Online Remote Behavioural Intervention for Tics (ORBIT) (ORBIT)

September 8, 2021 updated by: Nottinghamshire Healthcare NHS Trust

Therapist-guided, Parent-assisted Remote Digital Behavioural Intervention for Tics in Children and Adolescents With Tourette Syndrome: an Internal Pilot Study and Single-blind Randomised Controlled Trial

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.

Study Overview

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.

Study Type

Interventional

Enrollment (Actual)

224

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

      • Nottingham, United Kingdom
        • Nottinghamshire Healthcare NHS Foundation Trust

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

9 years to 17 years (Child)

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Description

Inclusion Criteria:

  1. Aged 9 to 17: patient confirmed through screening.
  2. Suspected or confirmed Tourette syndrome/ chronic tic disorder:

    - Including Moderate/severe tics: Score >15 on the Yale Global Tic Severity Scale (YGTSS) Total Tic Severity Score (TTSS); TTSS score>10 if motor or vocal tics only: researcher confirms at screening appointment

  3. Competent to provide written, informed consent (parental consent for child aged <16): researcher confirms at screening appointment.
  4. Broadband internet access and regular PC/ laptop/Mac user, with mobile phone SMS: patient confirmed through screening.

Exclusion Criteria:

  1. Previous structured behavioural intervention for tics e.g. HRT/CBIT or exposure and response prevention within last 12 months: Patient confirmed through screening.
  2. Change to medication for tics (start or stop tic medication) within the previous 2 months: Patient confirmed through screening and subsequent medication/interventions commenced throughout out the trial are recorded at each time point for analysis.
  3. Diagnoses of alcohol/substance dependence, psychosis, suicidality, or anorexia nervosa: Confirmed through parent DAWBA. DAWBAs that score people as being likely to have these conditions will be second reviewed by the CI (who is a medical expert) to ascertain that they should definitely be excluded from the trial. If the child is considered at immediate risk of suicide, the research team will inform the GP or usual treating clinician.
  4. Moderate/severe intellectual disability: Confirmed through qualitative judgement of the assessor at the telephone screen (and confirmed at baseline through CAIDS-Q) through questions relating to type of school the child attends and previous diagnoses.
  5. Immediate risk to self or others: Confirmed through screening questions and DAWBA. The participants GP will be informed of this.
  6. Parent or child not able to speak or read/write English: Patient confirmed through screening by the assessor.

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: Double

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: Exposure Response Prevention for tics
10-weeks, online delivered, therapist supported exposure response prevention (ERP) therapy for tics
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'.
Active Comparator: Active Control (Psychoeducation)
10-weeks, online delivered, therapist supported psychoeducation for tics
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.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Assessing change in tics in participants using the Yale Global Tic Severity Scale - Total Tic score
Time Frame: Baseline, 3, 6, 12 and 18 months
Investigator administered semi structured symptom checklist of 46 tic disorder symptoms. The Total Tic Score is derived by adding the Total Motor Tic Score and the Total Phonic Tic Score
Baseline, 3, 6, 12 and 18 months

