Lifestyle, exercise and activity package for people living with progressive multiple sclerosis (LEAP-MS): protocol for a single-arm feasibility study

Julie Latchem-Hastings, Elizabeth Randell, Kate Button, Fiona Jones, Rachel Lowe, Helen Dawes, Fiona Wood, Freya Davies, Vincent Poile, Rhian O'Halloran, Barbara Stensland, Emma Tallantyre, Rebecca Playle, Adrian Edwards, Monica Busse, Julie Latchem-Hastings, Elizabeth Randell, Kate Button, Fiona Jones, Rachel Lowe, Helen Dawes, Fiona Wood, Freya Davies, Vincent Poile, Rhian O'Halloran, Barbara Stensland, Emma Tallantyre, Rebecca Playle, Adrian Edwards, Monica Busse

Abstract

Background: We have co-designed a tailored blended physiotherapy intervention for people with progressive multiple sclerosis (PwPMS) who often struggle to access support for physical activity. Underpinned by self-management principles, the Lifestyle, Exercise and Activity Package for people with Multiple Sclerosis (LEAP-MS) intervention incorporates face-to-face or online physiotherapy coaching sessions with an accompanying online physical activity platform. The LEAP-MS platform is a multi-user system enabling user and physiotherapist to co-create activity plans. The LEAP-MS platform consists of an information and activity suite, interactive components enabling selection of exercises into an activity programme, goal setting and activity logging. The platform also facilitates online remote support from a physiotherapist through an embedded online messaging function. We aim to evaluate the LEAP-MS platform in a feasibility trial.

Methods: LEAP-MS will be evaluated within a single-arm feasibility study with embedded process evaluation. After registration and initial eligible screening, 21 participants will be required to complete baseline self-completion measures. This will be followed by an initial home-based or online coaching session with a physiotherapist (who has received tailored self-management and digital resource training) and access to the online intervention for an initial 3-month period. During this period, participants are given the option to request up to five further home-based or online physiotherapy coaching sessions. Follow-up questionnaires and semi-structured interviews will be administered 3 months after baseline with participants and intervention physiotherapists. The LEAP-MS platform will be available to participants for a further 3 months. Usage of the LEAP-MS platform will be tracked during the full 6-month period and final follow-up will be conducted 6 months after baseline.

Discussion: Feasibility outcomes (recruitment, retention, intervention uptake and safety) will be reported. The process evaluation will be undertaken to identify possible mechanisms for any observed effects. The data will inform full-scale evaluations of this co-produced, blended physiotherapy intervention.

Trial registration: ClinicalTrials.gov , NCT03951181 . Registered 15 May 2019.

Keywords: Feasibility study; Intervention; Multiple sclerosis; Physical activity; Physiotherapy; Self-management.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Participant flow diagram
Fig. 2
Fig. 2
The LEAP-MS intervention logic model detailing objectives, activities and outcomes of PwPMS and the intervention physiotherapist

