.
2. Adult Ambulatory Neuromuscular Assessment (AANA) [ Time Frame: Baseline only ]
   An adult version of the North Star Ambulatory Assessment that measures motor function.
3. Manual Muscle Strength Testing (MMST) [ Time Frame: Baseline only ]
   Measures muscle strength.

Eligibility Criteria

• Ages Eligible for Study: 18 Years and older (Adult, Older Adult)
• Sexes Eligible for Study: All
• Accepts Healthy Volunteers: No

Criteria

Inclusion Criteria:

1. Diagnosed with one of four specific muscle diseases on the basis of diagnostic criteria:

   1. Limb girdle muscular dystrophy; symptomatic limb girdle muscular dystrophy genetically or pathologically proven
   2. Dystrophinopathies resulting in a Becker' muscular dystrophy phenotype (excluding Duchenne muscular dystrophy) with pathology or genetic diagnosis
   3. Facioscapulohumeral muscular dystrophy diagnosed clinically with specific genetic abnormality in the subject or their family
   4. Inclusion body myositis clinic-pathologically defined, clinically defined or probable IBM based on ENMC research diagnostic criteria 2013 (submitted)
2. duration of muscle disease greater than six months
3. over the age of 18 years
4. access to the internet and a computer on which they can receive the intervention materials
5. HADS scores > 8 for depression or >8 for anxiety

Exclusion Criteria:

1. Major active co-morbidities unrelated to muscle disease such as arthritis, respiratory disease, cardiovascular disease

2. Unstable complications of muscle disease including:

   1. neuromuscular respiratory weakness
   2. cardiomyopathy
3. Cognitive impairment that prevents comprehension of the questionnaires; assessed using the Montreal Cognitive Assessment
4. Unable to read English questionnaires
5. Major diagnosed active mental health co-morbidities e.g. psychosis, major depression, obsessive compulsive disorder, active suicide risk
6. Current or recent participation in other treatment intervention studies (< 4 weeks after completion)
7. Currently receiving psychological support or psychotherapy

Contacts and Locations

Locations

United Kingdom

King's College Hospital; The Royal London Hospital; University Hospital Southampton; King's College London

London, United Kingdom

Sponsors and Collaborators

King's College Hospital NHS Trust

King's College London

Barts & The London NHS Trust

Muscular Dystrophy Association

University Hospital Southampton NHS Foundation Trust

Investigators

• Principal Investigator: Michael Rose; King's College Hospital NHS Trust
• Principal Investigator: Trudie Chalder; King's College London
• Principal Investigator: Lance McCracken; King's College London
• Principal Investigator: Christopher Graham; University of Leeds
• Principal Investigator: Sam Norton; King's College London
• Principal Investigator: Aleksandar Radunovic; Barts & The London NHS Trust

More Information

Publications:

Graham CD, Gouick J, Krahe C, Gillanders D. A systematic review of the use of Acceptance and Commitment Therapy (ACT) in chronic disease and long-term conditions. Clin Psychol Rev. 2016 Jun;46:46-58. doi: 10.1016/j.cpr.2016.04.009. Epub 2016 Apr 20.

Graham CD, Gouick J, Ferreira N, Gillanders D. The influence of psychological flexibility on life satisfaction and mood in muscle disorders. Rehabil Psychol. 2016 May;61(2):210-7. doi: 10.1037/rep0000092.

Graham CD, Simmons Z, Stuart SR, Rose MR. The potential of psychological interventions to improve quality of life and mood in muscle disorders. Muscle Nerve. 2015 Jul;52(1):131-6. doi: 10.1002/mus.24487. Epub 2015 May 28.

Rose MR, Sadjadi R, Weinman J, Akhtar T, Pandya S, Kissel JT, Jackson CE; Muscle Study Group. Role of disease severity, illness perceptions, and mood on quality of life in muscle disease. Muscle Nerve. 2012 Sep;46(3):351-9. doi: 10.1002/mus.23320.

Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):

Rose M, Graham CD, O'Connell N, Vari C, Edwards V, Taylor E, McCracken LM, Radunovic A, Rakowicz W, Norton S, Chalder T. A randomised controlled trial of acceptance and commitment therapy for improving quality of life in people with muscle diseases. Psychol Med. 2022 Feb 23:1-14. doi: 10.1017/S0033291722000083. Online ahead of print.

Rose MR, Norton S, Vari C, Edwards V, McCracken L, Graham CD, Radunovic A, Chalder T. Acceptance and Commitment Therapy for Muscle Disease (ACTMus): protocol for a two-arm randomised controlled trial of a brief guided self-help ACT programme for improving quality of life in people with muscle diseases. BMJ Open. 2018 Oct 3;8(10):e022083. doi: 10.1136/bmjopen-2018-022083.

• Responsible Party: King's College Hospital NHS Trust
• ClinicalTrials.gov Identifier: NCT02810028
• Other Study ID Numbers: PB-PG-061331085
• First Posted: June 22, 2016
• Last Update Posted: August 22, 2019
• Last Verified: August 2019

Individual Participant Data (IPD) Sharing Statement:

• Plan to Share IPD: No

Keywords provided by King's College Hospital NHS Trust:

Limb girdle muscular dystrophy; Becker's muscular dystrophy; Facioscapulohumeral muscular dystrophy; Inclusion-body myositis; Acceptance and Commitment Therapy; ACT

Additional relevant MeSH terms:

Muscular Diseases; Musculoskeletal Diseases; Neuromuscular Diseases; Nervous System Diseases