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Assessing change in tics in participants using the Parent Tic Questionnaire
Time Frame: Baseline, 5wks, 3mths, 6mths, 12mths & 18 months
Self administered questionnaire to collect the number, frequency and intensity of 14 common motor and 14 common vocal tics
Baseline, 5wks, 3mths, 6mths, 12mths & 18 months
Assessing change in symptom severity/improvement in participants using the Clinical Global Impressions Scale.
Time Frame: 3, 6, 12 & 18 months
Clinician determined measure that summarises the patient's history, symptoms, behaviours and psychosocial circumstances
3, 6, 12 & 18 months
Assessing change in tic impairment in participants using the Yale Global Tic Severity Scale Impairment Scale (assessing change)
Time Frame: Baseline, 3, 6, 12 & 18 months
This forms part of the YGTSS but focuses on distress and impairment experienced in the individuals life
Baseline, 3, 6, 12 & 18 months
Assessing change in global functioning in participants using the Children's Global Assessment Scale
Time Frame: Baseline, 3, 6, 12 & 18 months
A measure of psychiatric disturbance integrating psychological, social and academic functioning
Baseline, 3, 6, 12 & 18 months
Assessing change in general functioning in participants using the Strengths and Difficulties Questionnaire
Time Frame: Baseline, 3, 6, 12 & 18 months
Self-report, parent completed questionnaire measuring behavioural and emotional difficulties in children. The baseline SDQ is completed as part of a screening tool "DAWBA".
Baseline, 3, 6, 12 & 18 months
Assessing change in mood in participants using the Mood and Feelings Questionnaire
Time Frame: Baseline, 1, 3, 6, 12 & 18 months
Child completed, self-report questionnaire collecting information on depressive symptoms
Baseline, 1, 3, 6, 12 & 18 months
Assessing change in anxiety in participants using the Spence Child Anxiety Scale
Time Frame: Baseline, 3, 6, 12 & 18 months
Self-report child completed questionnaire evaluating symptoms of separation anxiety, social phobia, obsessive-compulsive disorder, pain, agoraphobia, generalised anxiety and fear of physical injury
Baseline, 3, 6, 12 & 18 months
Assessing change in quality of life in participants using the Child Health Utility 9D
Time Frame: Baseline, 3, 6,12,18 months
Self-report parent and child completed quality of life measure
Baseline, 3, 6,12,18 months
Assessing change in tic-related quality of life in participants using the Child and Adolescent Gilles de la Tourette Syndrome
Time Frame: Baseline, 3, 6, 12 & 18 months
A disease specific measure of health related quality of life for children and adolescents with Tourette Syndrome. There are two version, one for children aged 6-12 years and a second for young people aged 3-8 years
Baseline, 3, 6, 12 & 18 months
Assessing participants change in use of services using the Modified Client Service Receipt Inventory
Time Frame: Baseline, 3, 6, 12 & 18 months
A questionnaire to collect information on services received, service related issues, school attendance and family income
Baseline, 3, 6, 12 & 18 months
Assessing change in side effects in participants using the Adverse events/side effects
Time Frame: Baseline, 1, 3, 6, 12 & 18 months
A 17 item scale of common side effects
Baseline, 1, 3, 6, 12 & 18 months
Assessing participants perception of treatment credibility using a specifically created 'treatment credibility' questionnaire
Time Frame: 3 weeks
A two item questionnaire to assess how well the treatment suits children, according to the perception of the 1) parent/carer and 2) child/young person
3 weeks
Assessing participants perception of treatment satisfaction using a specifically created 'treatment satisfaction' questionnaire
Time Frame: 3 months
A 7 item scale questionnaire developed for the study to assess treatment satisfaction from the perception of the 1) parent/carer and 2) child/young person
3 months
Assessing participants perception of their need for further treatment using a specifically created 'Need for further treatment' questionnaire
Time Frame: 3 months
A single item questionnaire asking if the child or young person requires more treatment for their tics from the perception of the 1) parent/carer and 2) child/young
3 months
Assessing participants change of use of other medication/interventions using a specifically created 'Concomitant interventions' questionnaire
Time Frame: Baseline, 3, 6, 12 & 18 months
Assessment of any other treatment or interventions the child or young person is accessing during the study
Baseline, 3, 6, 12 & 18 months
Describing sample characteristics using Development and Wellbeing Assessment (DAWBA) at screening/baseline
Time Frame: Screening/Baseline
The DAWBA is a package of interviews and questionnaires completed by parents and teachers and designed to generate ICD-10 and DSM-IV / DSM-5 psychiatric diagnoses for children and young people.
Screening/Baseline
Determining presence of an intellectual disability at screening/baseline using the Child and Adolescent Intellectual Disability Screening Questionnaire (CAIDS-Q)
Time Frame: Screening/Baseline
A 7-item questionnaire to determine the presence of intellectual disability at screening/baseline, completed by the parent/
Screening/Baseline
Understanding the characteristics of the sample a specifically created demographics questionnaire at screening/baseline
Time Frame: Screening/Baseline
Parent completed questionnaire asking about the child's age, gender, ethnicity, parental education/ occupation, list of the child's current diagnoses and interventions (including medications) and GP and school details.
Screening/Baseline
Determining the for presence of Autism Spectrum Disorder using the Social Communication Questionnaire (SCQ) at screening/baseline
Time Frame: Screening/Baseline
A 40 item, parent-report questionnaire asking about characteristic autistic behaviour at the age of 4 to 5 years and currently.
Screening/Baseline
Assessing Premonitory urges for tics using the Premonitory Urge for Tics Scale (PUTS) at screening/baseline
Time Frame: Screening/Baseline
A self-report instrument specifically designed to measure the current frequency of different types of premonitory urges in patients with tic disorders
Screening/Baseline
Assessing ADHD symptoms using the Swanson, Nolan, and Pelham Rating Scale (SNAP-IV) at screening/baseline
Time Frame: Screening/Baseline
A parent completed 26-item behavioural rating scale that employs the core symptoms of ADHD and oppositional defiance disorder (ODD) as defined by the Diagnostic and Statistical Manual of Mental Disorders.
Screening/Baseline

Other Outcome Measures

Outcome Measure
Measure Description
Time Frame
To assess the process evaluation of the interventions qualitative interviews will be conducted
Time Frame: 3months
A sub-sample of participants will be as asked to participate in qualitative interviews as part of a process evaluation.
3months

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

May 7, 2018

Primary Completion (Actual)

February 18, 2020

Study Completion (Actual)

April 12, 2021

Study Registration Dates

First Submitted

March 12, 2018

First Submitted That Met QC Criteria

March 23, 2018

First Posted (Actual)

March 30, 2018

Study Record Updates

Last Update Posted (Actual)

September 9, 2021

Last Update Submitted That Met QC Criteria

September 8, 2021

Last Verified

September 1, 2021

More Information

Terms related to this study

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

Yes

IPD Plan Description

Data are available for use by researchers with a sound research idea from priment@ucl.ac.uk

IPD Sharing Time Frame

Data will be made available beginning 3 months and ending 5 years after the specified trial outcome paper(s) is/are published.

IPD Sharing Supporting Information Type

  • Study Protocol
  • Statistical Analysis Plan (SAP)
  • Informed Consent Form (ICF)
  • Analytic Code

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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