References

    1. Murray TJ. Diagnosis and treatment of multiple sclerosis. BMJ. 2006;332(7540):525–527. doi: 10.1136/bmj.332.7540.525.
    1. Society MS. How many people have MS in the UK? 2017.
    1. Lublin F. New multiple sclerosis phenotypic classification. Europ. Neurol. 2014;71(1):1–5.
    1. Lorscheider et al, on behalf of the MSBase Study Group, Defining secondary progressive multiple sclerosis, Brain, Volume 139, Issue 9, 2016, Pages 2395–2405, 10.1093/brain/aww173
    1. Lublin FD, Reingold SC. Defining the clinical course of multiple sclerosis: results of an international survey. Neurol. 1996;46(4):907–911. doi: 10.1212/WNL.46.4.907.
    1. MS Trust . Primary progressive MS. 2017.
    1. Khurana V, Sharma H, Medin J. Estimated prevalence of secondary progressive multiple sclerosis in the USA and Europe: results from a systematic literature search. Neurol. 2018;90:380. doi: 10.1212/WNL.0000000000005009.
    1. Office of National Statistics. Population mid-year estimates. 2017. Accessed 18 Mar 2017.
    1. McCrone P, Heslin M, Knapp M, Bull P, Thompson A. Multiple sclerosis in the UK: service use, costs, quality of life and disability. PharmacoEconomics. 2008;26(10):847–860. doi: 10.2165/00019053-200826100-00005.
    1. Ernstsson O, Gyllensten H, Alexanderson K, Tinghog P, Friberg E, Norlund A. Cost of illness of multiple sclerosis - a systematic review. PLoS ONE. 2016;11(7):e0159129. doi: 10.1371/journal.pone.0159129.
    1. Harding KE, Wardle M, Moore P, Tomassini V, Pickersgill T, Ben-Shlomo Y, Robertson NP. Modelling the natural history of primary progressive multiple sclerosis. J. Neurol. Neurosurg. Psychiatry. 2015;86(1):13–19. doi: 10.1136/jnnp-2014-307791.
    1. National Institute for Clinical Excellence. Multiple sclerosis in adults: management clinical guidelines. 2014. . Accessed 19 May 2021.
    1. Paltamaa J, Sjögren T, Peurala H, Heinonen A. Effects of physiotherapy interventions on balance in multiple sclerosis: a systematic review and meta-analysis of randomized controlled trials. J Rehabil Med. 2012;44(10):811–823. doi: 10.2340/16501977-1047.
    1. Wiles CM, Newcombe RG, Fuller KJ, Shaw S, Furnival-Doran J, Pickersgill TP, Morgan A. Controlled randomised crossover trial of the effects of physiotherapy on mobility in chronic multiple sclerosis. J. Neurol. Neurosurg. Psychiatry. 2001;70(2):174–179. doi: 10.1136/jnnp.70.2.174.
    1. Butera C, Tronci S, Bianchi F, Guerriero R, Amadio S, Comola M, Esposito F, Radaelli M, Leocani L, Comi G, Del Carro U. Botulinum Toxin A and physiotherapy in multiple sclerosis spasticity: patient-tailored goal setting and the measurement of its achievement. Clin. Neurophysiol. 2019;130(1):e4. doi: 10.1016/j.clinph.2018.09.045.
    1. World Physiotherapy. Description of physical therapy: policy statement. 2019. Accessed 31 March 2021.
    1. World Health Organisation. Physical activity 2020. Accessed 21 March 2021.
    1. Lifestyle. In Oxford Online Dictionary. Retrieved from 11 March 2021.
    1. Farhud D. Impact of lifestyle on health. Iran J Public Health. 2015;44(11):1442–1444.
    1. Snook EM, Motl RW. Effect of exercise training on walking mobility in multiple sclerosis: a meta-analysis. Neurorehabil Neural Repair. 2009;23(2):108–116. doi: 10.1177/1545968308320641.
    1. Motl RW, Pilutti LA. The benefits of exercise training in multiple sclerosis. Nat Rev Neurol. 2012;8(9):487–497. doi: 10.1038/nrneurol.2012.136.
    1. Latimer-Cheung AE, Pilutti LA, Hicks AL. The effects of exercise training on fitness, mobility, fatigue, and health-related quality of life among adults with multiple sclerosis: a systematic review to inform guideline development. Arch Phys Med Rehabil. 2013;94(9):1800–1828. doi: 10.1016/j.apmr.2013.04.020.
