Exploring the potential of SMART for improving cognitive health in people with multiple sclerosis

Abstract

Introduction: For people living with multiple sclerosis (MS), cognitive difficulties (including problems with attention, planning, and problem-solving) are a common and particularly debilitating and distressing consequence. The efficacy of cognitive training and rehabilitation remains unclear, leaving a need to establish suitable evidence-based treatment options. Objectives/Aims: In response to the current state of evidence, we aim to examine the feasibility of trialling SMART (Strengthening Mental Abilities with Relational Training) - a theory-based online cognitive training programme - as a treatment option for improving cognitive health in people with multiple sclerosis. Method(s): We are recruiting 60 patients with MS and cognitive impairment to a three-arm feasibility randomised-controlled trial, comparing (1) SMART + treatment-as-usual (TAU) with (2) TAU and (3) active control ('sham') training + TAU. Consenting eligible patients complete a cognitive assessment battery and questionnaires assessing the impact of living with MS, health-related quality of life, subjective cognitive difficulties, and service/ resource use. After completing baseline assessments, participants are randomly allocated to one of the three trial arms. Participants complete follow-up assessments at 3 and 6 months post-randomisation and take part in feasibility-feedback interviews. Our critical criteria for progression to a full-scale trial are around intervention acceptability ('green' = >=80% of SMART group completing >=6 sessions of SMART training), recruitment (green = >=80% of target N consented/randomised), and retention (green = >=80% of all randomised participants completing three-month follow-up). Result(s): Based on available data (53 participants enrolled to date), we are currently green on intervention acceptability (91%) and retention (97%). We appear green for recruitment (90% of target enrolled); identified latencies between consent and randomisation complicate the picture, but (in consultation with our Trial Steering Committee) we have identified ways to address latencies in full-scale trialling. Conclusion(s): Assessment against core criteria currently favours progression and indicates that a full trial would be feasible. Qualitative feedback suggests that SMART can be a usable and acceptable programme for people with MS, supporting further investigation and efficacy testing (of effects on cognitive health outcomes and broader quality of life).