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Trial details imported from ClinicalTrials.gov
For full trial details, please see the original record at
https://clinicaltrials.gov/ct2/show/NCT05374473
Registration number
NCT05374473
Ethics application status
Date submitted
25/04/2022
Date registered
16/05/2022
Date last updated
12/12/2023
Titles & IDs
Public title
An Online Lifestyle Modification Course for People With Multiple Sclerosis
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Scientific title
An Online Lifestyle Modification Course for People With MS: a Randomised Controlled Trial of Course Effectiveness
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Secondary ID [1]
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23458
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Universal Trial Number (UTN)
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Trial acronym
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Linked study record
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Health condition
Health condition(s) or problem(s) studied:
Multiple Sclerosis
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Condition category
Condition code
Intervention/exposure
Study type
Interventional
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Description of intervention(s) / exposure
Behaviour - Lifestyle modification
Behaviour - Standard-care
Experimental: Intervention - Intervention-tailored program with information regarding modifiable lifestyle related risk factors implicated in disease progression.
Other: Standard-care - containing general health information sourced from standard MS websites.
Behaviour: Lifestyle modification
Content in the intervention arm was adapted from an evidence-based lifestyle modification program for people with MS outlined in print previously presented in a face-to-face format. The integrated lifestyle modification program translates the research evidence regarding modification of lifestyle related risk factors and health outcomes based on a detailed review of the literature around modifiable lifestyle risk factors that may influence MS disease progression, as outlined in the book Overcoming Multiple Sclerosis: the 7-step recovery program.
Behaviour: Standard-care
Content in standard-care arm was adapted from MS-related websites
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Intervention code [1]
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Behaviour
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Comparator / control treatment
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Control group
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Outcomes
Primary outcome [1]
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Change in physical health-related quality of life from baseline to 6- 12- and 30-month follow-up
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Assessment method [1]
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Health-related quality of life will be measured using the Multiple Sclerosis Quality of Life survey (MSQOL-54) (Vickrey, Hays, Harooni, Myers, & Ellison, 1995). The MSQoL-54 is a psychometrically validated, MS-specific, multi-dimensional inventory of patient-centered health status, and consists of 54 questions on items relevant to people with Multiple Sclerosis in the areas of health distress, sexual function, satisfaction with sexual function, overall quality of life, cognitive function, energy, and pain and social function. A physical and a mental dimension underlie the MSQOL-54: the Physical Health Composite (PHC) and Mental Health Composite (MHC). PHC scores range from 0 to 100, where higher values indicate better physical quality of life. Changes in PHC scores (from baseline to 6- 12- and 30-month follow-up) will be assessed and compared between participants in the intervention and standard care groups.
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Timepoint [1]
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Pre-intervention (Baseline) to post-intervention (6-, 12- and 30-month follow-up)
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Primary outcome [2]
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Change in mental health-related quality of life from baseline to 6- 12- and 30-month follow-up
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Assessment method [2]
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Health-related quality of life will be measured using the Multiple Sclerosis Quality of Life survey (MSQOL-54)(Vickrey, Hays, Harooni, Myers, & Ellison, 1995). The MSQoL-54 is a psychometrically validated, MS-specific, multi-dimensional inventory of patient-centered health status, and consists of 54 questions on items relevant to people with Multiple Sclerosis in the areas of health distress, sexual function, satisfaction with sexual function, overall quality of life, cognitive function, energy, and pain and social function. A physical and a mental dimension underlie the MSQOL-54: the Physical Health Composite (PHC) and Mental Health Composite (MHC). MHC scores range from 0 to 100, where higher values indicate better mental quality of life. Changes in MHC scores (from baseline to 6- 12- and 30-month follow-up) will be assessed and compared between participants in the intervention and standard care groups.
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Timepoint [2]
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Pre-intervention (Baseline) to post-intervention (6-, 12- and 30-month follow-up)
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Secondary outcome [1]
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Change in depression
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Assessment method [1]
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Participants in the intervention group will be compared to those in the standard-care group on their changes in depression from baseline to 6-, 12- and 30-month follow-up. The Hospital Anxiety and Depression Scale (HADS) is used to measure depressive symptoms. The HADS is commonly used for screening for anxiety and depression, as well as selecting and monitoring treatment and has been used to measure anxiety and depression in Multiple Sclerosis (Zigmond & Snaith, 1983). The HADS contains 14 items and consists of two subscales: anxiety and depression. The depression subscale ranges from 0 to 21 points. Scores of 11 or more indicate a significant condition of depression, with scores of 8-10 represents 'mild to moderate' and 0-7 'no depression'. Changes in depression (increased or decreased depression scores and shifted depression classification) will be assessed and compared between participants in the intervention and standard care groups.
