Home-based Complex Intervention for Children With Ataxia Telangiectasia

Exploring Effectiveness, Feasibility, and Acceptability of a Novel Home-based Complex Intervention for Children With Ataxia Telangiectasia: a Pilot Randomised Controlled Trial

Ataxia telangiectasia is a rare, genetic and progressive condition with no known cure. Therapies present a mainstream management option and have the potential to offer optimisation of fitness and general health. This pilot RCT aims to explore the effectiveness, feasibility, and acceptability of a co-produced home-based complex exercise intervention for children with ataxia telangiectasia. The study was designed through broad consultation with a collaborative of children and young people with A-T including family members, therapists, clinicians and researchers, called the A-Team collaborative (https://osf.io/edzn3/)

Ataxia telangiectasia (A-T) usually presents in early childhood, primarily affecting the pulmonary, neurological and immunological systems. World-wide prevalence estimates vary between 1 in 40,000 and 1 in 100,000 live births. A-T typically presents with cerebellar ataxia in early childhood, generally before the age of four years, such that by early teenage most patients require a wheelchair for mobility. Oculomotor, extrapyramidal and peripheral nervous system problems occur in later childhood and adolescence. Lung disease and difficulties with feeding, swallowing and nutrition are also common. A-T also carries a high risk of malignancy, and life-expectancy for individuals with A-T is decreased, with survival time of 25 years.

People living with A-T require coordinated multi-disciplinary care to optimally manage their complex needs. Symptomatic management and rehabilitation is advocated to improve quality of life and minimize complications that could increase morbidity and mortality. However, the feasibility and acceptability of allied health interventions and outcome measures for this population group are under-researched. Parents participating in a research engagement meeting reported being unclear about how best to deal with the signs and symptoms of A-T at home, how to find help and how and when to access support. This uncertainty is echoed by therapists treating children and adults with ataxia. Evidence is lacking about what type of therapy is needed and how it might be best delivered. The investigators intend to address these concerns and perspectives by investigating the effectiveness, feasibility, and acceptability of a home-based exercise intervention that offers therapeutic interventions for the impairments, activity limitations, and participation restrictions related to A-T.

An extensive review undertaken at the beginning of this overall project scoping the evidence on care and management of A-T provided by allied health professionals and nurses, identified a range of interventions that reportedly positively impact A-T related impairments, together with quality of life, indicating that outcomes can be improved for this population. Through i) considerable and robust engagement to date with key stakeholders (including parents, older children and young adults with A-T, physiotherapists, occupational therapists and charity workers), and ii) evidence from other research studies involving pediatric populations with the same or similar health conditions which indicate the potential benefits of yoga and breathing exercises in optimizing health, fitness and wellbeing, the investigators have identified a strong need for this study.

Objectives

1. Assess the effectiveness of the complex home-based exercise intervention on physical function, respiratory muscle strength, participation, and quality of life

2. Investigate the feasibility of the complex home-based exercise intervention in terms of:

   1. online and remote delivery by a multi-disciplinary health profession team with an allied health-professional lead (exploring factors such as undertaking online assessment, supervising exercise and wider trial activities, supporting participants and their families and monitoring safety)
   2. participant and families' abilities to undertake the exercises (exploring factors such as frequency and duration of exercises, and length of the intervention programme)
   3. use of a digital platform for accessing exercise movies and sharing feedback and experience with research team and other participating families

3. Investigate the feasibility of the home-based clinical trial design in terms of:

   1. participant recruitment and online consent taking
   2. online and remote delivery of home-based intervention
   3. online assessments at four different time points and engagement with extensive trial-based battery of outcome measures
   4. conducting exit interviews online
   5. use of the digital platform for trial involvement

4. Determine intervention fidelity in terms of:

   1. the degree to which the intervention is implemented as intended
   2. frequency, intensity and duration of exercise interventions
   3. what were the barriers faced (if any) and how were they addressed?
   4. what were the facilitators (if any) for undertaking the exercises?

5. Explore the perception and experiences of parents/legal guardians and children with A-T undertaking the exercises regarding engagement, effectiveness, and acceptability of the intervention

6. Analyse the data of this pilot study to

   1. Select the most appropriate outcome measure and inform design of an onward RCT
   2. Make recommendations about whether a fully powered trial may be undertaken depending on whether the feasibility of the home-based exercise intervention and the home-based clinical trial design is established.
   3. Inform the power calculation for the subsequent RCT using the outcome data from this study

The project that this study is a part of, is funded by Action for A-T and supported for PPIE and recruitment by the A-T Society. Dr Lisa Bunn is the principal investigator and Dr Tracey Parkin the co-principal investigator of this project. A list of all the collaborators of this project is available on the following link- https://osf.io/edzn3/

Inclusion Criteria:

• Diagnosis of A-T confirmed clinically
• Aged 4-11 years
• Able to walk independently (with no or only intermittent support) over 10 metres and stand unaided for 1 minute
• Able to communicate in English either independently or with the assistance of their parent/legal guardian (where parent/guardian is able to communicate in English) or using a translator arranged by the participating family
• Has the ability to assent and parents/legal guardians have the ability to give consent on their child's behalf

Exclusion Criteria:

• Those with other/additional diagnoses thought by the study team to probably compromise the intervention, e.g. with significant intellectual disability
• Currently undergoing cancer therapies or acutely unwell
• Children who are participants of another trial/intervention programme
• Non-UK based families