Title: A Pilot Study to Assess the Feasibility of a Web-based Intervention for Prevention of Relapse in Bipolar Disorder (ERP-Online).
Funder: Department of Health (England)

Abstract: ??Relapse in BD is associated with high personal and societal costs (4,5). NICE recommend psychosocial interventions (PSI) focusing on management of early warning signs (EWS) of relapse (6), as they have been shown to reduce hospitalisation and improve functioning (7). However barriers to delivery, including a lack of clinically trained staff, means that most people who would benefit from this approach do not receive it. Barriers are greater in rural areas where face to face contact is most limited. A web-based relapse prevention resource would allow Trusts in all geographical areas to deliver PSI for individuals with BD to help reduce relapse rates and therefore reduce costs. This study aims to assess the feasibility of a web-based approach to delivering a brief relapse prevention intervention for BD in order to improve accessibility. The web intervention is based on an existing face-to-face protocolized intervention called Enhanced Relapse Prevention (ERP). ERP was developed by members of our team and has been shown to improve outcome for people with BD (3). Pilot work suggests that dissemination may be improved by offering this intervention online. Phase 1 aims to translate ERP into a web-based format (ERP online) that is acceptable to SUs. Phase 2 aims to to assess the feasibility of the remote access research design using a pilot RCT and to explore the acceptability and accessibility of ERP online using qualitative and quantitative methods. Potential benefits and the value of these benefits for SUs will also be assessed to inform outcome measures in a definitive trial. Phase 3 aims to develop a dissemination strategy for effective web-based interventions that will ensure maximum awareness of the intervention in all stakeholder groups. This strategy will facilitate the transition of ERP online from research into practice following a definitive trial and will have wider implications in the dissemination of other current and future web-based interventions for mental health problems In order to achieve these aims, ERP will be translated into a web-based format in collaboration with a service user and carer reference group (SRG). Individuals with BD will be recruited from primary and secondary NHS services, voluntary sector organisations or may self refer into the study and will be randomly allocated to receive access to ERP online alongside their current treatment or to continue to receive current treatment only. Baseline and follow-up measures will be delivered online or via telephone over a 48-week period. Mood will be assessed using 12-weekly blind rated SCID LIFE telephone assessments. A range of other outcomes will be measured using baseline and 24-weekly follow-up assessments. Current treatment will be measured to define the waitlist control group and to explore the current accessibility of relapse prevention interventions to identify the potential for ERP online to improve access. Acceptability will be explored using frequency and pattern of use, qualitative interviews with a subsample of participants and feedback from the SRG. A dissemination strategy will be developed through consultation with experts in web-marketing, key representatives from national health websites, frontline clinical staff and service users. This research will address key questions to strengthen the design of a definitive trial of ERP online, which has potential to be empowering for SU by encouraging a more active role in the management of their BD in line with DoH priorities (8,9). If successful, ERP online will improve frontline NHS care by producing an evidence-based relapse prevention intervention in an easily accessible format, via a website. ERP online has potential to be cost effective and easily integrated into NHS services nationwide as it is consistent with current government priorities (5) and requires far less resources than face-to-face interventions.


Research activity codes: 7.1 INDIVIDUAL CARE NEEDS
Health categories: MENTAL HEALTH