    1. Marck CH, Hadgkiss EJ, Weiland TJ, van der Meer DM, Pereira NG, Jelinek GA. Physical activity and associated levels of disability and quality of life in people with multiple sclerosis: a large international survey. BMC Neurology. 2014;14:143. doi: 10.1186/1471-2377-14-143.
    1. Clarke R, Coote S. Perceptions of participants in a group, community, exercise programme for people with multiple sclerosis. Rehabil Res Pract. 2015;
    1. Malcomson KS, Lowe-Strong AS, Dunwoody L. What can we learn from the personal insights of individuals living and coping with multiple sclerosis? Disabil Rehabil. 2008;30(9):662–674. doi: 10.1080/09638280701400730.
    1. Soundy A, Benson J, Dawes H, Smith B, Collett J, Meaney A. Understanding hope in patients with multiple sclerosis. Physiotherapy. 2012;98(4):349–355. doi: 10.1016/j.physio.2011.05.003.
    1. Sangelaji B, Smith CM, Paul L, Sampath KK, Treharne GJ, Hale LA. The effectiveness of behaviour change interventions to increase physical activity participation in people with multiple sclerosis: a systematic review and meta-analysis. Clin Rehabil. 2016;30(6):559–576. doi: 10.1177/0269215515595274.
    1. Bandura A. Self-efficacy: toward a unifying theory of behavioral change. Psych Review. 1977;84(2):191–215. doi: 10.1037/0033-295X.84.2.191.
    1. Bandura A. Social cognitive theory of self-regulation. Organ. Behav. Hum. Decis. Process. 1991;50(2):242–287. doi: 10.1016/0749-5978(91)90022-L.
    1. Dlugonski D, Motl RW, Mohr DC, Sandroff BM. Internet-delivered behavioral intervention to increase physical activity in persons with multiple sclerosis: sustainability and secondary outcomes. Psychol Health Med. 2012;17(6):636–651. doi: 10.1080/13548506.2011.652640.
    1. Tallner A, Pfeifer K, Maurer M. Web-based interventions in multiple sclerosis: the potential of tele-rehabilitation. Ther Adv Neurol Diso. 2016;9(4):327–335. doi: 10.1177/1756285616640684.
    1. McAuley E, Wojcicki TR, Gothe NP, Mailey EL, Szabo AN, Fanning J, Olson EA, Phillips SM, Motl RW, Mullen SP. Effects of a DVD-delivered exercise intervention on physical function in older adults. J Gerontol A Biol Sci Med Sci. 2013;68(9):1076–1082. doi: 10.1093/gerona/glt014.
    1. Coote S, Gallagher S, Msetfi R, Larkin A, Newell J, Motl RW, et al. A randomised controlled trial of an exercise plus behaviour change intervention in people with multiple sclerosis: the step it up study protocol. BMC Neurology. 2014;14:24. doi: 10.1186/s12883-014-0241-9.
    1. Paul L, Coulter EH, Miller L, McFadyen A, Dorfman J, Mattison PG. Web-based physiotherapy for people moderately affected with multiple sclerosis; quantitative and qualitative data from a randomized, controlled pilot study. Clin Rehabil. 2014;28(9):924–935. doi: 10.1177/0269215514527995.
    1. Morris K, McAuley E, Motl RW. Self-efficacy and environmental correlates of physical activity among older women and women with multiple sclerosis. Health Educ. Res. 2008;23(4):744–752. doi: 10.1093/her/cym067.
    1. Motl RW, Sandroff BM, Wingo BC, et al. Phase iii, randomized controlled trial of the behaviour intervention for increasing physical activity in multiple sclerosis: project BIPAMS. Contemp Clin Trials. 2018;71:154–161. doi: 10.1016/j.cct.2018.06.017.
    1. Silveira SL, McCroskey J, Wingo BC, Motl RW. eHealth-based behavioral intervention for increasing physical activity in persons with multiple sclerosis: fidelity protocol for a randomized controlled trial. JMIR Res Protoc. 2019;8(3):e12319. doi: 10.2196/12319.
    1. Feinstein A, Freeman J, Lo AC. Treatment of progressive multiple sclerosis: what works, what does not, and what is needed. Lancet Neurol. 2015;14(2):194–207. doi: 10.1016/S1474-4422(14)70231-5.
