Online Remote Behavioural Intervention for Tics (ORBIT)
Condition: Tic Disorders; Tourette Syndrome
MeSH terms: Tourette Syndrome; Tics; Tic Disorders; Syndrome
Study type: Interventional

Summary: 
      Online Remote Behavioural Intervention for Tics (ORBIT).

      Primary objective: to evaluate the clinical effectiveness of BiP Tic, a therapist-guided,
      parent-assisted, internet-based behavioural therapy intervention for tics in young people,
      compared with usual care plus online education.

      Secondary objectives include 1) optimising the design of the intervention, 2) undertaking an
      internal pilot, 3) evaluating cost effectiveness and 4) longer term impact, and 5)
      identifying barriers to implementation.
    

Detailed description: 
      The ORBIT (Online Remote Behavioural Intervention for Tics) trial is comparing the
      effectiveness of two treatments delivered online for children and young people with Tourette
      Syndrome or Chronic Tic Disorder. Families in England with a child/young person (aged 9-17
      years) who experiences tics are being asked to take part. Interested families undergo a
      telephone screen with a researcher and then asked to complete an online questionnaire. They
      then attend a screening appointment at either Great Ormond Street Hospital (London) or
      Queen's Medical Centre (Nottingham).

      Families that are eligible and want to take part are randomly allocated to one of two
      treatments. One treatment uses behavioural therapy (BT), the other involves psychoeducation.
      Both treatments last for 10-weeks and involve completing online chapters (for the parent and
      child) with the support of a therapist, there are also some tasks to complete offline. After
      finishing the treatment, families are asked to complete more questionnaires (at 3, 6, 12 and
      18 months after starting the treatment). A smaller sample of families and healthcare
      professionals are also interviewed about their experience of participation. The study is
      looking to see if the online delivered treatment may be effective at helping children and
      young people manage their tics. The study is also exploring whether the online programme is
      acceptable to families, identifying any problems in getting families to take part/complete
      the programme and also healthcare professionals' views about the programme. It is important
      to research online therapy for tics because, at the moment, many people with tics do not get
      any therapy because there are not enough trained tic therapists. If online delivered
      treatment is effective, this may mean more children and young people could access tic
      therapy.
    

Intervention name(s): Exposure Response Prevention for tics; Psychoeducation for tics
Intervention type(s): Behavioral; Other
Intervention description(s): The intervention consists of evidence-based interventions adapted from previously published treatment manuals on Exposure and Response Prevention (ERP) and established behavioural intervention for tics protocols. Each of the 10 modules includes age-appropriate texts, animations and exercises. Prticipants are instructed to practice suppressing their tics, this is known as 'response prevention'. Then, with the help of their parent/carer, the participant is instructed to provoke premonitory urges (the urge to tic often felt before the tic is expressed) and try to supress the need to express/demonstrate the tic, this known as 'exposure'.; The comparator intervention reviews the definition of tics, natural history, common presentations, prevalence, aetiology, risks and protective factors and strategies for describing tics to other people etc. Problem-solving and development of expertise in tic disorders is emphasised. The intervention includes strategies for promoting positive behaviours which will be rewarded by a parent as a parallel element to the tic control practice in the behavioural therapy arm. There is no information on tic control within the management package.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Investigator, Outcomes Assessor)
Primary purpose: Treatment
Keywords: Tic disorders; Tourette Syndrome; Online delivered therapy