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

Introduction: Transitioning to secondary progressive multiple sclerosis (SPMS) is a difficult time for people, fraught with 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 In parallel, healthcare appointments become less frequent, most disease modifying treatments are withdrawn, and social contacts typically become more difficult to maintain.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 (M-age = 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. Adaptations to 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.

Automated summary

Transitioning to secondary progressive multiple sclerosis (SPMS) is challenging for individuals, with changes in healthcare appointments, withdrawal of treatments, and difficulties in maintaining social contacts. This study aimed to assess the feasibility, effectiveness, and value of providing ACT-based telephone support during this transition. Results showed that while the recruitment strategy was not feasible, data collection procedures were acceptable and the intervention did not demonstrate efficacy based on self-report measures alone. Further adjustments are needed before progressing to a definitive trial.