Acceptance and Commitment Therapy plus usual care for improving quality of life in people with motor neuron disease (COMMEND): a multicentre, parallel, randomised controlled trial in the UK

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Acceptance and Commitment Therapy plus usual care for improving quality of life in people with motor neuron disease (COMMEND) : a multicentre, parallel, randomised controlled trial in the UK

Gould, Rebecca L. (författare): UCL, Div Psychiat, London W1T 7NF, England.

McDermott, Christopher J. (författare): Univ Sheffield, Sheffield Inst Translat Neurosci, NIHR Sheffield Biomed Res Ctr, Sheffield, England.

Thompson, Benjamin J. (författare): Univ Sheffield, Clin Trials Res Unit, Sheffield, England.

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Rawlinson, Charlotte, V (författare): UCL, Div Psychiat, London W1T 7NF, England.

Bursnall, Matt (författare): Univ Sheffield, Clin Trials Res Unit, Sheffield, England.

Bradburn, Mike (författare): Univ Sheffield, Clin Trials Res Unit, Sheffield, England.

Kumar, Pavithra (författare): Univ Sheffield, Clin Trials Res Unit, Sheffield, England.

Turton, Emily J. (författare): Univ Sheffield, Clin Trials Res Unit, Sheffield, England.

White, David A. (författare): Univ Sheffield, Clin Trials Res Unit, Sheffield, England.

Serfaty, Marc A. (författare): UCL, Div Psychiat, London W1T 7NF, England.;Priory Hosp North London, London, England.

Graham, Christopher (författare): Univ Strathclyde, Dept Psychol Sci & Hlth, Glasgow, Scotland.

McCracken, Lance, 1962- (författare): Uppsala universitet,Institutionen för psykologi

Goldstein, Laura H. (författare): Kings Coll London, Inst Psychiat Psychol & Neurosci, Dept Psychol, London, England.

Al-Chalabi, Ammar (författare): Kings Coll London, Maurice Wohl Clin Neurosci Inst, London, England.

Orrell, Richard W. (författare): UCL, UCL Queen Sq Inst Neurol, London, England.

Williams, Tim (författare): Newcastle Tyne Hosp NHS Fdn Trust, Newcastle Upon Tyne, England.

Noad, Rupert (författare): Derriford Hosp, Dept Neuropsychol, Plymouth, England.

Baker, Idris (författare): Swansea Bay Univ Hlth Board, Swansea, Wales.

Faull, Christina (författare): LOROS Hosp, Leicester, England.

Lambert, Thomas (författare): Univ Hosp North Midlands NHS Trust, Dept Neurosci, Stoke On Trent, England.

Chhetri, Suresh K. (författare): Lancashire Teaching Hosp NHS Fdn Trust, Reg Neurosci Ctr, Preston, Lancs, England.

Ealing, John (författare): Northern Care Alliance NHS Trust, Salford, England.

Hanratty, Anthony (författare): South Tees Hosp NHS Fdn Trust, Middlesbrough, England.

Radunovic, Aleksandar (författare): Barts Hlth NHS Trust, London, England.

Gunawardana, Nushan (författare): Cambridge Univ Hosp NHS Fdn Trust, Dept Neurol, Cambridge, England.

Meadows, Gail (författare): Northern Lincolnshire & Goole NHS Fdn Trust, Dept Psychol Med, Grimsby, England.

Gorrie, George H. (författare): Queen Elizabeth Univ Hosp, Inst Neurol Sci, Glasgow, Scotland.

Young, Tracey (författare): Univ Sheffield, Sheffield Ctr Hlth & Related Res, Div Populat Hlth, Sheffield, England.

Lawrence, Vanessa (författare): Kings Coll London, Hlth Serv & Populat Res Dept, Inst Psychiat Psychol & Neurosci, London, England.

Cooper, Cindy (författare): Univ Sheffield, Clin Trials Res Unit, Sheffield, England.

Shaw, Pamela J. (författare): Univ Sheffield, Sheffield Inst Translat Neurosci, NIHR Sheffield Biomed Res Ctr, Sheffield, England.

Howard, Robert J. (författare): UCL, Div Psychiat, London W1T 7NF, England.

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UCL, Div Psychiat, London W1T 7NF, England Univ Sheffield, Sheffield Inst Translat Neurosci, NIHR Sheffield Biomed Res Ctr, Sheffield, England. (creator_code:org_t)

Elsevier, 2024
2024
Engelska.
Ingår i: The Lancet. - : Elsevier. - 0140-6736 .- 1474-547X. ; 403:10442, s. 2381-2394

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Background: Motor neuron disease is a progressive, fatal neurodegenerative disease for which there is no cure. Acceptance and Commitment Therapy (ACT) is a psychological therapy incorporating acceptance, mindfulness, and behaviour change techniques. We aimed to evaluate the effectiveness of ACT plus usual care, compared with usual care alone, for improving quality of life in people with motor neuron disease.Methods: We conducted a parallel, multicentre, two -arm randomised controlled trial in 16 UK motor neuron disease care centres or clinics. Eligible participants were aged 18 years or older with a diagnosis of definite or laboratory -supported probable, clinically probable, or possible familial or sporadic amyotrophic lateral sclerosis; progressive muscular atrophy; or primary lateral sclerosis; which met the World Federation of Neurology's El Escorial diagnostic criteria. Participants were randomly assigned (1:1) to receive up to eight sessions of ACT adapted for people with motor neuron disease plus usual care or usual care alone by a web -based system, stratified by site. Participants were followed up at 6 months and 9 months post -randomisation. Outcome assessors and trial statisticians were masked to treatment allocation. The primary outcome was quality of life using the McGill Quality of Life Questionnaire -Revised (MQOL-R) at 6 months post -randomisation. Primary analyses were multi -level modelling and modified intention to treat among participants with available data. This trial was pre -registered with the ISRCTN Registry (ISRCTN12655391).Findings: Between Sept 18, 2019, and Aug 31, 2022, 435 people with motor neuron disease were approached for the study, of whom 206 (47%) were assessed for eligibility, and 191 were recruited. 97 (51%) participants were randomly assigned to ACT plus usual care and 94 (49%) were assigned to usual care alone. 80 (42%) of 191 participants were female and 111 (58%) were male, and the mean age was 63⋅1 years (SD 11⋅0). 155 (81%) participants had primary outcome data at 6 months post -randomisation. After controlling for baseline scores, age, sex, and therapist clustering, ACT plus usual care was superior to usual care alone for quality of life at 6 months (adjusted mean difference on the MQOL-R of 0⋅66 [95% CI 0⋅22-1⋅10]; d=0⋅46 [0⋅16-0⋅77]; p=0⋅0031). Moderate effect sizes were clinically meaningful. 75 adverse events were reported, 38 of which were serious, but no adverse events were deemed to be associated with the intervention.Interpretation: ACT plus usual care is clinically effective for maintaining or improving quality of life in people with motor neuron disease. As further evidence emerges confirming these findings, health-care providers should consider how access to ACT, adapted for the specific needs of people with motor neuron disease, could be provided within motor neuron disease clinical services.

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Acceptance and Commitment Therapy plus usual care for improving quality of life in people with motor neuron disease (COMMEND) : a multicentre, parallel, randomised controlled trial in the UK

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