    1. Backus D. Increasing physical activity and participation in people with multiple sclerosis: a review. Arch. Phys. Med. Rehabil. 2016
    1. Elsworth C, Winward C, Sackley C, Meek C, Freebody J, Esser P, Izadi H, Soundy A, Barker K, Hilton-Jones D, Lowe CM, Paget S, Tims M, Parnell R, Patel S, Wade D, Dawes H. Supported community exercise in people with long-term neurological conditions: a phase II randomized controlled trial. Clin. Rehabil. 2011;25(7):588–598. doi: 10.1177/0269215510392076.
    1. Campbell E, Coulter EH, Mattison PG, Miller L, McFadyen A, Paul L. Physiotherapy rehabilitation for people with progressive multiple sclerosis: a systematic review. Arch. Phys. Med. Rehabil. 2016;97(1):141–151. doi: 10.1016/j.apmr.2015.07.022.
    1. Freeman J, Hendriel W, Jarrett L, Hawton A, Barto A, Dennett R, et al. Assessment of a home-based standing frame programme in people with progressive multiple sclerosis (SUMS): a pragmatic, multi-centre, randomised, controlled trial and cost-effectiveness analysis. Lancet Neurol. 2019;18(8):736–747. doi: 10.1016/S1474-4422(19)30190-5.
    1. Davies F, Edwards A, Brain K, Edwards M, Jones R, Wallbank R, et al. You are just left to get on with it: qualitative study of patient and carer experiences of the transition to secondary progressive multiple sclerosis. BMJ Open. 2015;5:e007674. doi: 10.1136/bmjopen-2015-007674.
    1. MS Society. MS treatment in Wales: is access still a lottery? Accessed 18 Jan 2017.
    1. MacLurg K, Reilly P, Hawkins S, Gray O, Evason E, Whittington D. A primary care-based needs assessment of people with multiple sclerosis. Br. J. Gen. Pract. 2005;55(514):378–383.
    1. Somerset M, Campbell R, Sharp DJ, Peters TJ. What do people with MS want and expect from health-care services? Health Expect. 2001;4(1):29–37. doi: 10.1046/j.1369-6513.2001.00111.x.
    1. Elsworth CDH, Sackley C, Soundy A, Howells K, Wade D, Hilton-Jones D, Freebody J, Izadi H. A study of perceived facilitators to physical activity in neurological conditions. Int. J. Ther. Rehabil. 2009;16(1):17–23. doi: 10.12968/ijtr.2009.16.1.37936.
    1. Feys P, Giovannoni G, Dijsselbloem N, Centonze D, Eelen P, Lykke Andersen S. The importance of a multi-disciplinary perspective and patient activation programmes in MS management. Mult Scler. J. 2016;
    1. Hale LA, Smith C, Mulligan H, Treharne GJ. “Tell me what you want, what you really really want....”: asking people with multiple sclerosis about enhancing their participation in physical activity. Disabil. Rehabil. 2012;34(22):1887–1893. doi: 10.3109/09638288.2012.670037.
    1. Verhagen E, Engbers L. The physical therapist’s role in physical activity promotion. Br J Sports Med. 2009;43(2):99–101. doi: 10.1136/bjsm.2008.053801.
    1. Hale LA, Smith C, Mulligan H, Adhia D, Siew B, Treharne G. Exploring the Blue Prescription intervention to promote physical activity in people with long-term conditions. Int J Therap Rehab. 2018;
    1. Abaraogu UO, Edeonuh JC, Frantz J. Promoting physical activity and exercise in daily practice: current practices, barriers and training needs of physiotherapists in Eastern Nigeria. Physiother Can. 2016;68(1):37–45. doi: 10.3138/ptc.2014-74.
    1. Busse M, Latchem-Hastings J, Button K, Poile V, Davies F, O' Halloran R, Stensland B, Tallantyre E, Lowe R, Wood F, Dawes H, Edwards A, Jones F. Web-based physical activity intervention for people with progressive multiple sclerosis: application of consensus-based intervention development guidance. BMJ Open. 2021;11(3):e045378. doi: 10.1136/bmjopen-2020-045378.
