Acceptance and Commitment Therapy for Muscle Disease

Study Overview
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Brief Summary
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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.

Detailed Description
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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.

Official Title
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Acceptance and Commitment Therapy for Muscle Disease

Conditions
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Muscle Diseases

Intervention / Treatment
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* Behavioral: Acceptance and Commitment Therapy (ACT)


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Diagnosed with one of four specific muscle diseases on the basis of diagnostic criteria: Limb girdle muscular dystrophy; symptomatic limb girdle muscular dystrophy genetically or pathologically proven Dystrophinopathies resulting in a Becker' muscular dystrophy phenotype (excluding Duchenne muscular dystrophy) with pathology or genetic diagnosis Facioscapulohumeral muscular dystrophy diagnosed clinically with specific genetic abnormality in the subject or their family Inclusion body myositis clinic-pathologically defined, clinically defined or probable IBM based on ENMC research diagnostic criteria 2013 (submitted) duration of muscle disease greater than six months over the age of 18 years access to the internet and a computer on which they can receive the intervention materials HADS scores > 8 for depression or >8 for anxiety Exclusion Criteria: Major active co-morbidities unrelated to muscle disease such as arthritis, respiratory disease, cardiovascular disease Unstable complications of muscle disease including: neuromuscular respiratory weakness cardiomyopathy Cognitive impairment that prevents comprehension of the questionnaires; assessed using the Montreal Cognitive Assessment Unable to read English questionnaires Major diagnosed active mental health co-morbidities e.g. psychosis, major depression, obsessive compulsive disorder, active suicide risk Current or recent participation in other treatment intervention studies (< 4 weeks after completion) Currently receiving psychological support or psychotherapy

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: ACT + Standard Medical Care (SMC)<br>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)<br>* 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.<br>|
| No Intervention: Standard Medical Care (SMC)<br>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. | |

What is the study measuring?
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Primary Outcome Measures

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

Secondary Outcome Measures

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

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Limb girdle muscular dystrophy, Becker's muscular dystrophy, Facioscapulohumeral muscular dystrophy, Inclusion-body myositis, Acceptance and Commitment Therapy, ACT