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Timepoint [1]
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Secondary outcome [2]
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Change in anxiety
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Assessment method [2]
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Participants in the intervention group will be compared to those in the standard-care group on their changes in anxiety, from baseline to 6-, 12- and 30-month follow-up. The Hospital Anxiety and Depression Scale (HADS) is used to measure anxiety. The HADS is commonly used for screening for anxiety and depression, as well as selecting and monitoring treatment and has been used to measure anxiety and depression in Multiple Sclerosis (Zigmond & Snaith, 1983). The HADS contains 14 items and consists of two subscales: anxiety and depression. The anxiety subscale ranges from 0 to 21 points. Scores of 11 or more indicate a significant condition of anxiety, with scores of 8-10 represents 'mild to moderate' and 0-7 'no anxiety'. Changes in anxiety (increased or decreased anxiety scores or shifted anxiety classification) will be assessed and compared between participants in the intervention and standard care groups.
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Timepoint [2]
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Secondary outcome [3]
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Change in fatigue
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Assessment method [3]
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Participants in the intervention group will be compared to those in the standard-care group on changes in fatigue from baseline to 6-, 12- and 30-month follow-up. Fatigue will be measured by the 9-item Fatigue Severity Scale (FSS)(Krupp, LaRocca, Muir-Nash, & Steinberg, 1989). The FSS has mean score range from 1-7, with higher score indicates more fatigue. A mean score = 4 will be used as a cut-off to indicate clinically significant fatigue. A meaningful change on the FSS has been reported demonstrated to be a change of =1.9 points in people with MS (Learmonth et al., 2013) and so here a change in mean score of 1.9 points or more will be considered clinically meaningful. Changes in fatigue (increased or decreased fatigue scores or shifted fatigue classification) will be assessed and compared between participants in the intervention and standard care groups.
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Timepoint [3]
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Pre-intervention (Baseline) to post-intervention (6-, 12- and 30-month follow-up)
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Secondary outcome [4]
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Change in disability
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Assessment method [4]
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Participants in the intervention group will be compared to those in the standard-care group on their changes in level of disability, from baseline to 6-, 12- and 30-month follow-up. The Patient-Determined Disease Steps (PDDS) will be used to measure disability (Hohol, Orav, &Weiner, 1999). The PDDS is a self-reported measure of disability, scored ordinally from 0 (normal) to 8 (bed bound) with detail descriptors and definitions. Changes in disability (increased or decreased PDDS scores) will be assessed and compared between participants in the intervention and standard care groups.
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Timepoint [4]
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Pre-intervention (Baseline) to post-intervention (6-, 12- and 30-month follow-up)
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Secondary outcome [5]
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Change in self-efficacy
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Assessment method [5]
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Participants in the intervention group will be compared to those in the standard-care group on changes in self-efficacy (the belief in one's ability to produce the effects or outcomes one wants). Self-efficacy will be measured using the University of Washington Self-Efficacy (UWSE) survey, a psychometrically sound instrument that includes 6 items for measuring self-efficacy, validated in MS (Amtmann et al., 2012). UWSE MS total score range from 6 to 30, higher scores indicate higher self-efficacy. Total scores will be converted to standardised T-scores, which have a mean of 50 and standard deviation of 10. Higher T-scores indicate greater self-efficacy. Changes in self-efficacy (increased or decreased T-scores) will be assessed and compared between participants in the intervention and standard care groups.
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Timepoint [5]
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Pre-intervention (Baseline) to post-intervention (6-, 12- and 30-month follow-up)
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Eligibility
Key inclusion criteria
1. Be able to read, write, and speak English;
2. Be 18 years old or over;
3. Have a confirmed diagnosis of relapsing-remitting MS by a neurologist;
4. Be able to access the internet and be able to view sessions.
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Minimum age
18
Years
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Maximum age
No limit
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Sex
Both males and females
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Can healthy volunteers participate?
No
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Key exclusion criteria
1. Experiencing any serious co-morbid chronic illness or neurological illness/injury
other than MS that would threaten regular participation or significantly affect the
outcome measures in its own right, such as motor neurone disease or stroke, as
determined by the study investigators;
2. Currently participating in another study or self-management program involving
modification of lifestyle.
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Study design
Purpose of the study
Supportive Care
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Allocation to intervention
Randomised controlled trial
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Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
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Methods used to generate the sequence in which subjects will be randomised (sequence generation)
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Masking / blinding
Blinded (masking used)
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Who is / are masked / blinded?