    1. Kurtze JF. Rating neurologic impairment in multiple sclerosis: an expanded disability status scale (EDSS) Neurol. 1983;33(11):1444–1452. doi: 10.1212/WNL.33.11.1444.
    1. Amtmann D, Bamer AM, Cook KF, Askew RL, Noonan VK, Brockway JA. University of Washington self-efficacy scale: a new self-efficacy scale for people with disabilities. Arch Phys Med Rehabil. 2012;93(10):1757–1765. doi: 10.1016/j.apmr.2012.05.001.
    1. David M, Sarah D, Laura K, Jill D, Ray F, Crispin J. Validation of the Oxford Participation and Activities Questionnaire. JPRO. 2016;7:73–80.
    1. Herdman M, Gudex C, Lloyd A, Janssen M, Kind P, Parkin D, Bonsel G, Badia X. Development and preliminary testing of the new five-level version of EQ-5D (EQ-5D-5L) Qual Life Res. 2011;20(10):1727–1736. doi: 10.1007/s11136-011-9903-x.
    1. Fisk JD, Ritvo PG, Ross L, Hasse DA, Marrie TJ, Schlech WF. Measuring the functional impact of fatigue: initial validation of the fatigue impact scale. Clin Infect Dis. 1994;18(1):S79–S83. doi: 10.1093/clinids/18.Supplement_1.S79.
    1. Hobart J, Lamping D, Fitzpatrick R, Riazi A, Thompson A. The multiple sclerosis impact scale (MSIS-29): a new patient-based outcome measure. Brain. 2001;124(5):962–973. doi: 10.1093/brain/124.5.962.
    1. Kamper S, Maher CG, Mackay G. Global rating of change scales: a review of strengths and weaknesses and considerations for design. J Man Manip Ther. 2009;17(3):163–170. doi: 10.1179/jmt.2009.17.3.163.
    1. McKenna S, Jones F, Glenfield P, Lennon S. Bridges self-management program for people with stroke in the community: a feasibility randomized controlled trial. International Journal of Stroke. 2015;10(5):679–704. doi: 10.1111/ijs.12195.
    1. Lowe R, Barlow C, Lloyd B, et al. Lifestyle, Exercise and Activity Package for People living with Progressive Multiple Sclerosis (LEAP-MS): adaptions during the COVID-19 pandemic and remote delivery for improved efficiency. Trials. 2021;22(1):286. doi: 10.1186/s13063-021-05245-1.
    1. Collett J, Dawes H, Bateman J. Exercise for long term neurological conditions: multiple sclerosis and Huntington’s disease clinical exercise science. London: Routledge; 2016.
    1. Dawes H. Physical management for neurological conditions 4th edition ‘Physical activity and exercise’. London: Churchill Livingstone; 2018.
    1. Eldridge SM, Chan CL, Campbell MJ, Bond CM, Hopewell S, Thabane L, Lancaster GA. CONSORT 2010 statement: extension to randomised pilot and feasibility trials. BMJ. 2016;355:i5239. doi: 10.1136/bmj.i5239.
    1. Avery KNL, Williamson PR, Gamble C, O’Connell Francischetto E, Metcalfe C, Davidson P, et al. Informing efficient randomised controlled trials: exploration of challenges in developing progression criteria for internal pilot studies. BMJ Open. 2017. 10.1136/bmjopen-2016-013537.
    1. Kell C, Sweet J. Widening possibilities of interpretation when observing learning and teaching through the use of a dynamic visual notation. Innovations in Education and Teaching International. 2017;54(2):162–169. doi: 10.1080/14703297.2016.1273789.
    1. Braun V, Clarke V. Using thematic analysis in psychology. Qualitative Research in Psychology. 2006;3(2):77–101. doi: 10.1191/1478088706qp063oa.
    1. Grant A. Doing excellent social research with documents: practical examples and guidance for qualitative researchers. London: Routlege; 2018.
    1. Dix K, H G. Defining the value of Allied Health Professionals with expertise in multiple sclerosis 2013. . Accessed 22 Oct 2018
    1. Norris M, Kilbride C. From dictatorship to a reluctant democracy: stroke therapists talking about self-management. Disabil. Rehabil. 2014;36(1):32–38. doi: 10.3109/09638288.2013.776645.

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