The people receiving the treatment/s
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Intervention assignment
Parallel
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Other design features
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Phase
Not Applicable
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Type of endpoint/s
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Statistical methods / analysis
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Recruitment
Recruitment status
Active, not recruiting
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Data analysis
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Reason for early stopping/withdrawal
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Other reasons
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Date of first participant enrolment
Anticipated
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Actual
24/06/2022
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Date of last participant enrolment
Anticipated
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Actual
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Date of last data collection
Anticipated
1/12/2024
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Actual
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Sample size
Target
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Accrual to date
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Final
945
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Recruitment in Australia
Recruitment state(s)
VIC
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Recruitment hospital [1]
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The University of Melbourne - Melbourne
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Recruitment postcode(s) [1]
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3010 - Melbourne
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Funding & Sponsors
Primary sponsor type
Other
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Name
University of Melbourne
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Address
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Country
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Ethics approval
Ethics application status
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Summary
Brief summary
Lifestyle factors are known to affect the progression of multiple sclerosis (MS). Studies of
participants with MS attending an evidence-based lifestyle modification program, delivered
via face-to-face workshops, have demonstrated improved mental and physical health, reduced
relapse rate and improved quality of life over 3 years follow up, and that behaviour change
was feasible and sustainable. However, the face-to-face modality of this educational
intervention is resource intensive, and accessibility may be impeded by geography, cost, and
MS-specific factors such as illness, fatigue, and disability. Furthermore, the COVID-19
pandemic has highlighted the unpredictable ability to travel and the importance of
flexibility of health-related education.
The Neuroepidemiology Unit at the University of Melbourne has developed the Multiple
Sclerosis Online Course (MSOC) to deliver a widely accessible and user-friendly educational
tool for people with MS. The course aims to deliver the best available evidence regarding
lifestyle-related risk factors in the development and progression of MS and behaviour
modification to improve health outcomes.
Two forms of the course were developed:
1. an intervention course delivering evidence-based information regarding modifiable
lifestyle related risk factors implicated in disease progression; and
2. a standard-care course, similar in format and presentation, but containing general
information sourced from standard MS websites. Both courses have seven modules delivered
over six weeks.
A feasibility study involving the delivery of the intervention and standard-care course was
conducted from April to June 2021. The study assessed the primary outcomes of attrition in
both intervention and standard-care arm. Secondary outcomes assessed assessed learnability,
accessibility, and desirability via a Likert scale follow-up survey. A qualitative analysis
examining motivation, expectations and outcomes was also conducted. Tertiary outcomes
assessed the completion of the baseline surveys, a requirement to enter the course. Based on
the feasibility study, the investigators have modified recruitment strategies, functionality,
and the community forum aspects of the course. Investigators now aim to test the
effectiveness of the intervention arm of the course versus the standard-care arm in a larger
randomised controlled trial.
Objective:
To prospectively examine whether an MS Online intervention course (intervention arm) can
deliver an evidence-based educational intervention that results in behaviour change which can
be sustained and translated into improved health outcomes for people with MS, and whether
these effects are superior to the MS Online standard-care course (control arm).
Participants who are 18 or older, diagnosed with multiple sclerosis by a doctor are welcome
to join our study.
The online course will run for 6 weeks. During this time, there are no formal assessments or
minimum time investment required, which means participants are free to navigate the course as
they see fit.
Prior to commencing the study, participants will be asked fill-out a survey about their
health (e.g., fatigue) and lifestyle (e.g., diet) and will be asked to fill this out again
during the study.
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Trial website
https://clinicaltrials.gov/ct2/show/NCT05374473
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Trial related presentations / publications
Jelinek, G. (2016). Overcoming multiple sclerosis: the evidence-based 7 step recovery program. Atlantic Books.
Marck CH, De Livera AM, Brown CR, Neate SL, Taylor KL, Weiland TJ, Hadgkiss EJ, Jelinek GA. Health outcomes and adherence to a healthy lifestyle after a multimodal intervention in people with multiple sclerosis: Three year follow-up. PLoS One. 2018 May 23;13(5):e0197759. doi: 10.1371/journal.pone.0197759. eCollection 2018.
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Public notes
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Contacts
Principal investigator
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Sandra L Neate, Doctor
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Address
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University of Melbourne
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Contact person for public queries
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Contact person for scientific queries
Summary Results
For IPD and results data, please see
https://clinicaltrials.gov/ct2/show/NCT05374473
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